The current coronavirus pandemic (COVID-19) has resulted in tremendous growth in telehealth services in Australia and around the world. The rapid uptake of telehealth has mainly been due to necessity – following social distancing requirements and the need to reduce the risk of transmission. Although telehealth has been available for many decades, the COVID-19 experience has resulted in heightened awareness of telehealth amongst health service providers, patients and society overall. With increased telehealth uptake in many jurisdictions during the pandemic, it is timely and important to consider what role telehealth will have post-pandemic. In this article, we highlight five key requirements for the long-term sustainability of telehealth. These include: (a) developing a skilled workforce; (b) empowering consumers; (c) reforming funding; (d) improving the digital ecosystems; and (e) integrating telehealth into routine care.

BackgroundGroup therapy and education and support sessions are used within health care across a range of disciplines such as chronic disease self-management and psychotherapy interventions. However, there are barriers that constrain group attendance, such as mobility, time, and distance. Using videoconferencing may overcome known barriers and improve the accessibility of group-based interventions.ObjectiveThe aim of this study was to review the literature to determine the feasibility, acceptability, effectiveness, and implementation of health professional–led group videoconferencing to provide education or social support or both, into the home setting.MethodsElectronic databases were searched using predefined search terms for primary interventions for patient education and/or social support. The quality of studies was assessed using the Mixed Methods Appraisal Tool. We developed an analysis framework using hierarchical terms feasibility, acceptability, effectiveness, and implementation, which were informed by subheadings.ResultsOf the 1634 records identified, 17 were included in this review. Home-based groups by videoconferencing are feasible even for those with limited digital literacy. Overall acceptability was high with access from the home highly valued and little concern of privacy issues. Some participants reported preferring face-to-face groups. Good information technology (IT) support and training is required for facilitators and participants. Communication can be adapted for the Web environment and would be enhanced by clear communication strategies and protocols. A range of improved outcomes were reported but because of the heterogeneity of studies, comparison of these across studies was not possible. There was a trend for improvement in mental health outcomes. Benefits highlighted in the qualitative data included engaging with others with similar problems; improved accessibility to groups; and development of health knowledge, insights, and skills. Videoconference groups were able to replicate group processes such as bonding and cohesiveness. Similar outcomes were reported for those comparing face-to-face groups and videoconference groups.ConclusionsGroups delivered by videoconference are feasible and potentially can improve the accessibility of group interventions. This may be particularly useful for those who live in rural areas, have limited mobility, are socially isolated, or fear meeting new people. Outcomes are similar to in-person groups, but future research on facilitation process in videoconferencing-mediated groups and large-scale studies are required to develop the evidence base.

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We examined the acceptability of multi-site videoconferencing as a method of providing group education to older people in their homes. There were 9 groups comprising 52 participants (mean age 73 years) with an average of four chronic conditions. Tablet computers or PCs were installed in participant's homes and connected to the Internet by the National Broadband Network (high-speed broad band network) or by the 4G wireless network. A health literacy and self-management programme was delivered by videoconference for 5 weeks. Participants were able to view and interact with all group members and the facilitator on their devices. During the study, 44 group videoconferences were conducted. Evaluation included 16 semi-structured interviews, 3 focus groups and a journal detailing project implementation. The participants reported enjoying home-based group education by videoconference and found the technology easy to use. Using home-based groups via videoconference was acceptable for providing group education, and considered particularly valuable for people living alone and/or with limited mobility. Audio difficulties were the most commonly reported problem. Participants connected with 4G experienced more problems (audio and visual) than participants on the National Broadband Network and those living in multi-dwelling residences reported more problems than those living in single-dwelling residences. Older people with little computer experience can be supported to use telehealth equipment. Telehealth has the potential to improve access to education about chronic disease self-management.

Introduction Carers support programmes are commonly delivered in person, limiting attendance opportunities for rural carers and others who have access barriers. Studies using technology typically use text-based forums rather than real-time technology such as videoconferencing (VC). Delivering home-based carers support programmes by VC may mitigate barriers for accessing support. We report implementation findings for delivering a telehealth peer-support programme for isolated carers of people with dementia. Methods Participants were recruited through aged care providers, peak bodies and media activities. Inclusion criteria were primary dementia caregiver with Internet access and being socially or geographically isolated. The study design was a staggered randomised waitlist design. Measures included the UCLA Loneliness Scale (ULS-6) and selected scales from the e-Health Literacy Questionnaire. Recruitment activities utilised digital processes. Participants completed a six-week programme delivered by VC. Qualitative data comprised logs detailing administration and IT procedures and difficulties. Post programme, 28 participants undertook semi-structured interviews. Data were analysed using descriptive statistics and thematic analysis. Results There were 16 groups comprising 69 participants located throughout Australia, with 87% using their own devices. Technical issues were few but included connection problems, which were compounded by low digital literacy skills. Qualitative data themes included changing perceptions in using technology, differences in communicating by VC and technical support required. Recruitment activities were time-consuming and would benefit from IT tailored for group-based work. Eight groups continued to meet on a self-organised basis. Discussion Providing peer-support groups using telehealth may have the potential to develop self-sustaining peer networks for isolated caregivers of people with dementia.

E-health has the potential to increase access to services in rural and remote communities. The evidence shows that it is as safe, effective and reliable as most conventional methods for interacting with patients while enabling people to stay within their own communities.

Social support is a key component in managing long-term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre-post-test methodology was employed. A social network tool was completed by 45 (87%) participants either pre- or post-intervention, of which 24 (46%) participants completed the tool pre- and post-intervention. In addition, 14 semi-structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre- and post-intervention namely, health professionals, close family and partners. However, post-intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre-intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self-management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.

Respect for patient wishes expressed in advance directives is reassuringly high. The findings suggest significant misunderstanding by medical practitioners of terminologies and systems around substitute decision-making for incompetent persons. Further education and standardisation of terminologies and systems across different jurisdictions would assist in addressing these issues. Low response rate, relating to only one legal jurisdiction, means results may not be generalisable.