Necessity as the Catalyst of Change: Exploring Client and Provider Perspectives of Accelerated Implementation of Telehealth by a Regional Australian Community Service Organisation during COVID-19 Restrictions

The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis

BACKGROUND

Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes.

OBJECTIVE

The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes.

METHODS

We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework.

RESULTS

Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework.

CONCLUSIONS

Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth.

Best Practices for Telehealth in Nurse-Led Care Settings-A Qualitative Study

The COVID-19 pandemic in the US prompted a sudden shift to telehealth in nurse-led care sites which provide services to diverse geolocations. Using a lens of intersectionality, this study characterizes provider and patient-perceived best and promising practices emerging from geographical variation. The aim of this study was to identify best practices of implementing telehealth in nurse-led care models in Colorado through patient and provider experiences of the sudden implementation of telehealth that can enhance health equity. In this exploratory/descriptive qualitative study, a purposive sample of 18 providers and 30 patients were interviewed using a guide informed by the RE-AIM implementation and evaluation framework to capture the contextual experiences related to the sudden shift to telehealth. Textual theme analysis and reflexive team strategies guided the interpretation. Four primary themes of perceived best practices were identified: using multiple modalities, tailoring triage and scheduling, cultivating safety through boundaries and expectations, and differentiating established versus new patient relationships. The findings suggest that telehealth is a flexible and powerful tool to enhance the delivery of equitable care through nurse-led care models within diverse communities such as the one represented in this study. Nurse leaders are positioned to participate in innovative research and create policies and protocols to ensure telehealth is a viable resource to deliver equitable, safe, and accessible high-quality healthcare.

Exploring healthcare providers' perspectives on virtual care delivery: insights into telemedicine services

BACKGROUND

The rapid advancement of technology has led to a concurrent advancement of telemedicine, that is the delivery of medical services over a long distance using technological methods. The consistently growing numbers of COVID-19 cases warranted the use of telemedicine as an alternative method of care-delivery. This study aims to evaluate perceptions of healthcare services provided virtually among healthcare providers (HCPs) in Kuwait and to assess their acceptance and intention to implement such services.

METHODS

An exploratory mixed methods design was conducted, where in phase one HCPs' perceptions towards telemedicine were explored through an online questionnaire and the quantitative data were summarized by descriptive analysis using SPSS. Scores for usefulness and for attitude toward the use of telemedicine were calculated. Then semi-structured interviews were conducted in phase two and the qualitative data were analyzed thematically.

RESULTS

In phase one, 421 HCPs answered the questionnaire. In terms of telemedicine knowledge, 15.4% of HCPs had previously used telemedicine technology and 39% already knew about it. Additionally, 42.3% preferred to use telemedicine, and 88.5% had a moderate to high usefulness score. Telemedicine's ease of use was perceived positively. Attitude median score was 73 with an IQR of 16 (63-79). Half of the participants intend to use telemedicine. In phase two, twenty-two interviews were conducted resulting in six themes; HCPs' acceptance of telemedicine, facilitators and motives for telemedicine implementation, skills and training required to conduct telemedicine, barriers limiting the use of telemedicine, strategies to overcome the barriers, and benefits of telemedicine.

CONCLUSION

Most of the HCPs favor telemedicine integration into Kuwait's healthcare system as their perceptions of telemedicine were overall positive, paving the way to develop implementation strategies.

Mental health service users' experiences of telehealth interventions facilitated during the COVID-19 pandemic and their relevance to nursing: An integrative review

WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Service users report telehealth interventions to be useful in terms of access and convenience however, a preference for face-to-face interventions remains. Nurses are using telehealth interventions in clinical practice however, further research is necessary in this area as the evidence of their involvement is limited. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper highlights the use of telehealth interventions should augment rather than replace face-to-face care provision.

ABSTRACT

INTRODUCTION: The Covid-19 pandemic saw the swift implementation of physical and social distancing that impacted the way in which mental health services were facilitated. Consequently, telehealth/e-health interventions are increasing in use.

AIM

This integrative review aims to explore existing literature regarding mental health service users' experiences of telehealth interventions facilitated through the COVID-19 pandemic, to determine the visibility of nursing involvement in the facilitation of telehealth interventions and to use these experiences to inform nursing practice.

METHOD

A methodical search of eight (n = 8) academic databases was undertaken using CINAHL, SCOPUS, EMBASE, PsycINFO, Web of Science, Cochrane, MEDLINE and Academic Search Complete between January 2020 and January 2022.

RESULTS

A total of 5133 papers were screened by title and abstract of which (n = 77) progressed for full-text screening. Five (n = 5) papers met the inclusion criteria for this review and results were mapped onto the four meta-paradigms of nursing: person; where the findings discuss the acceptability of telehealth interventions; environment; where the findings highlight barriers and facilitators to the use of telehealth interventions; health; where the findings discuss staff time and logistical issues relating to telehealth interventions and nursing; where the findings centre around the therapeutic relationship.

DISCUSSION

This review highlights there is a paucity of direct evidence relating to nursing involvement in the facilitation of telehealth interventions. However, there are benefits to the use of telehealth interventions that include increased access to services, less perceived stigma and increased engagement which are relevant to nursing practice. A lack of individual contact and concerns relating to infrastructure indicates a fondness for face-to-face interventions remains high.

IMPLICATIONS FOR PRACTICE

There is a need for further research on the role of the nurse in the facilitation of telehealth interventions, specific interventions used and outcomes of such interventions.

Telepractice in the diagnosis and treatment of pediatric speech-language disorders: The opinions and experiences of speech-language pathologists

PURPOSE

This prospective cross-sectional study aimed to investigate the opinions and experiences with telepractice (TP) of Dutch-speaking speech-language pathologists (SLPs) living in the Dutch-speaking part of Belgium (Flanders). This study will help to optimize care for children with speech-language disorders as we will gain more insight into the experienced barriers and facilitators while using TP for assessing and treating these disorders.

METHOD

Twenty-nine Dutch-speaking speech-language pathologists living in Flanders (age category 20-30 years: n = 16/29, 55.2%, 31-40 years: n = 10/29, 34.2%, 41-50 years: n = 2/29, 6.9%, 51-60 years: n = 1/29, 3.4%) were recruited through the social media. An online questionnaire was developed based on the available literature and administered to the SLPs. To compare the opinions and experiences of SLPs with TP, χ2 tests or Fisher's exact tests were used.

RESULTS

The study showed a statistically significant association between years of clinical experience of SLPs and their opinion that TP does not provide more options in a clinical setting compared to face-to-face contact. SLPs who had expertise in multiple domains experienced significantly more added value of TP during the corona pandemic than SLPs who had expertise in only one specific domain. Additionally, SLPs who worked in a private practice indicated significantly more difficulties in developing a therapeutic relationship due to a lack of personal contact than SLPs who worked in other settings. 51.7% (15/29) of the SLPs experienced technical barriers using TP.

CONCLUSION

Expertise in multiple domains of pediatric speech-language therapy resulted in experiencing more added value of TP during the corona pandemic, possibly because of the experience of multiple different and simultaneous advantages of TP in several domains. Additionally, SLPs in a private practice experienced more difficulties in developing a therapeutic relationship due to a lack of personal contact with their clients. This is in contrast to hospitals where children are often seen for a shorter period. Hence, there may be less chance of a negative perception of relationships with clients. Another conclusion is that treatment drop-out was not larger using TP compared to face-to-face therapy. However, SLPs experienced that the use of TP was not promoted/encouraged by their employer possibly because of technical barriers. It is hoped that the findings of this study will help SLPs and policymakers overthrow existing barriers and make telepractice a substantial, effective, and efficient service delivery model.

Police, permits and politics: Navigating life on Australia's state borders during the COVID-19 pandemic

Objective

To explore the ways in which the Coronavirus disease‐19 (COVID‐19) pandemic has affected Australians who live and travel in cross‐border regions in the course of their daily lives.

Design

Semi‐structured interviews were undertaken with participants by telephone. The analysis utilised qualitative exploratory methods and provided rich data through immersive and reflexive analysis.

Setting

Interviews of people across Australia.

Participants

Of 90 people interviewed in relation to their experiences of the COVID‐19 pandemic, 13 described challenges related to border crossing that impacted their usual work and personal life.

Main outcome Measure

Description of challenges faced by Australians living close to state borders due to internal border closures in the early period of COVID‐19 (2020).

Results

Policy changes surrounding border closures negatively impacted people’s wellbeing in Australia with three key interconnected themes identified for Australians living in cross‐border regions. First, border closures presented participants of these communities with physical barriers which reduced access to healthcare and employment. Second, participants reported how restrictions on travel to neighboring states and territories impacted their mental wellbeing. Finally, many Australians in cross‐border regions faced financial struggles exacerbated by border closures.

Conclusion

Normally, interstate borders are largely invisible with formalities relevant to few circumstances. Since the emergence of the COVID‐19 pandemic, Australians who used to regularly cross these borders in the course of their daily activities were no longer able or willing to do so due to the uncertain circumstances surrounding border policy. This study elaborates on the impact of these closures on people’s physical, financial, and emotional state.