Werkmeister Benjamin, Haase Anne M, Fleming Theresa, Officer Tara N
School of Health, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand.
Department of Psychological Medicine, University of Otago (Wellington), Wellington, New Zealand.
JMIR Form Res. 2023 Sep 22;7:e50486. doi: 10.2196/50486.
The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services.
This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians' use of telehealth services to inform policy and practice.
Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes.
The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians' flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth.
For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives.
新冠疫情加速了远程医疗服务在远程心理健康护理中的应用。尽管研究表明远程医疗可以提高服务提供的效率，并且可能受到某些客户的青睐甚至是首选，但疫情后其使用情况有所不同。一旦与疫情相关的限制放宽，一些地区减少了远程医疗服务的提供，而其他地区则维持了这些服务。了解影响这些决策的因素可以为基于证据的心理健康服务中远程医疗未来发展决策提供有价值的见解。
本研究探讨了新西兰奥特亚罗瓦多地区门诊心理健康服务中远程医疗使用和减少使用的相关因素。我们旨在促进对影响临床医生使用远程医疗服务的因素的理解，以为政策和实践提供参考。
采用解释性描述方法，这项序贯混合方法研究包括对33名心理健康临床医生进行半结构化访谈，随后对新冠疫情之前及期间临床医生预约活动的人群水平定量数据进行时间序列分析。对访谈进行主题分析，并对选定主题进行重新构建以进行定量测试。使用行政数据进行时间序列分析，以探讨这些数据支持这些主题的程度。在2019年9月2日至2022年8月1日期间，总共分析了4,117,035条观测数据。然后通过对定性主题的重新审视来综合研究结果。
研究地区远程医疗的兴起和衰退与三个总体主题相关：临床医生的准备情况和角色适应性、人群决定因素和服务能力。参与者谈到了熟悉程度和培训的重要性，但指出了专科角色之间的差异。定量数据进一步表明，根据提供的远程医疗服务形式（例如视听或电话）存在差异。此外，在年龄、性别和种族方面也存在差异；然而，临床医生认识到有效地使用远程医疗使临床医生具有灵活性并让客户有更多选择。反过来，临床医生谈到了诸如远程医疗可用性和数字排斥等系统因素，这些因素支撑着远程医疗的日常功能。
为了使远程医疗服务在疫情等情况不需要时也能蓬勃发展，需要对临床医生进行远程医疗培训、改善数字基础设施，并为心理健康团队提供资源。本研究的优势在于其使用了人群水平的数据，并考虑了跨多个团队运营的远程医疗服务。反过来，这些研究结果反映了各种心理健康临床医生的声音，包括从特定文化视角开展工作的团队。
