Cook Renee, Haydon Helen M, Thomas Emma E, Ward Elizabeth C, Ross Julie-Anne, Webb Clare, Harris Michael, Hartley Carina, Burns Clare L, Vivanti Angela P, Carswell Phillip, Caffery Liam J
Centre for Online Health, The University of Queensland, Brisbane, Australia.
Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
J Telemed Telecare. 2025 Apr;31(3):376-385. doi: 10.1177/1357633X231189846. Epub 2023 Aug 5.
IntroductionTelehealth use within allied health services currently lacks structure and consistency, ultimately affecting who can, and cannot, access services. This study aimed to investigate the factors influencing allied health professionals' (AHP) selection of consumers and appointments for telehealth.MethodsThis study was conducted across 16 allied health departments from four Australian hospitals. Semi-structured focus groups were conducted with 58 AHPs. Analysis was underpinned by Qualitative Description methodology with inductive coding guided by Braun and Clarke's thematic analysis approach.ResultsSix themes were identified that influenced AHPs' evaluation of telehealth suitability and selection of consumers. These included the following: (1) ease, efficiency and comfort of telehealth for clinicians; (2) clear benefits of telehealth for the consumer, yet the consumers were not always given the choice; (3) consumers' technology access and ability; (4) establishing and maintaining effective therapeutic relationships via telehealth; (5) delivering clinically appropriate and effective care via telehealth; and (6) external influences on telehealth service provision. A further theme of 'assumption versus reality' was noted to pervade all six themes.DiscussionClinicians remain the key decision makers for whether telehealth is offered within allied health services. Ease and efficiency of use is a major driver in AHP's willingness to use telehealth. Assumptions and pre-conceived frames-of-reference often underpin decisions to not offer telehealth and present major barriers to telehealth adoption. The development of evidence-based, decision-support frameworks that engage the consumer and clinician in determining when telehealth is used is required. Services need to actively pursue joint decision-making between the clinician and consumer about service delivery preferences.
引言
目前，联合健康服务中的远程医疗使用缺乏结构和一致性，最终影响了哪些人能够获得服务以及哪些人无法获得服务。本研究旨在调查影响联合健康专业人员（AHP）选择远程医疗消费者和预约的因素。
方法
本研究在澳大利亚四家医院的16个联合健康部门进行。对58名AHP进行了半结构化焦点小组访谈。分析以定性描述方法为基础，采用布劳恩和克拉克的主题分析方法进行归纳编码。
结果
确定了六个影响AHP对远程医疗适用性评估和消费者选择的主题。这些主题包括：（1）远程医疗对临床医生的便捷性、效率和舒适度；（2）远程医疗对消费者有明显益处，但消费者并不总是有选择权；（3）消费者的技术获取和能力；（4）通过远程医疗建立和维持有效的治疗关系；（5）通过远程医疗提供临床适当且有效的护理；（6）远程医疗服务提供的外部影响。还注意到一个“假设与现实”的主题贯穿于所有六个主题之中。
讨论
临床医生仍然是联合健康服务中是否提供远程医疗的关键决策者。使用的便捷性和效率是AHP愿意使用远程医疗的主要驱动力。假设和先入为主的参照框架常常支撑着不提供远程医疗的决定，并成为远程医疗采用的主要障碍。需要制定基于证据的决策支持框架，让消费者和临床医生共同决定何时使用远程医疗。服务机构需要积极推动临床医生和消费者就服务提供偏好进行共同决策。
