ATHS  Survey: Telehealth Services during COVID-19

ATHS  Survey: Telehealth Services during COVID-19.

We undertook an online cross-sectional survey of subscribers to the Australian Telehealth Society (ATHS) newsletter between July 5th, 2020 and September 10th, 2020. The Flinders University Social and Behavioural Research Ethics Committee approved this research (Project number 8668). The abstract of the paper we wrote analysing the survey results and the raw data from the survey are provided below.

Abstract

Background:

In Australia, telehealth services were used as an alternative method of health care delivery during the COVID-19 pandemic. Through a realist analysis of a survey of health professionals, we have sought to identify the underlying mechanisms that have assisted Australian health services adapt to the physical separation between clinicians and patients.

Methods: Using a critical realist ontology and epistemology, we undertook an online survey of health professionals subscribing to the Australian Telehealth Society newsletter. The survey had close- and open-ended questions, constructed to identify contextual changes in the operating environment for telehealth services, and assess the mechanisms which had contributed to these changes. We applied descriptive and McNemar’s Chi-square analysis for the close-ended component of the survey, and a reflexive thematic analysis approach for the open-ended questions which were framed within the activity based funding system which had  previously limited telehealth services to regional Australia.

Results

Of the 91 respondents most (73%) reported a higher volume of telephone-based care since COVID and an increase in use of video consultations (60% of respondents). Respondents felt that the move to provide care using telehealth services had been a “forced adoption” where clinicians began to use telehealth services (often for the first time) to maintain health care. Respondents noted significant changes in managerial and medical culture which supported the legitimisation of telehealth services as a mode of access to care. The support of leaders and the use personal and organisational networks to facilitate the operation of telehealth service were felt to be particularly valuable. Access to, and reliability of, the technology were considered extremely important for services. Respondents also welcomed the increased availability of more human and financial resources.

Conclusions

During the pandemic, mechanisms that legitimise practice, build confidence, support relationships and supply resources have fostered the use of telehealth. This ongoing interaction between telehealth services, contexts and mechanisms is complex. The adoption of telehealth access to enable physically separated care, may mark a “new context’; or it could be that once the pandemic passes, previous policies and practices will re-assert themselves and curb support for telehealth-enabled care

Access the paper describing the survey here:

Taylor, A., Caffery, L., Gesesew, H. A., King, A., Bassal, A., Ford, K., Kealey, J., Maeder, A., McGuirk, M., Parkes, D., & Ward, P. R. (2021). How Australian health care services adapted to telehealth during the COVID-19 pandemic: A survey of telehealth professionals. Frontiers in Public Health, 9. https://doi.org/10.3389/fpubh.2021.648009

Who participated in the survey

 

Characteristics of participants n (%)A
Distribution Channel, n=91 E-mail 65(71.4)
Anonymous 26 (28.6)
 

 

 

Q2.4 Work place, (n= 81)

Australian Capital Territory 2 (2.5)
Queensland 25 (30.9)
New South Wales 13 (16)
Northern Territory 1 (1.2)
South Australia 4 (4.9)
Tasmania 1 (1.2)
Victoria 27 (33.3)
Western Australia 4 (4.9)
Outside Australia 4 (4.9)
Q2.1 Level of involvement of telehealth provision, (n= 88) Directly 54 (59.3)
Indirectly 34 (37.4)
Q2.2. Role of direct involvement of telehealth provision, (n= 50) Health service manager, coordinator, or researcher 18 (36)
OthersB 32 (64)
 

 

Q2.2. Role of direct involvement of telehealth provision, (n= 50)

 

 

General practice 4 (8)
Specialist medical 11 (22)
Nursing 6 (12)
Allied health 11 (22)
Health service manager 15 (30)
Researcher 3 (6)
Coordinator
 

 

Q2.3 Role of indirect involvement of telehealth provision, (n= 29)

Administrator 7 (24.1)
Equipment supplier 1 (3.4)
Services provider 3 (10.3)
Technical support 13 (44.8)
Training or education 5 (17.2)
  1. A) The percentage is ‘Valid percent’
    B) Others’ refers to General practice, Specialist Medical, Nursing and Allied Health

The raw survey results:

Question number: items | sub-items N* 1, n(%) 2, n(%) 3, n(%) 4, n(%) 5, n(%) Below 3 Above 3 P-value
Q4.1: Organizational change Extending the type of services offered 57 1 (1.8) 4 (7) 3 (5.3) 19 (33.3) 30 (52.6) 5 (9.3) 49 (90.7) 0.000
Changing geographical criteria 52 10 (19.2) 9 (17.3) 3 (5.8) 14 (26.9) 16 (30.8) 19 (38.8) 30 (61.2) 0.116
Applying different funding or payment criteria 47 7 (15.9) 8 (18.2) 4 (9.1) 11 (25) 14 (31.8) 15 (37.5) 25 (62.5) 0.114
Q4.2: Constraints of Organizational change Constrained by legal arrangements 32 6 (18.8) 7 (21.9) 11 (34.4) 6 (18.8) 2 (6.3) 13 (61.9) 8 (38.1) 0.275
Constrained by contractual arrangements 26 7 (26.9) 4 (15.4) 9 (34.6) 6 (23.1) 0 11 (64.7) 6 (35.3) 0.225
Constrained by financial arrangements 38 8 (21.1) 12 (31.6) 8 (21.1) 5 (1.2) 5 (13.2) 20 (66.7) 10 (33.3) 0.068
Q4.3: Collaboration of Organizational change Between organisational units 42 1 (2.4) 3 (7.1) 3 (7.1) 29 (69) 6 (14.3) 4 (10.3) 35 (89.7) 0.000
Between medical specialities or allied health 43 1 (2.3) 1 (2.3) 5 (11.6) 29 (67.4) 7 (16.3) 2 (5.3) 36 (94.7) 0.000
With information technology providers 40 2 (5) 6 (15) 8 (20) 19 (47.5) 5 (12.5) 8 (25) 24 (75) 0.005
Q5.1: Managerial culture Before the outbreak of COVID-19 51 2 (3.9) 15 (29.4) 18 (35.3) 12 (23.5) 4 (7.8) 17 (51.5) 16 (48.5) 0.862
After the outbreak of COVID-19 54 0 5 (9.3) 8 (14.8) 16 (29.6) 25 (46.3) 5 (10.9) 41 (89.1) 0.000
Q5.2: Medical culture Before the outbreak of COVID-19 45 1 (2.2) 16 (35.6) 19 (42.2) 5 (11.1) 4 (8.9) 17 (65.4) 9 (34.6) 0.117
After the outbreak of COVID-19 53 0 5 (9.4) 13 (24.5) 18 (34) 17 (32.1) 5 (12.5) 35 (87.5) 0.000
Q5.3: Technical culture Before the outbreak of COVID-19 50 1 (2) 13 (26) 22 (44) 9 (18) 5 (10) 14 (50) 14 (50) 1.000
After the outbreak of COVID-19 53 0 7 (13.2) 18 (34) 12 (22.6) 16 (30.2) 7 (20) 28 (80) 0.000
 

 

Q6.1: Confidence

Triaging the most suitable patients 54 1 (1.9) 6 (11.1) 14 (25.9) 22 (40.7) 11 (20.4) 7 (17.5) 33 (82.5) 0.000
Having easy to use systems 55 0 0 2 (3.6) 16 (29.1) 37 (67.3) 0 53 (100)
Knowing systems are private and secure 54 0 4 (7.4) 10 (18.5) 18 (33.3) 22 (40.7) 4 (9.1) 40 (90.9) 0.000
Able to get technical or administrative support quickly 55 0 2 (3.6) 8 (14.5) 24 (43.6) 21 (38.2) 2 (4.3) 45 (95.7) 0.000
Trusting the colleagues I work with 54 0 7 (13) 21 (38.9) 13 (24.1) 13 (24.1) 7 (21.2) 26 (78.8) 0.001
Q7.1: Communication techniques Using email 30 1 (3.3) 1 (3.3) 15 (50) 8 (26.7) 5 (16.7) 2 (13.3) 13 (86.7) 0.005
Using the telephone 24 0 3 (12.5) 6 (25) 10 (41.7) 5 (20.8) 3 (16.7) 15 (83.7) 0.005
Using video conferencing 39 0 2 (5.1) 4 (10.3) 11 (28.2) 22 (56.4) 2 (5.7) 33 (94.3) 0.000
Q7.2: Consensus on telehealth implementation With clinicians 44 0 3 (6.8) 3 (6.8) 25 (56.8) 13 (29.5) 3 (7.3) 38 (92.7) 0.000
With management 43 0 4 (9.3) 1 (2.3) 22 (51.2) 16 (37.2) 4 (9.5) 38 (90.5) 0.000
With technologists 35 1 (2.9) 4 (11.4) 4 (11.4) 21 (60) 5 (14.3) 5 (16.1) 26 (83.9) 0.000
 

Q7.3: Importance of relationships

My personal and organisational networks 42 0 0 1 (2.4) 27 (64.3) 14 (33.3) 0 41 (100)
Communities of practice 33 2 (6.1) 2 (6.1) 6 (18.2) 15 (45.5) 8 (24.2) 4 (14.8) 23 (85.2) 0.000
Teamwork 40 0 0 0 24 (60) 16 (40) 0 40 (100)
Formal partnerships 29 1 (3.4) 4 (13.8) 2 (6.9) 15 (51.7) 7 (24.1) 5 (18.5) 22 (81.5) 0.001
Having good leadership 47 0 0 2 (4.3) 17 (36.2) 28 (59.6) 0 45 (100)
 

 

Q8.1: Resource importance

Access to suitable technology 51 0 0 3 (5.9) 19 (37.3) 29 (56.9) 0 48 (100)
Reliability of technology 50 0 0 0 16 (32) 34 (68) 0 50 (100)
Provision of staff training 41 1 (2.4) 1 (2.4) 2 (4.9) 21 (51.2) 16 (39) 2 (5.1) 37 (94.9) 0.000
Access to appropriate physical space 38 2 (5.3) 7 (18.4) 3 (7.9) 17 (44.7) 9 (23.7) 9 (25.7) 26 (74.3) 0.004
Q8.3:                             Performance of NBN connection 25 1 (4) 2 (8) 7 (28) 15 (6) 0 3 (16.7) 15 (83.3) 0.000
 

Q8.4: Support for users

Additional technical support? 31 0 3 (9.7) 4 (12.9) 19 (61.3) 5 (16.1) 3 (11.1) 24 (88.9) 0.000
Provision of devices such as tablets to use telehealth services? 32 0 0 8 (25) 15 (46.9) 9 (28.1) 0 24 (100)
Communications services (internet, mobile data allowances)? 28 0 2 (7.1) 3 (10.7) 15 (53.6) 8 (28.6) 2 (8) 23 (92) 0.000
Educational or training material 35 0 2 (5.7) 5 (14.3) 20 (57.1) 8 (22.9) 2 (6.7) 28 (93.3) 0.000
 

Q8.4: ICT organization

Enable exchange of information between health professionals? 41 0 3 (7.3) 2 (4.9) 20 (48.8) 16 (39) 3 (7.7) 36 (92.3) 0.000
Connect video conference systems used by other organisations? 40 1 (2.5) 5 (12.5) 2 (5) 20 (50) 12 (30) 6 (15.8) 32 (84.2) 0.000
Maintain patient privacy? 44 0 2 (4.5) 2 (4.5) 17 (38.6) 23 (52.3) 2 (4.8) 40 (95.2) 0.000
 

 

 

Q9.1: Acceptance

Government or organisational decisions 52 0 0 9 (17.3) 20 (38.5) 23 (44.2) 0 43 (100)
Health reforms or strategies 49 0 6 (12.2) 14 (28.6) 19 (38.8) 10 (20.4) 6 (17.1) 29 (82.9) 0.000
Guidelines or regulations 45 2 (4.4) 16 (35.6) 7 (15.6) 14 (31.1) 6 (13.3) 18 (47.4) 20 (52.6) 0.746
Availability of payments 48 1 (2.1) 3 (6.3) 13 (27.1) 11 (22.9) 20 (41.7) 4 (11.4) 31 (88.6) 0.000
Changed referral process 35 3 (8.6) 8 (22.9) 9 (25.7) 12 (34.3) 3 (8.6) 11 (42.3) 15 (57.7) 0.433
Inclusion of remote consultations in appointment systems 46 0 5 (10.9) 12 (26.1) 22 (47.8) 7 (15.2) 5 (14.7) 29 (85.3) 0.000
Remote consultations becoming part of daily routines 52 0 4 (7.7) 13 (25) 21 (40.4) 14 (26.9) 4 (10.3) 35 (89.7) 0.000
Any other change (specify below) 11 2 (18.2) 0 2 (18.2) 2 (18.2) 5 (45.5) 2 (22.2) 7 (77.8) 0.096
Q3.1: Change in volume of telehealth consultations Using telephone 37 0 1 (2.7) 2 (5.4) 7 (18.9) 27 (73) 1 (2.9) 34 (97.1) 0.000
Using video conferencing 35 2 (5.7) 0 1 (2.9) 11 (31.4) 21 (60) 2 (5.9) 32 (94.1) 0.000
Q3.2: quality of care Quality of care compared to face-to-face care 25 0 0 8 (32) 12 (48) 5 (20) 0 17 (100)
Q3.5: patient satisfaction When using telephone services? 27 0 1 (3.7) 8 (29.6) 14 (51.9) 4 (17.8) 1 (5.3) 18 (94.7) 0.000
When using video conferencing services? 24 0 1 (4.2) 4 (16.7) 13 (54.2) 6 (25) 1 (5) 19 (95) 0.000
Q3.6: Telehealth vs face-to-face; Time spent on patient consultations 31 1 (3.2) 4 (12.9) 11 (35.5) 9 (29) 6 (19.4) 5 (25) 15 (75) 0.025
 

Q3.7: Telehealth services

General advice about COVID-19 30 1 (3.3) 9 (30) 9 (30) 9 (30) 2 (6.7) 10 (47.6) 11 (52.4) 0.827
Advice on how and where to get tested for COVID 23 1 (4.3) 9 (39.1) 6 (26.1) 5 (21.7) 2 (8.7) 10 (58.8) 7 (41.2) 0.467
Advice on managing COVID-19 health conditions 23 1 (4.3) 4 (17.4) 11 (47.8) 3 (13) 4 (17.4) 5 (41.7) 7 (58.3) 0.564
Management of non-COVID-19 health conditions 34 0 3 (8.8) 6 (17.6) 6 (17.6) 19 (55.9) 3 (10.7) 25 (89.3) 0.000
 

Q3.8: remote consultation

Use of the telephone is now routine 34 0 2 (5.9) 1 (2.9) 16 (47.1) 15 (44.1) 2 (6.1) 31 (93.9) 0.000
Use of video conferencing is now routine 34 3 (8.8) 2 (5.9) 1 (2.9) 14 (41.2) 14 (41.2) 5 (15.2) 28 (84.8) 0.000
Use of remote monitoring of patient conditions is now routine 30 3 (10) 10 (33.3) 4 (13.3) 6 (20) 7 (23.3) 13 (50) 13 (50) 1.00
Q3.10:                                        Additional measures to support telehealth services 39 1 (2.6) 4 (10.3) 13 (33.3) 11 (28.2) 10 (25.6) 5 (19.2) 21 (80.8) 0.002
  • *N= total number of participants who answered the item; % is valid percent only
  • 2: Does your organization use NBN is a 4-point Likert scale and is not included in the table/

(n=53; Yes=25 (47.2); Unsure=15 (28.3); No=8 (15.1); Duse a different service=5 (9.4))

  • 3: change in delivery of healthcare is not included in the table

(n=38; different health providers have become involved in health care provision (1) = 6(15.8); new protocols or models of care for health care have been developed (2) = 12 (31.6); other changes (3) = 3 (7.9); 1 & 2=12 (31.6); 2 &3 = 5(13.2))

  • You may notice that the sum of ‘Below 3’ and ‘Above 3’ is not equal with ‘N’ because the median (3) is excluded.