Lincoln International Institute for Rural Health (LIIRH), University of Lincoln, Lincoln, UK.
Centre Population et Développement (UMR 196 Paris Descartes - IRD), SageSud (ERL INSERM 1244), Institut de Recherche pour le Développement, Paris, France.
BMC Health Serv Res. 2023 Feb 27;23(1):200. doi: 10.1186/s12913-023-09083-6.
Telehealth usage has been promoted in all settings but has been identified as a panacea to issues of access and equity in the rural context. However, uptake and widespread integration of telehealth across all parts of the health system has been slow, with a myriad of barriers documented, including in rural settings. The crisis of the COVID-19 pandemic, saw barriers rapidly overturned with the unprecedented and exponential rise in telehealth usage. The uniqueness of the crisis forced telehealth adoption, but as the urgency stabilises, pandemic learnings must be captured, utilised, and built upon in a post-pandemic world. The aim of this study was to document staff experiences and perceptions of delivering rural psychological therapies via telehealth during the pandemic and to capture learnings for future rural telehealth delivery.
An online cross-sectional survey that explored mental health professional's experiences, use, and perceptions of telehealth before and after pandemic-enforced changes to service delivery.
Sixty-two respondents completed the questionnaire (response rate 68%). Both the delivery of telehealth via telephone and online video conferencing significantly increased during the pandemic (66% vs 98%, p < .001 for telephone and 10% vs 89%, p < 0.001 for online video). Respondents indicated that client's access to services and attendance had improved with telehealth use but their attention and focus during sessions and non-verbal communication had been negatively affected. The challenges for older adults, people with learning and sensory disabilities, and residents in remote areas with poorer mobile/internet connectivity were identified. Despite these challenges, none of the respondents indicated a preference to return to fully face-to-face service delivery with most (86%) preferring to deliver psychological therapies fully or mostly via telehealth.
This study addresses three major gaps in knowledge: the experience of delivering local telehealth solutions to address rural mental health needs, the provision of strong rural-specific telehealth recommendations, and the dearth of rural research emanating from the United Kingdom. As the world settles into a living with COVID-19 era, the uniqueness of the rural telehealth context may be forgotten as urban myopia continues to dominate telehealth policy and uptake. It is critical that rural resourcing and digital connectivity are addressed.
远程医疗已在各种环境中得到推广，但在农村环境中，它被认为是解决可及性和公平性问题的万灵药。然而，远程医疗在整个卫生系统中的普及和广泛融合一直进展缓慢，记录了无数的障碍，包括在农村环境中。COVID-19 大流行的危机见证了障碍的迅速克服，远程医疗的使用呈前所未有的指数级增长。这场危机的独特性迫使人们采用远程医疗，但随着紧迫性的稳定，必须在大流行后世界中获取、利用和建立大流行期间的经验教训。本研究的目的是记录大流行期间通过远程医疗提供农村心理治疗的工作人员的经验和看法，并为未来农村远程医疗的提供获取经验教训。
这是一项在线横断面调查，旨在探索精神卫生专业人员在大流行前和大流行后服务提供方式改变期间对远程医疗的经验、使用和看法。
共有 62 名受访者完成了问卷（回复率为 68%）。大流行期间，通过电话和在线视频会议提供远程医疗的服务量显著增加（电话：66%比 98%，p<0.001；在线视频：10%比 89%，p<0.001）。受访者表示，远程医疗的使用改善了客户获得服务的机会和出勤率，但在会议期间和非语言交流方面，客户的注意力和专注度受到了负面影响。还确定了老年人、有学习和感官障碍的人以及移动/互联网连接较差的偏远地区居民的挑战。尽管存在这些挑战，但没有受访者表示希望完全恢复面对面服务，大多数人（86%）更喜欢完全或主要通过远程医疗提供心理治疗。
本研究解决了三个主要的知识差距：为满足农村心理健康需求而提供本地远程医疗解决方案的经验、提供强有力的农村特定远程医疗建议以及缺乏来自英国的农村研究。随着世界进入与 COVID-19 共存的时代，农村远程医疗环境的独特性可能会被遗忘，因为城市短视继续主导远程医疗政策和采用。解决农村资源和数字连接问题至关重要。
