College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
Front Public Health. 2021 Feb 26;9:648009. doi: 10.3389/fpubh.2021.648009. eCollection 2021.
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. 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. 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. During the pandemic, mechanisms that legitimise practise, 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 practises will re-assert themselves and curb support for telehealth-enabled care.
在澳大利亚，远程医疗服务在 COVID-19 大流行期间被用作替代医疗保健提供方式。通过对健康专业人员调查的现实主义分析，我们试图确定有助于澳大利亚卫生服务适应临床医生和患者之间身体分离的基本机制。使用批判现实主义本体论和认识论，我们对订阅澳大利亚远程医疗协会通讯的健康专业人员进行了在线调查。该调查有封闭式和开放式问题，旨在确定远程医疗服务运营环境的背景变化，并评估促成这些变化的机制。我们对调查的封闭式部分应用了描述性和 McNemar 的卡方分析，以及开放式问题的反思性主题分析方法，这些问题是在以前限制远程医疗服务在澳大利亚偏远地区的基于活动的资金系统框架内提出的。在 91 名受访者中，大多数（73%）报告自 COVID 以来电话护理量增加，视频咨询使用量增加（60%的受访者）。受访者认为，转向使用远程医疗服务提供护理是一种“被迫采用”，因为临床医生开始使用远程医疗服务（通常是第一次）来维持医疗保健。受访者注意到管理和医疗文化的重大变化，这支持了远程医疗服务作为获得护理的一种模式的合法化。领导的支持以及个人和组织网络的使用来促进远程医疗服务的运作被认为是特别有价值的。受访者还欢迎更多人力和财力资源的增加。在大流行期间，使实践合法化、建立信心、支持关系和提供资源的机制促进了远程医疗的使用。远程医疗服务、背景和机制之间这种持续的相互作用是复杂的。采用远程医疗服务来实现身体分离的护理，可能标志着“新背景”；或者可能是一旦大流行过去，以前的政策和实践将重新出现，并限制对远程医疗支持的护理。
