A rural doctor's telehealth training program during the COVID-19 pandemic.

INTRODUCTION: In Australia, remote consultations have been used as an adjunct to traditional healthcare delivery during the COVID-19 pandemic using telephone and video techniques with an increase in the use of telephone consultations, and to a lesser extent video consultations, for management of patient conditions, assessment, treatment, monitoring and diagnosis. METHODS: To establish the needs of rural doctors for training in the provision of remote consultations, an online survey of members of the Australian College of Rural and Remote Medicine was undertaken. Subsequently an online scenario-based training program was designed to improve the competencies of members in providing these consultations. The outcomes of this program were analysed using pre- and post-intervention surveys, and qualitative analysis of session recordings. RESULTS: The program improved trainee confidence and competence in providing safe, quality remote consultations, particularly when using video technologies. Competencies in communication, history taking, physical online examination, clinical management and professionalism improved. Trainees adapted their practice because they were then able to manage potential issues, were more aware of the capabilities of telehealth technologies and could assist a health professional, such as a nurse or Aboriginal Health Worker (with the patient) to do an examination. Concerns remained about set-up time, technical quality, privacy, interaction with and examination of patients, and how to assess the severity of conditions. CONCLUSION: The outcomes of the program showed significant improvement in the levels of confidence and competencies required for providing remote consultations using telehealth services. A need remains to improve virtual interactions with patients, and to acquire better technology and financial support for remote consultations. In an environment where government is asking whether remote consultations are appropriate and clinically effective, these findings provide guidance from a professional group of experienced rural practitioners.

Transitioning a home telehealth project into a sustainable, large-scale service: a qualitative study.

BACKGROUND: This study was a component of the Flinders Telehealth in the Home project, which tested adding home telehealth to existing rehabilitation, palliative care and geriatric outreach services. Due to the known difficulty of transitioning telehealth projects services, a qualitative study was conducted to produce a preferred implementation approach for sustainable and large-scale operations, and a process model that offers practical advice for achieving this goal. METHODS: Initially, semi-structured interviews were conducted with senior clinicians, health service managers and policy makers, and a thematic analysis of the interview transcripts was undertaken to identify the range of options for ongoing operations, plus the factors affecting sustainability. Subsequently, the interviewees and other decision makers attended a deliberative forum in which participants were asked to select a preferred model for future implementation. Finally, all data from the study was synthesised by the researchers to produce a process model. RESULTS: 19 interviews with senior clinicians, managers, and service development staff were conducted, finding strong support for home telehealth but a wide diversity of views on governance, models of clinical care, technical infrastructure operations, and data management. The deliberative forum worked through these options and recommended a collaborative consortium approach for large-scale implementation. The process model proposes that the key factor for large-scale implementation is leadership support, which is enabled by 1) showing solutions to the problems of service demand, budgetary pressure and the relationship between hospital and primary care, 2) demonstrating how home telehealth aligns with health service policies, and 3) achieving clinician acceptance through providing evidence of benefit and developing new models of clinical care. Two key actions to enable change were marketing telehealth to patients, clinicians and policy-makers, and building a community of practice. CONCLUSIONS: The implementation of home telehealth services is still in an early stage. Change agents and a community of practice can contribute by marketing telehealth, demonstrating policy alignment and providing potential solutions for difficult health services problems. This should assist health leaders to move from trials to large-scale services.