‘Massive potential’ or ‘safety risk’? Health worker views on telehealth in the care of older people and implications for successful normalization

Abstract

BackgroundTelehealth technologies, which enable delivery of healthcare services at distance, offer promise for responding to the challenges created by an ageing population. However, successful implementation of telehealth into mainstream healthcare systems has been slow and fraught with failure. Understanding of frontline providers’ experiences and attitudes regarding telehealth is a crucial aspect of successful implementation. This study aims to examine healthcare worker views on telehealth, and their implications for implementation to mainstream healthcare services for older people. The study includes a focus on two further dimensions of urban versus rural services and level of clinician experience with telehealth.MethodsSeven semi-structured focus groups were conducted with a total of 44 healthcare workers providing services to older people in the areas of rehabilitation and allied health, residential aged care and palliative care. Focus groups included both telehealth experienced and inexperienced groups. Of the experienced groups, two provided services to both urban and rural patients, and two to rural patients. Inexperienced groups included one rural and two urban. Thematic analysis was undertaken to identify predominant themes. Between-group differences and agreement in viewpoints for each of these themes are discussed and mapped to the theoretical constructs of Normalization Process Theory.ResultsThe views of participants varied with the extent of telehealth experience and perception of accessibility of healthcare services. Four themes describing clinician attitudes and perceptions that could impact on successful implementation of telehealth services are outlined: 1) Workability of telehealth: exponential growth in access or decay in the quality of healthcare? 2) What is an acceptable level of risk to patient safety with telehealth? 3) Shifting responsibilities and recalibrating the team; and 4) Change of architecture required to enable integration of telehealth service delivery.ConclusionsThe use of telehealth technologies to provide healthcare services to older people may be more readily normalized in areas where existing services are limited. Though exposure to telehealth may be a factor, changes to the perceived feasibility of telehealth in relation to conventional services, as well as supportive infrastructure and training and skill recalibration may be more critical to successful normalization of telehealth services for older people.

Using Normalization Process Theory in feasibility studies and process evaluations of complex healthcare interventions: a systematic review

“…Shemeili [ 127 ] Abu Dhabi NPT Medicines management in hospital care of older people Yes Process evaluation Qualitative Prospective Yes No N/A 92. Shulver et al [ 128 ] Australia NPT Telecare for older people Yes Field study Qualitative Prospective Yes Yes Yes 93. Spangaro et al [ 129 ] Australia NPM Screening for intimate partner violence Systematic review [ 238 ] – Process evaluation Qualitative Retrospective Yes No N/A 94.…”

“…For example, in the USA, Hoberg et al [ 98 ] examined the implementation of a new form of group therapy for people with mental health problems, while Leon et al [ 48 ] showed how provider initiated testing and counselling for HIV was successfully normalised in a South African setting. Studies of implementation of E-Health and telemedicine —including telephone advice—were also numerous ( n = 21, 19.4% [ 21 , 22 , 49 , 59 – 62 , 66 , 71 , 73 – 75 , 83 , 85 , 87 , 88 , 93 , 112 , 114 , 118 , 125 , 128 , 130 , 145 ]). Here, a Norwegian team led by Wilhelmsen et al [ 145 ] showed how problems of participation and action—and especially the interactional workability—of a service providing internet-based cognitive behavioural therapy led to ambivalence on the part of general practitioners about its use, to low levels of follow-up and to doctors reverting to ‘standard treatment’ [ 145 ].…”

Human Touch via Touchscreen: Rural Nurses' Experiential Perspectives on Telehealth Use in Pediatric Hospice Care

“…A fear about virtual interaction is whether the communication format depersonalizes the team or family experience, particularly when discussing the sensitive topics relevant to pediatric end-of-life care. Palliative and hospice teams have shared concerns about the way telehealth impacts professional roles: telehealth's impact to professional autonomy, 21 fear of decay in the quality of care provided, 23 and concern for risk of not being present to assist the patient such as in adverse medication reactions. 23 [Parent] seemed relieved that their child's history was known and shared in front of them on the screen.…”

“…Palliative and hospice teams have shared concerns about the way telehealth impacts professional roles: telehealth's impact to professional autonomy, 21 fear of decay in the quality of care provided, 23 and concern for risk of not being present to assist the patient such as in adverse medication reactions. 23 [Parent] seemed relieved that their child's history was known and shared in front of them on the screen. The fact that we knew the name of her favorite stuffed animal did seem to help on the screen to have a bit of ''being known already'' to help the screen be more personal.…”

A study of Cook Islands nurses' attitudes towards electronic medical records technology

“…Covell and Sidani () discussed conditions where the uptake and use of knowledge by nurses are optimal. Shulver, Killington, and Crotty () emphasized the importance of technical support and appropriate training. Barriers to knowledge transfer included a lack of experience with internet‐based platforms (Jarvis‐Selinger, Bates, Araki, & Lear, ), lack of knowledge and ability to use computers, and a need to improve computer infrastructure (Green, Hardie, Dohan, & Tan, ); inadequate access to computers and the internet led to a lack of confidence in using ICTs and a self‐perpetuating pattern of exclusion (The Australian Institute for Social Research, 2006).…”