Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

Abstract

Background Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. Methods A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. Results All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. Conclusion Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

People at heightened risk of deterioration from COVID-19: living ‘with’ or living ‘despite’ public health communications?

“…This includes people with lower health literacy levels; those who are socially, medically, or economically disadvantaged; those from culturally diverse backgrounds who may or may not prefer to communicate in a language other than English; and those from vulnerable groups (such as people with disability, mental health conditions, experiencing homelessness). 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 A lack of targeted communication for some of these groups results in much higher risks of being influenced by circulating misinformation and disinformation 15 and in failure to adhere to recommended preventive actions. 5 , 11…”

“…5 , 10 , 11 This decision-making can only happen in a meaningful way when individuals can access accurate, evidence-based information about what they can, and cannot, safely do. 1 , 8 , 18 Despite clear guidance from peak bodies globally, 2 , 3 , 7 , 8 , 13 and some examples of successfully tailored materials within Aboriginal and CALD communities within Australia, 3 , 7 , 8 information to more broadly support vulnerable groups to live well through the pandemic is largely absent. How then can vulnerable people truly live with COVID-19, rather than live in isolation from the rest of the community, until the pandemic ends?…”

“… Engaging with people at heightened risk, and the organisations that service them, to determine directly what their main concerns or challenges are in living with COVID-19 and to learn how they are managing risk (devising and sharing solutions) in an environment of increased COVID-19 transmission. 1 , 13 , 15 , 19 Collecting and making sense of better individualised risk data to inform communications and public health messaging. Such communications must be tailored to need and pre-tested with users drawn from diverse community groups.…”

“…Engaging with people at heightened risk, and the organisations that service them, to determine directly what their main concerns or challenges are in living with COVID-19 and to learn how they are managing risk (devising and sharing solutions) in an environment of increased COVID-19 transmission. 1 , 13 , 15 , 19…”

“…The need for accurate, timely, up-to-date information to support public health measures to protect health has been highlighted since the very earliest days of the pandemic, as has the critical role for community engagement and the need for practical supports. 1 , 6 , 11 , 13 , 14 Vulnerable groups, including those at heightened risk of deteriorating due to COVID-19, are disproportionately disadvantaged by the pandemic. 8 It is therefore not surprising that consequent negative social, economic, health and other impacts have emerged and are notable.…”