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Table 2 Health worker positions on each of the 4 identified themes

From: ‘Massive potential’ or ‘safety risk’? Health worker views on telehealth in the care of older people and implications for successful normalization

Theme Urban clinicians Novice telehealth urban clinicians Residential aged care staff Rural allied health clinicians Telehealth clinicians
Workability of telehealth: exponential growth in access or decay in the quality of healthcare? Reservations about the safety and suitability of telehealth and the limitations it places on what they can do at distance. Better than nothing for people in rural areas who cannot easily access face-to-face services Significant portion of caseload could be serviced via telehealth, but similar reservations to urban clinicians, particularly for complex cases Positive about the effectiveness of telehealth and saw it as just as good as face-to-face ‘Massive potential’ to expand services and provide better access to healthcare to rural locations Positive about the potential of telehealth and keen to explore possibilities the technology could offer to enhance and expand their services
What is an acceptable level of risk to patient safety with telehealth? Concerned about the levels of perceived risk with telehealth, associated with not being with the patient to assist in the event of an adverse advent (for example a fall during exercise) Revert from telehealth back to face-to-face if complications arise, but acknowledged that ongoing experience can promote new ways of managing challenges of telehealth Focussed on perceived improvements in outcomes for aged care residents who had received services via telehealth, rather than risk to their safety Focussed on the potential improvements to patient outcomes through better access to services, rather than risk to patient safety. Telehealth is ‘safe’ and ‘equivalent, if not better’ than conventional face-to-face therapy Accepting and pragmatic about risk, which they thought of as something to be planned for and managed as an integral part of the provision of services via telehealth
Shifting responsibilities and recalibrating the team ‘Risk’ problems with telehealth could be alleviated by having a support person ‘on the ground’ with the patient. ‘Risk’ problems with telehealth could be alleviated by having a support person ‘on the ground’ with the patient Took on the role of ‘on the ground’ support during videoconferences with residents of the aged care facilities, and through this increased their skill levels Keen to forge links with urban speciality services to support rural clients Adequate training of ‘on the ground’ supporters is important
Change of architecture required to enable integration of telehealth service delivery     Existing ‘traditional’ organizational and systemic structures need significant overhaul before being able to fully support outreach telehealth services Concerns about the limitations of existing technological infrastructure and support. Keeping up with rapidly changing technology and the required technological training and support will be challenging