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 | 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) | |
- 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.