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The pros and cons of telehealth for people in rural and remote areas

Canadian researchers recently investigated the use of telehealth in delivering a self management program for stroke survivors and carers.

The findings  – profiled below in the latest update from the Primary Health Care Research and Information Service ( PHC RIS) – will no doubt be of interest locally, given the increasing use of telehealth.

 ***

Telehealth: the pros and cons

Rachel Katterl writes:

From the middle of last year, people in regional, rural and outer metropolitan areas were able to undertake consultations with a health care provider via live video. Known as telehealth consultations, this initiative aims to remove some of the access barriers to health care in Australia.

A recent Canadian study aimed to explore the question of whether telehealth consultations are comparable to face-to-face health care service delivery.

Canada, which has similar health challenges to Australia, also faces difficulties with delivering services to people living in rural and remote regions of the country. Telehealth services are one way of providing equitable access to health services for rural and remote populations.

Moving on after Stroke (MOST), which is a group-based self-management program for stroke survivors and their caregivers, has been shown to facilitate improved community integration and positive health behaviours after stroke. Researchers from Ontario explored the experiences of rural and remote patients undertaking this program using telehealth technology.

In interviews with the participants, the positives and negatives of telehealth consultations were consistent with findings in previous research projects.

Positives included the ability to access otherwise unavailable services, general satisfaction with the videoconference style of delivery, and decreased travel time and costs. Some individuals reported a greater feeling of connectedness with group members compared to telephone based services.

However, the authors noted: “…given the opportunity, all the participants would have preferred face-to-face participation in their own community”.

This is due to MOST participants experiencing difficulties with subtle but important aspects of communication: body language, eye contact, gaze, gesture, and their ability to gauge and detect emotion. Audio lags also meant that some participants did not engage in conversations as they were concerned with “cutting off” other participants.

The findings of this study are consistent with previous research on the topic of patient experience of telehealth consultations.

This study highlights a number of important points.

Firstly, the technical aspects of videoconferencing, particularly good internet connection speeds and reliable connections, are critical for telehealth consultations as this will avoid visual and auditory lags in the signal. Achieving a high level of picture resolution is important to ensure that the finer aspects of interpersonal communication, such as facial expression, are clear to participants.

Secondly, while telehealth consultations are an important aspect of improving access to care, they will not replace traditional face-to-face consultations.

The importance of rapport building and the ‘therapeutic relationship’ should not be underestimated, and telehealth consultations may not always be appropriate. For example, for mental health issues, initial consultations may be undertaken face-to-face, with follow up consultations via telehealth means.

• Rachel Katterl is Research Associate, Primary Health Care Research & Information Service (PHC RIS)

***

Taylor DM, Stone SD, Huijbregts MP (2012). Remote participants’ experiences with a group based stroke self-management program using videoconference technology. Rural and Remote Health, 12, 1947.

This article, which can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/22463728, features in the 12 April, 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.

The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php

 ***

Previous PHC RIS columns at Croakey 

What helps GPs provide better mental healthcare (and what doesn’t)

• Improving collaboration in diabetes care

• Improving dementia management in general practice

 Pets and what they do for our health

• Improving the diagnosis of ovarian cancer

• Chronic health problems and depression

• Helping older patients with chronic diseases to navigate the health system

• Tackling overuse of antibiotics

• When doctors prescribe exercise, does it make any difference?

• Caring for country is also good for Aboriginal people

• The perils of surrogate markers

• Are Australians willing to pay more for better oral health?

• What helps encourage self-care for those with chronic illness?

• More effort needed to strengthen shared care for people with serious mental illness

 

Comments 1

  1. Ben Mullings says:

    The reasoning in the above article that a ‘therapeutic relationship’ is something to be established during an initial face-to-face appointment, but then left as-is for subsequent appointments, reflects some misunderstandings about how therapeutic alliances function in mental health care. It is widely known that the alliance tends to build over the first 5 sessions and that it develops right across the treatment period. For some people it will be enough, but for others, offering just one appointment in person will be nowhere near sufficient. My concern is for vulnerable people who are experiencing complex mental health issues, particularly in cases where that may not be obvious in a single face-to-face appointment. It would be a very difficult situation in cases where somone asks for treatment in person, is given an initial face-to-face assessment, and is then only offered videoconferenced services.

    The other problem I can see is the notion that telehealth wont replace face-to-face treatment, but rather, is meant to expand access. That sounds fair enough in principle, but the difficulty lies with the delivery of face-to-face services in regional, rural and remote locations. If people living in such areas would prefer face-to-face treatment, then every effort should be made to make that available for their care, as is the case for their suburban counterparts. This raises the issue of PREFERENCE for treatment. When a patient is comfortable receiving treatment on-line there is no problem and one can therefore rightly say that equitable access has been expanded. However, where the patient really would prefer face-to-face treatment and has merely tolerated the fact that they had to settle on telehealth instead, we end up running the risk of selling people short on the basis that they live too far away from town.

    People might say “it’s better than nothing”, but is that really true? And should we be offering services to people in regional, rural, and remote regions on the basis that it is better than nothing?

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social policy
Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17