Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales

Exploration of the barriers and facilitators influencing use of telehealth for orthotic/prosthetic services in the United States of America: An orthotist/prosthetists perspective

Innovative models of healthcare, such as telehealth, are required to meet the growing demand for orthotic/prosthetic (O&P) services. While O&P users report being very satisfied with telehealth, many clinical facilities have reverted to in-person modes of care as COVID-19 restrictions have eased. As such, there is a disconnect between benefits of telehealth to O&P users, and the clinical services being delivered in-person. The aim of this study was to explore the orthotist/prosthetist's perspective of the barriers and facilitators influencing use of telehealth in the United States of America (USA). O&P practitioners were recruited from across the USA. In-depth, semi-structured interviews were used to document practitioner demographics, the services being provided using telehealth, and practitioners' perspective of the barriers and facilitators influencing use of telehealth. Data describing participant demographics and services were summarised. Interviews were transcribed verbatim and analysed using thematic analysis. 30 practitioners from across the USA participated. Telehealth was used to deliver a range of O&P services including: initial evaluations, routine follow-ups, and delivery of a device in rare circumstances. Barriers to using telehealth included: poor phone/internet connection and lack of access to technology. Facilitators to using telehealth included: a patient-focussed attitude, and recognition of the benefit of telehealth. Telehealth is being used across the entire spectrum of O&P care. Once the significant barriers were resolved, like access to reliable internet/phone reception, telehealth was feasible. An outstanding telehealth experience was facilitated by practitioners who focused on the benefits that telehealth can provide (not the limitations), as well as giving O&P users agency over the choice to use telehealth. There are opportunities to improve access to safe and effective O&P telehealth services by adopting a right-touch approach to practitioner regulation, and advocating for reimbursement that supports better systems and procedures within clinical facilities.

Telehealth-guided provider-to-provider communication to improve rural health: A systematic review

INTRODUCTION

Telehealth may address healthcare disparities for rural populations. This systematic review assesses the use, effectiveness, and implementation of telehealth-supported provider-to-provider collaboration to improve rural healthcare.

METHODS

We searched Ovid MEDLINE®, CINAHL®, EMBASE, and Cochrane CENTRAL from 1 January 2010 to 12 October 2021 for trials and observational studies of rural provider-to-provider telehealth. Abstracts and full text were dual-reviewed. We assessed the risk of bias for individual studies and strength of evidence for studies with similar outcomes.

RESULTS

Seven studies of rural uptake of provider-to-provider telehealth documented increases over time but variability across geographic regions. In 97 effectiveness studies, outcomes were similar with rural provider-to-provider telehealth versus without for inpatient consultations, neonatal care, outpatient depression and diabetes, and emergency care. Better or similar results were reported for changes in rural clinician behavior, knowledge, confidence, and self-efficacy. Evidence was insufficient for other clinical uses and outcomes. Sixty-seven (67) evaluation and qualitative studies identified barriers and facilitators to implementing rural provider-to-provider telehealth. Success was linked to well-functioning technology, sufficient resources, and adequate payment. Barriers included lack of understanding of rural context and resources. Methodologic weaknesses of studies included less rigorous study designs and small samples.

DISCUSSION

Rural provider-to-provider telehealth produces similar or better results versus care without telehealth. Barriers to rural provider-to-provider telehealth implementation are common to practice change but include some specific to rural adaptation and adoption. Evidence gaps are partially due to studies that do not address differences in the groups compared or do not include sufficient sample sizes.

The Telehealth Spine Physical Examination: A Practical Approach Learned During the COVID-19 Pandemic

Background

The COVID-19 pandemic has led to a surge in the use of telehealth visits across the country to minimize in-person visits and to limit the spread of COVID-19. To date, no standards or outlines for telehealth spine examinations have been detailed and many surgeons simply defer the physical examination when performing telehealth visits. Nevertheless, just as physical examination of the spine is an integral part of live clinical encounters, appropriately modified physical examinations should also be part of virtual visits.

Methods

In this study we provide our methodology for guiding providers and patients in efficiently performing telehealth spine examinations.

Results

The study details steps for efficiently performing a physical examination in the telehealth setting. Our written suggestions are supplemented with photographs and video recordings to help streamline the virtual examination.

Conclusions

An effective and efficient spine physical examination can be performed during telehealth visits. Future directions include verifying the findings from our virtual physical examination with in-person examinations.

Determinants of access to eHealth services in regional Australia

BACKGROUND

Australia has a universal public healthcare system, but access to eHealth services (i.e. use of the Internet and related technologies for healthcare services) remains a remarkable challenge, particularly in regional, rural and remote communities. Similar to many other countries, Australia faces the challenges of an ageing population and chronic disease management as well as balancing the supply of and the demand for quality healthcare and advanced medical procedures. The prima facie case for inequality in accessing eHealth services across geographical settings is widely acknowledged. However, regional residents' perceptions on access to eHealth services lack empirical evidence. Therefore, this study empirically investigates the current state and predictors of eHealth service access in regional Australia.

METHODS

A cross-sectional questionnaire-based household survey was conducted within a total of 390 randomly selected adults from the Western Downs Region in Southeast Queensland, Australia. Bivariate analysis was conducted to examine the relationship between eHealth access and respondents' characteristics. A multivariate logistic regression model was also performed to identify the significant predictors of eHealth service access in regional Australia.

RESULTS

Approximately 78% of the households have access to eHealth services. However, access to eHealth services in socioeconomically disadvantaged households was lower (19%) than that of their advantaged counterparts (25%). Factors that significantly increased the likelihood of accessing eHealth services included middle age (odds ratio [OR] = 2.75, 95% confidence interval [CI]: 1.84, 8.66), household size (three to four members) (OR = 2.29, 95% CI: 1.19, 4.73), broadband Internet access (OR = 1.67, 95% CI: 1.15, 2.90) and digital literacy (OR = 2.39, 95% CI: 1.23, 4.59). Factors that negatively influenced access to eHealth services were low educational levels (OR = 0.28, 95% CI: 0.09, 0.61), low socioeconomic status (OR = 0.65, 95% CI: 0.28, 0.83) and remote locations (OR = 0.66, 95% CI: 0.23, 0.80).

CONCLUSION

Emerging universal eHealth access provides immense societal benefits in regional settings. The findings of this study could assist policy makers and healthcare practitioners in identifying factors that influence eHealth access and thereby formulate effective health policies to optimise healthcare utilisation in regional Australia.