Implications of telehealth services for healthcare delivery and access in rural and remote communities: perceptions of patients and general practitioners
I Nyoman Sutarsa
A B * , Rosny Kasim A , Ben Steward A , Suzanne Bain-Donohue A , Claudia Slimings A , Sally Hall Dykgraaf A and Amanda Barnard A
A Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Florey Building, 54 Mills Road, Acton, ACT 2601, Australia.
B Department of Population Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali 80232, Indonesia.
Australian Journal of Primary Health 28(6) 522-528 https://doi.org/10.1071/PY21162
Submitted: 12 July 2021 Accepted: 14 July 2022 Published: 3 August 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University
Abstract
Background: Accelerated by the coronavirus disease 2019 (COVID-19) pandemic, Australia has shifted towards greater use of telehealth to deliver care for rural and remote communities. This policy direction might risk a shift away from the traditional model of informed person-centred care built around care relationships to a technology-mediated health transaction. Potential opportunity costs of widespread telehealth services on the quality of care for rural and remote communities remain understudied.
Methods: A qualitative study was conducted in three local health districts of rural New South Wales, Australia. Data were collected through in-depth interviews. A total of 13 participants was interviewed. Data were analysed using thematic analysis.
Results: Patient participants perceived telehealth as an alternative when specialist care was limited or absent. Both patients and clinicians perceived that the deeper caring relationship, enabled through face-to-face interactions, could not be achieved through telehealth services alone, and that telehealth services are often superficial and fragmented in nature. Patients in this study contended that virtual consultations can be distant and lacking in personal touch, and risk losing sight of social circumstances related to patients’ health, thereby affecting the trust placed in healthcare systems.
Conclusions: Simply replacing face-to-face interactions with telehealth services has the potential to reduce trust, continuity of care, and effectiveness of rural health services. Telehealth must be used to assist local clinicians in providing the best possible care to rural and remote patients within an integrated service delivery model across diverse rural contexts in Australia.
Keywords: continuity of patient care, delivery of health care, integrated care, health services, healthcare disparities, health system and policy, rural health services, telehealth.
References
Australian Institute of Health and Welfare (2019) ‘Rural and remote health.’ (AIHW: Canberra, ACT, Australia)Bradford N, Caffery L, Smith A (2016) Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability. Rural and Remote Health 16, 3808
| Telehealth services in rural and remote Australia: a systematic review of models of care and factors influencing success and sustainability.Crossref | GoogleScholarGoogle Scholar |
Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
| Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |
Clair MS, Murtagh DP, Kelly J, Cook J (2019) Telehealth a game changer: closing the gap in remote Aboriginal communities. The Medical Journal of Australia 210, S36–S37.
| Telehealth a game changer: closing the gap in remote Aboriginal communities.Crossref | GoogleScholarGoogle Scholar |
Creswell JW (2012) ‘Educational research: planning, conducting, and evaluating quantitative and qualitative research.’ (Pearson: Boston, MA)
Gelber H (2001) The experience in Victoria with telepsychiatry for the child and adolescent mental health service. Journal of Telemedicine and Telecare 7, 32–34.
| The experience in Victoria with telepsychiatry for the child and adolescent mental health service.Crossref | GoogleScholarGoogle Scholar |
Goodwin S, McGuirk M, Reeve C (2017) The impact of video telehealth consultations on professional development and patient care. The Australian Journal of Rural Health 25, 185–186.
| The impact of video telehealth consultations on professional development and patient care.Crossref | GoogleScholarGoogle Scholar |
Gurney J, Fraser L, Ikihele A, Manderson J, Scott N, Robson B (2021) Telehealth as a tool for equity: pros, cons and recommendations. NZMJ 134, 111–115.
Hall Dykgraaf S, Desborough J, de Toca L, et al. (2021) “A decade’s worth of work in a matter of days”: the journey to telehealth for the whole population in Australia. International Journal of Medical Informatics 151, 104483
| “A decade’s worth of work in a matter of days”: the journey to telehealth for the whole population in Australia.Crossref | GoogleScholarGoogle Scholar |
Hanefeld J, Powell-Jackson T, Balabanova D (2017) Understanding and measuring quality of care: dealing with complexity. Bulletin of the World Health Organization 95, 368–374.
| Understanding and measuring quality of care: dealing with complexity.Crossref | GoogleScholarGoogle Scholar |
Hersh WR, Hickam DH, Severance SM, Dana TL, Krages KP, Helfand M (2006) Diagnosis, access and outcomes: update of a systematic review of telemedicine services. Journal of Telemedicine and Telecare 12, 3–31.
| Diagnosis, access and outcomes: update of a systematic review of telemedicine services.Crossref | GoogleScholarGoogle Scholar |
Kaambwa B, Ratcliffe J, Shulver W, et al. (2017) Investigating the preferences of older people for telehealth as a new model of health care service delivery: a discrete choice experiment. Journal of Telemedicine and Telecare 23, 301–313.
| Investigating the preferences of older people for telehealth as a new model of health care service delivery: a discrete choice experiment.Crossref | GoogleScholarGoogle Scholar |
LeBlanc M, Petrie S, Paskaran S, Carson D, Peters PA (2020) Patient and provider perspectives on eHealth interventions in Canada and Australia: a scoping review. Rural and Remote Health 20, 5754
| Patient and provider perspectives on eHealth interventions in Canada and Australia: a scoping review.Crossref | GoogleScholarGoogle Scholar |
Moffatt JJ, Eley DS (2010) The reported benefits of telehealth for rural Australians. Australian Health Review 34, 276–281.
| The reported benefits of telehealth for rural Australians.Crossref | GoogleScholarGoogle Scholar |
Raven M, Butler C, Bywood P (2013) Video-based telehealth in Australian primary health care: current use and future potential. Australian Journal of Primary Health 19, 283–286.
| Video-based telehealth in Australian primary health care: current use and future potential.Crossref | GoogleScholarGoogle Scholar |
Roberts S, Spain B, Hicks C, London J, Tay S (2015) Telemedicine in the Northern Territory: An assessment of patient perceptions in the preoperative anaesthetic clinic. Australian Journal of Rural Health 23, 136–141.
| Telemedicine in the Northern Territory: An assessment of patient perceptions in the preoperative anaesthetic clinic.Crossref | GoogleScholarGoogle Scholar |
Rodriguez A, Smith J (2018) Phenomenology as a healthcare research method. Evidence-Based Nursing 21, 96–98.
| Phenomenology as a healthcare research method.Crossref | GoogleScholarGoogle Scholar |
Roine R, Ohinmaa A, Hailey D (2001) Assessing telemedicine: a systematic review of the literature. Canadian Medical Association Journal 165, 765–771. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc81454/
Smith AC, Gray LC (2009) Telemedicine across the ages. The Medical Journal of Australia 190, 15–19.
| Telemedicine across the ages.Crossref | GoogleScholarGoogle Scholar |
The Royal Australian College of General Practitioners (RACGP) (2019) ‘Telehealth video consultations guide.’ (The Royal Australian College of General Practitioners: Melbourne, Vic.)
van Manen M (2016) ‘Researching lived experience: human science for an action sensitive pedagogy.’ 2nd edn. (Routledge Taylor and Francis Group: London and New York)
World Health Organization (2016) Global diffusion of eHealth: making universal health coverage achievable. Report of the third global survey on eHealth. (WHO Library: Geneva, Switzerland)
