Implications of telehealth services for healthcare delivery and access in rural and remote communities: perceptions of patients and general practitioners

Abstract

Background Accelerated by the coronavirus disease 2019 (COVID-19) pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed person-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied. Methods A qualitative study was conducted in three local health districts of rural New South Wales, Australia. Data were collected through in-depth interviews. A total of 13 participants was interviewed. Data were analysed using thematic analysis. Results Patient participants perceived telehealth as an alternative when specialist care was limited or absent. Both patients and clinicians perceived that the deeper caring relationship, enabled through face-to-face interactions, could not be achieved through telehealth services alone, and that telehealth services are often superficial and fragmented in nature. Patients in this study contended that virtual consultations can be distant and lacking in personal touch, and risk losing sight of social circumstances related to patients’ health, thereby affecting the trust placed in healthcare systems. Conclusions Simply replacing face-to-face interactions with telehealth services has the potential to reduce trust, continuity of care, and effectiveness of rural health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within an integrated service delivery model across diverse rural contexts in Australia.

Impact of the COVID-19 pandemic on primary care delivery in a remote Aboriginal community

“…This study explored the impact of the initial COVID-19 response on the delivery of primary care in a remote First Nations community, and it highlights the importance of a case management-based model in this setting. The significant reduction in primary care presentations observed during and immediately after the initial COVID-19 restrictions was expected and has been observed in other studies in non-Indigenous settings (Sumner et al 2022). The findings from this study suggest the reduction in the number was not a result of reduced service availability compared with the same period in 2019.…”

“…Despite the PHCC of interest remaining open, public health and community messaging were urging people to 'stay at home' and this likely influenced people to delay non-urgent appointments regardless of baseline health status. As identified by Sumner et al (2022), it is likely that fear of contracting COVID-19 and uncertainty of treatment and prognosis was a factor in reduced healthcareseeking behaviour. Additional public health screening procedures and misinformation about COVID-19 may also have been an influencing factor in people limiting their engagement with primary care services (Pickles et al 2021).…”

Perspectives: Reflections on the use of video consultations

“…Overall, in most of the studies, participants reported positive aspects of video consultations. The exception was Sutarsa et al (2022) who found that they were distant and lacking in personal touch or ability to form a deeper caring relationship between the patient and clinician. They warned that replacing face-to-face with video consultations could lead to a loss of trust and continuity of care.…”

Factors critical for the successful delivery of telehealth to rural populations: A descriptive qualitative study.

“…In terms of service implementation, these elements are important but do not outline the broader implementation factors critical to the success of telehealth delivery in rural areas. One study by Sutarsa et al explored the implications of telehealth as a replacement for face-to-face services from the perspectives of general practitioners and clients (7) and articulated that telehealth services are not a like-for-like service compared to face-to-face modes.…”