What are the behavioural enablers and barriers for use of telehealth for clinical follow up appointments (clinician, clinic)?
What behavioural issues need to be managed in the event that telehealth is set as the default for clinical follow up appointments?
We designed a mixed methods study to address research questions. The study included observational visits to clinics, conducting interviews with clinic staff, and reviewing clinical records in six clinics (three urban and three non-urban) between 1 July 2021 and 30 June 2022.
Clinic data showed that there was a variation in telehealth use across clinics and clinicians which were not explained by clients’ demographics. Our clinic visits and interviews with clinic staff identified barriers and enablers for use of telehealth which were similar to those found previously: evidence of effectiveness, training and technology, perceptions about telehealth use by clinicians and clients, organisational structure and management, and economic feasibility.
In our interviews, clinicians stated that they apply their own clinical judgment and consider the client’s preference when making decisions about offering a telehealth follow up appointment – an approach which is recommended by the current Australian teleaudiology guidelines and supported by the Hearing Australia Clinical Governance Framework. However, the overall low rate of telehealth follow up appointments in the clinics that we studied suggests it is unlikely that all suitable clients consistently received a telehealth offer. Moreover, there was a general perception by clinicians and clinic managers that most clients prefer face-to-face appointments rather than telehealth. Face-to-face appointments were generally used as default for follow up appointments regardless of the client’s suitability for telehealth.
Factors influencing clinicians’ views to setting telehealth as the default for clinical follow up appointments were identified. These included their autonomy and clinical judgment to achieve optimal outcomes for individual clients. In response, we recommend the co-creation of a continuum of interventions in collaboration with clinicians and clinics, ordered from least restricted (i.e., monitoring telehealth use, providing information to clinicians) to most assertive (by default booking of telehealth follow up appointments).