Telehealth is here to stay but not without challenges: a consultation of cardiac rehabilitation clinicians during COVID-19 in Victoria, Australia

Abstract

Aims Delivery of cardiac rehabilitation (CR) was challenged during the pandemic caused by the Coronavirus disease (COVID-19), due to government stay-at-home directives which restricted in-person programmes. The Australian state of Victoria experienced the longest and most severe COVID-19 restrictions and was in lockdown for ∼6 months of 2020. We aimed to explore (i) clinicians’ experiences and perceptions and (ii) identify barriers and enablers, for delivering CR during the COVID-19 pandemic. Methods and results Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online consultation in November 2020. An inductive thematic analysis was undertaken, before deductively applying the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Thirty members participated in a 106-min consultation. Seventeen members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, and physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, and rural n = 3). Four main themes were inductively identified: consequences of change; use of technology; capacity; and the way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with adopters (staff, patients, and carers) and with organizations. Conclusion The COVID-19 pandemic expedited significant changes to CR delivery models. While clinicians are eager to retain technology-enabled delivery in addition to resuming in-person CR, it is now timely to review remote models of care, tools used and plan how they will be integrated with traditional in-person programmes.

Impact of Early COVID-19 Waves on Cardiac Rehabilitation Delivery in Australia: A National Survey

“…The novel coronavirus disease of 2019 (COVID-19) pandemic abruptly and significantly impacted CR delivery worldwide [ 5 ]. Across the world, programs were ceased, program elements reduced and delivery modes changed [ [5] , [6] , [7] ]. During the first year of the pandemic in Australia in 2020, there were two distinct COVID-19 waves particularly affecting two large eastern states; Victoria and New South Wales.…”

The Impact of the SARS-CoV-2 Virus (COVID-19) Pandemic and the Rapid Adoption of Telehealth for Cardiac Rehabilitation and Secondary Prevention Programs in Rural and Remote Australia: A Multi-Method Study

“…The centre-based services may not have had time and/or resources to address patients’ and clinicians’ barriers to engagement with technology. These include patient perception of impersonal care, resistance to change, low e-health literacy and lack of access to broadband connection [ 42 , 43 ]. In addition, these models were most likely not co-designed with patients, in particular with patients who are older, have low literacy, Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse groups.…”

“…The strength of this study is the use of quantitative clinical data combined with survey data to understand the clinicians’ perspective on the impact of COVID-19 on CR services and their response through telehealth. This comparison between an established telehealth service to those of centre-based programs that adopted telehealth is unique as, before COVID-19, the number of telehealth CR programs implemented into practice across regional, rural and remote areas world-wide was very low [ 17 , 43 ].…”

How does the genomic naive public perceive whole genomic testing for health purposes? A scoping review

“…Data analysis was conducted using the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework developed by Greenhalgh et al [39,40]. The framework was developed recently and has been used to examine various technology-based health interventions e.g., teleconsultation implementation [41,42] and several e-health tools [43][44][45]. This framework was deemed appropriated as one of its key purposes is to plan the implementation, scale-up or rollout of technological innovations in healthcare [39].…”