Sustaining telehealth among cardiac and pulmonary rehabilitation services: a qualitative framework study

Abstract

Aim: As we move into a new phase of the COVID-19 pandemic, cardiac and pulmonary services are considering how to sustain telehealth modalities long term. It is important to learn from services that had greater telehealth adoption and determine factors that support sustained use. We aimed to describe how telehealth has been used to deliver cardiac and pulmonary rehabilitation services across Queensland, Australia. Methods and Results Semi-structured interviews (n = 8) and focus groups (n = 7) were conducted with 27 cardiac and pulmonary clinicians and managers from health services across Queensland between June-August 2021. Interview questions were guided by Greenhalgh’s Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Hybrid inductive/deductive framework analysis elicited six main themes: 1. Variable levels of readiness; 2. Greater telehealth uptake in pulmonary versus cardiac rehabilitation; 3. Safety and risk management; 4. Client willingness - targeted support required; 5. Equity and access; and, 6. New models of care. We found sustained integration of telehealth in cardiac and pulmonary rehabilitation will require contributions from all stakeholders: consumers (e.g., co-design), clinicians (e.g. shared learning), health services (e.g., increasing platform functionality), and the profession (e.g., sharing resources). Conclusions There are opportunities for telehealth programs servicing large geographic areas, and to increase program participation rates more broadly. Centralised models of care serving large geographic areas could maximise sustainability with current resource limitations; however, realising the full potential of telehealth will require additional funding for supporting infrastructure and workforce. Individuals and organisations both have roles to play in sustaining telehealth in cardiac and pulmonary services.

The NASSS (Non-Adoption, Abandonment, Scale-Up, Spread and Sustainability) framework use over time: A scoping review

“…The NASSS was used to inform overall study design (n=9), including conceptualization. Studies used the NASSS to inform data collection methods (n=35) by adapting interview guides according to NASSS domains (e.g., [47,72]). Studies also used the NASSS to inform data analysis (n=41), for example by using the NASSS framework for directed content analysis (e.g., [66]).…”

“…The following are some exemplary quotes of organizational barriers reported in studies: “Technical infrastructure was sometimes poor, increasing the likelihood of technical crashes” [26] “Representatives from all three groups expressed that an impediment to engaging in the [Quality Improvement] teams was insufficient time and that meeting times conflicted with clinical engagements” [73] “Space and the need for dedicated and private telehealth rooms were also common concerns for clinicians. Such spaces need to be fitted with appropriate hardware, software, and peripheral devices.” [72] “Therapists stated that the intervention was often not discussed in meetings and was not integrated in electronic patient records they used.” [53] “Participants indicated they were concerned that administrative tasks would continue to be a significant time barrier with increased adoption and scale up.” [29]…”

“…“Space and the need for dedicated and private telehealth rooms were also common concerns for clinicians. Such spaces need to be fitted with appropriate hardware, software, and peripheral devices.” [72]…”

“…Such spaces need to be fitted with appropriate hardware, software, and peripheral devices." [72] "Therapists stated that the intervention was often not discussed in meetings and was not integrated in electronic patient records they used." [53] "Participants indicated they were concerned that administrative tasks would continue to be a significant time barrier with increased adoption and scale up."…”

The experiences of health workers using telehealth services for diabetes‐related foot complications: a qualitative exploration

“…Our findings suggest relationships on all levels were an important component of establishing the TFS service, including between patient and health care provider, between professionals, and between health care sites. However, while building relationships can improve access to services for patients, they take time to establish [42].…”