The rise of telehealth during the pandemic
Prior to the pandemic, telehealth services in Australia were reserved largely for specialist consultations involving patients outside major metropolitan areas. The pandemic prompted the government to expand this in March 2020, offering Medicare rebates for phone and video consultations for all Australians with an established relationship with a general practitioner. Within a month, there had been some expansion of services to include consultations with nurses in primary health care settings.
Many patients have embraced its convenience, and patients and doctors alike benefit from the socially-distanced safety net it provides. These experiences mirror pre-pandemic research that generally shows good satisfaction with telehealth among patients and clinicians, and sustained engagement in healthcare. As a result, many are calling for its extension beyond the pandemic.
But the rapid adoption triggered by the pandemic has left us in the midst a real-life experiment. The pivot to telehealth we’ve experienced is a complex change being done on a grand scale, and at pace. While it offers practical solutions to many, it may leave others vulnerable in its wake.
Dr Sharon James from the Department of General Practice led a team of researchers who conducted semi-structured interviews with primary healthcare nurses, to gather evidence that could inform decisions about ongoing telehealth services. Their results were recently published in BMJ Open.
Sharon says, “We ran an online survey in 2020, investigating the experiences of 637 primary healthcare nurses in Australia during the pandemic. For this current study, we interviewed 25 of them who had previously indicated willingness to be contacted for further study. Twelve were community-based nurses, while the remaining 13 were based at medical practices. Among the community nurses, there was a good mix of specialty areas, including women’s health, maternal and child health, and Indigenous health.
“We found four themes common across the participants.
“The first was preparedness, in terms of technological and staffing capacity as the change rolled out. Nurses working in well-resourced teams who had previous experience with telehealth found the change simple, while others found a lack of mobile, modern technology led to heavier reliance on phone consults, rather than video.
“The second was accessibility of care. While most saw telehealth as positively impacting access to healthcare through reducing both the tyranny of distance and financial hurdles, some expressed concerns around access for vulnerable groups, and limitations on the quality of assessment that could be conducted.
“The third main theme was around the care experience. A number of nurses were concerned about the loss of social contact for elderly patients, and the missed opportunities for nurses to pick up non-verbal cues from patients.
“Finally, there was a lot of discussion about changed nursing roles now. Many practice-based nurses found that constraints arising from the funding model made them less agile in the way they provided care for patients, while community-based nurses generally found the change easier. They were able to check-in on patients more regularly, promote their new services via social media, and some branched out into prevention through events for patients like online yoga.
“These valuable insights could help policy-makers and organizational leaders develop strategies for ongoing implementation that ensure primary health care nurses get the support they need, and ensure vulnerable patients are included.”