Department of Medicine: Rehabilitation Teaching and Research Unit, University of Otago, Christchurch, New Zealand.
Department of Population Health, University of Otago, Christchurch, New Zealand.
Child Care Health Dev. 2023 Jan;49(1):156-169. doi: 10.1111/cch.13028. Epub 2022 Jul 10.
Teledelivery of rehabilitation services has been proposed as a cost-effective option for supporting children with neurodisability and their families. However, little is understood of the conditions that support uptake of telehealth in paediatric rehabilitation, what is delivered during telehealth or perceptions of its outcomes. The aim of this study was to identify the context, process and outcomes of telehealth for children with neurodisability and their families. A secondary objective was to identify if variations in these aspects of telehealth occurred for Māori, the indigenous people of New Zealand.
A mixed-methods, three phase, realist evaluation identified context-mechanism-outcome configurations (CMOcs) of telehealth. In Phase 1, the Determinants of Implementation Behaviour Questionnaire indicated factors affecting practitioner uptake of telehealth (Context). In Phase 2, a casenote audit identified 'practitioner input' during telehealth (Mechanism). Phase 3 interviews with practitioners and parents explored 'parent response' to telehealth and practitioner and parent perceptions of its value (Mechanism and Outcomes). Subgroup analyses for Māori were planned.
From Phase 1, practitioners (29/37, 78%) intended to use telehealth; however, few did so regularly (7/37, 22%). Positive experiences of telehealth were described by all practitioners (n = 5) and families (n = 7) in Phase 3. CMOcs explained that practitioners' offering of telehealth occurred when practitioners were confident, valued access to therapy over the familiarity of in-person delivery, and when practitioners used coaching-style communication. Parents were receptive to telehealth when they trusted practitioners, felt listened to and were offered telehealth as a choice. When telehealth occurred, access to therapy was timely and more consistent than in-person delivery. Child outcomes appeared to be positive. Confidence in offering telehealth to Māori was low.
Initiatives to improve uptake of telehealth in paediatric rehabilitation should focus on creating conditions for practitioner implementation. Training in telehealth should include engagement with Māori. Adequate workspace and workplace culture change are required if telehealth is to be offered beyond the current 'early adopters'.
远程提供康复服务被认为是一种具有成本效益的选择，可以为神经残疾儿童及其家庭提供支持。然而，对于远程医疗在儿科康复中的应用条件、远程医疗过程中提供了什么以及对其结果的看法，人们知之甚少。本研究的目的是确定远程医疗对神经残疾儿童及其家庭的背景、过程和结果。次要目标是确定这些方面的远程医疗是否因新西兰原住民毛利人而有所不同。
采用混合方法、三阶段、真实评估方法，确定了远程医疗的背景-机制-结果配置（CMOcs）。在第 1 阶段，实施行为决定因素问卷表明了影响从业者接受远程医疗的因素（背景）。在第 2 阶段，病历审核确定了远程医疗期间的“从业者投入”（机制）。在第 3 阶段，对从业者和家长进行访谈，探讨了家长对远程医疗的反应以及从业者和家长对其价值的看法（机制和结果）。计划进行毛利人的亚组分析。
第 1 阶段，有 29 名从业者（37 名中的 78%）打算使用远程医疗；然而，只有 7 名（37 名中的 22%）经常这样做。所有从业者（n=5）和家庭（n=7）在第 3 阶段都描述了远程医疗的积极体验。CMOcs 解释说，当从业者有信心、重视治疗的可及性而不是面对面治疗的熟悉程度，并且当从业者使用指导式沟通时，他们会提供远程医疗。当家长信任从业者、感到被倾听并被提供远程医疗作为选择时，他们会接受远程医疗。当远程医疗发生时，治疗的可及性比面对面治疗更及时、更一致。儿童的结果似乎是积极的。从业者对向毛利人提供远程医疗的信心较低。
为了提高儿科康复中远程医疗的采用率，应重点为从业者的实施创造条件。远程医疗培训应包括与毛利人的接触。如果要在当前的“早期采用者”之外提供远程医疗，则需要足够的工作空间和工作场所文化变革。
