How Australian Health Care Services Adapted to Telehealth During the COVID-19 Pandemic: A Survey of Telehealth Professionals

Abstract

Background: In Australia, telehealth services were used as an alternative method of health care delivery during the COVID-19 pandemic. Through a realist analysis of a survey of health professionals, we have sought to identify the underlying mechanisms that have assisted Australian health services adapt to the physical separation between clinicians and patients.Methods: Using a critical realist ontology and epistemology, we undertook an online survey of health professionals subscribing to the Australian Telehealth Society newsletter. The survey had close- and open-ended questions, constructed to identify contextual changes in the operating environment for telehealth services, and assess the mechanisms which had contributed to these changes. We applied descriptive and McNemar's Chi-square analysis for the close-ended component of the survey, and a reflexive thematic analysis approach for the open-ended questions which were framed within the activity based funding system which had previously limited telehealth services to regional Australia.Results: Of the 91 respondents most (73%) reported a higher volume of telephone-based care since COVID and an increase in use of video consultations (60% of respondents). Respondents felt that the move to provide care using telehealth services had been a “forced adoption” where clinicians began to use telehealth services (often for the first time) to maintain health care. Respondents noted significant changes in managerial and medical culture which supported the legitimisation of telehealth services as a mode of access to care. The support of leaders and the use personal and organisational networks to facilitate the operation of telehealth service were felt to be particularly valuable. Access to, and reliability of, the technology were considered extremely important for services. Respondents also welcomed the increased availability of more human and financial resources.Conclusions: During the pandemic, mechanisms that legitimise practise, build confidence, support relationships and supply resources have fostered the use of telehealth. This ongoing interaction between telehealth services, contexts and mechanisms is complex. The adoption of telehealth access to enable physically separated care, may mark a “new context;” or it could be that once the pandemic passes, previous policies and practises will re-assert themselves and curb support for telehealth-enabled care.

Autism assessment via telehealth during the Covid 19 pandemic: Experiences and perspectives of autistic adults, parents/carers and clinicians

“…Despite these challenges and modifications to clinical practice, most clinicians still reported a high degree of confidence in conducting telehealth assessments. A recent survey of Australian healthcare professionals on how they adapted to telehealth during the pandemic showed that confidence to use telehealth increased with practice ( Taylor et al, 2021 ). Prior to the COVID-19 pandemic, telehealth assessments for autism were largely viewed as an option for families living in regional and remote locations only, allowing them access to expert clinicians and reducing the cost of health care and additional travel for these families ( Reese et al, 2015 ).…”

Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study

“…In these early months of the pandemic, politicians, policymakers, and the lay press across different countries and regions all emphasized the role of new modalities such as video and e-consultations in this unprecedented service change [29][30][31][32][33]. But despite this focus on the novel, the reality in most countries was that most remote consultations-especially in primary care-occurred using the old-fashioned telephone [34][35][36][37][38].…”

Sustaining allied health telehealth services beyond the rapid response to COVID-19: Learning from patient and staff experiences at a large quaternary hospital

“…Despite the reported benefits of telehealth models, including high patient satisfaction, equivalent clinical outcomes and cost-effectiveness, [1][2][3][4][5][6] its adoption into mainstream clinical practice had been slow prior to the COVID-19 pandemic. 7,8 Much of the literature investigating this highlights that while adoption can be hindered by access to technological infrastructure, 7,9 acceptance by front-line staff ultimately determines the success or failure of implementation efforts. 10,11 As such, key practicalities need to be met when establishing a telehealth service, including telehealth platform selection, environmental set-up, patient selection and suitability, as well as ethical, operational and professional considerations.…”