Framework to enhance the uptake of sustainable telehealth services across the DHBs in New Zealand

Abstract

Background

The healthcare sector today, across many countries, including New Zealand, faces many challenges, including a shortage of, and an uneven distribution of, health workers, an ageing population, and the prevalence of non-communicable diseases. Technological advances in telecommunications offer new applications for telehealth to enable fast, efficient, and effective patient care to address some of these challenges. The New Zealand Telehealth Forum and Resource Centre defined telehealth as an enabling technology to underpin changes to improve healthcare services delivery across New Zealand. The telehealth stocktake in 2014 by District Health Boards (DHBs) reported on telehealth services and affirmed that the uptake of telehealth in ongoing and routine operations of healthcare is slow, uneven, and fragmented. The onset of the COVID-19 pandemic in 2020 highlighted these issues in an already stressed system and providers quickly adopted telehealth services facilitate access to health services and thus prevent the spread of the virus. Despite the positive benefits, the uptake of telehealth services could not be sustained, and many providers reverted to in-person care amid decreasing COVID-19 risk in the community. Existing studies have suggested that telehealth technology’s success increases when a suitable framework supports its implementation. No framework has been designed to implement and uptake telehealth services across the DHBs in New Zealand, and frameworks available elsewhere are country- specific and may not apply in the New Zealand context.

Objective

This study develops an applicable framework to enhance the uptake of telehealth services across DHBs in New Zealand. The study’s main objective is to describe the status of telehealth services and identify factors at the organisational level that influence the uptake of telehealth services across DHBs in New Zealand and develop a framework.

Methods

A mixed-method research with concurrent triangulation was conducted to answer the research objectives in three phases. Phase 01 was a literature review identifying the factors at the organisational level that influence the uptake of telehealth services. A qualitative thematic analysis was performed in Phase 01 to develop the initial version of the framework underpinned by the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. Phase 02 was a survey to investigate the status of telehealth across DHBs in New Zealand. Phase 03 was a semi-structured interview to identify factors at the organisational level that influence the uptake of telehealth across DHBs in New Zealand.

Results

In Phase 01 of the study, 51 studies were identified and analysed thematically to develop the initial version of the framework. The developed framework identified factors at the organisational level across five major domains: namely, the extent of technology integration, human resources, technology infrastructure, financial support, and factors in the external environment. Results of Phase 02 confirmed that all 20 DHBs use telehealth services, with variable uptake across regions and clinical specialities. The use of video conferencing, a widely used telehealth technology, differed significantly across DHBs. Results showed an increased demand for video conferencing and reported insufficient infrastructure, with patients not having access to devices as the biggest challenges to uptake telehealth services. Survey findings indicated a shift in telehealth service focus, from clinical- related to patient-related telehealth interactions, which involved ensuring that patients can use telehealth services closer to home. In Phase 03 of the study, factors at the organisational level that influence the uptake of telehealth across DHBs were identified. Phases 02 and 03 were used to refine the framework developed so that it was specific to DHBs in New Zealand.

Discussion and conclusion

The Framework developed in this study identifies the factors at the organisational level that influence the uptake of telehealth services to support stakeholders across DHBs in the uptake of telehealth services. The data collection reported on the study was completed before the 2020 Covid-19 pandemic in New Zealand. The onset of the pandemic caused a rapidly changing, unpredictable environment that increased the demand for telehealth services across the country. The study recommends a follow-up assessment to indicate any changes in influencing factors that emerged during the pandemic across the DHBs and this could be used to update the developed framework. Moreover, the framework developed from this study can be extended to a national framework to promote telehealth services across primary and non-governmental organisations. The revised, extended framework can inform the Health New Zealand to develop a systematic approach to implement and promote nationwide equitable telehealth services benefiting New Zealanders.