Beyond forced telehealth adoption: A framework to sustain telehealth among allied health services

Abstract

Introduction As COVID-19 restrictions reduce globally, services will determine what components of care will continue via telehealth. We aimed to determine the clinician, service, and system level factors that influence sustained use of telehealth and develop a framework to enhance sustained use where appropriate. Methods This study was conducted across 16 allied health departments over four health service facilities (Brisbane, Australia). It used a multi-method observational study design, involving telehealth service activity data from hospital administrative databases and qualitative interviews with allied health staff (n = 80). Data were integrated and analysed using Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Results Increased telehealth use during the peak COVID period reverted to in-person activity as restrictions eased. Telehealth is unlikely to be sustained without a clear strategy including determination of roles and responsibilities across the organisation. Clinician resistance due to forced adoption remains a key issue. The main motivator for clinicians to use telehealth was improved consumer-centred care. Benefits beyond this are needed to sustain telehealth and improvements are required to make the telehealth experience seamless for providers and recipients. Data were synthesised into a comprehensive framework that can be used as a blueprint for system-wide improvements and service enhancement or redesign. Discussion Sustainability of telehealth activity beyond the peak COVID period is unlikely without implementation strategies to address consumer, clinician, service, and system factors. The framework can inform how these strategies can be enacted. Whilst developed for allied health disciplines, it is likely applicable to other disciplines.

Telepractice and Dysphagia Management: The Era of COVID-19 and Beyond

“…While the increased interest in telepractice created by the COVID pandemic has been positive, there have also been recognized challenges associated with the forced adoption and rapid uptake of telepractice services [ 9 , 18 , 81 ]. There are real concerns that some clinicians and organizations adopted telepractice without the training, infrastructure, and experience that would be expected in less-urgent times, and that this may have impacted the safety, effectiveness, and acceptance of some telepractice models [ 9 , 18 , 81 ]. The lessons learnt during this rapid transition to telepractice require some pause, reflection, and reconsideration.…”

“…Then, clinical teams need to have adequate supports to help make this service change happen. Just like establishing any new service, the development of telepractice services must involve careful consideration of numerous factors [ 16 , 18 , 82 , 83 ]. It is important for clinicians to have a robust understanding of their clinical service, care requirements, consumer needs, and technology options when developing telepractice services [ 83 ].…”

“…In papers which examined SLP experiences with telepractice during COVID, it has been highlighted that some services simply did not have the infrastructure to support telepractice [ 6 , 7 , 13 ]. In addition, many clinicians were unaware of the current evidence for telepractice delivery of dysphagia care, there was a recognized lack of prior training or experience in delivering services via telepractice, a lack of knowledge regarding how to adequately prepare clients for telepractice sessions and manage key issues such as data safety and security, and some faced challenges created by limited reimbursement options [ 6 – 13 , 16 – 18 ]. There was equally a critical absence of general knowledge among allied health professionals about how to operate a telepractice service [ 16 , 18 ].…”

“…In addition, many clinicians were unaware of the current evidence for telepractice delivery of dysphagia care, there was a recognized lack of prior training or experience in delivering services via telepractice, a lack of knowledge regarding how to adequately prepare clients for telepractice sessions and manage key issues such as data safety and security, and some faced challenges created by limited reimbursement options [ 6 – 13 , 16 – 18 ]. There was equally a critical absence of general knowledge among allied health professionals about how to operate a telepractice service [ 16 , 18 ]. Hence, it was a time of great confusion and anxiety for services, clinical staff, and clients.…”

Technology-supported models of nutrition care: Perspectives of health service providers

“…The NASSS framework incorporates seven domains, namely the condition; the technology; the value proposition; the adopter system; the organization; the wider context and embedding and adaption over time ( Figure 1 ). Although this framework is becoming more widely used in the literature to assess adoption, scale and sustainability of technology supported models of care from health service providers perspectives, 18 , 19 it appears that it has not been tested within a nutrition and chronic condition context.…”