Afterhours telehealth in Australian residential aged care facilities: A mixed methods evaluation

Abstract

Abstract Background The aged care system in Australia is failing. Residential aged care facilities (RACFs) and general practitioners (GPs) struggle to meet the care demands of their residents, particularly after hours. Many residents are given ambulance support and transferred to hospital emergency departments (EDs) for care that could be provided at RACFs. The MyEmergencyDoctor (MED) service was commissioned in a 12-month program (February 2020-February 2021) using ED physicians to provide afterhours telehealth care in six RACFs. Methods We conducted descriptive analyses of statistical data from the MED service, RACFs and the ambulance service and conducted a thematic analysis with interview data collected from GPs, RACF and MED service staff, and family members of residents. Results Most calls to MED (179/209) were recommended for care in the RACF and 30 for ambulance transport to hospital. There was a reduction in ED transfers from the six RACFs during the program compared to previous years and other RACFs. RACF staff reported that for 87 of the 209 calls to MED, they would have normally called the ambulance service directly if the MED afterhours service was not available to them. Qualitative themes included: Systems issues related to care in RACFs; Issues related to the MED Model of Care; Implementing the MED Program; and Experience of the MED program. Conclusions The afterhours telehealth model provided in-house care and reduced ambulance transfers, and GPs and RACF staff generally felt supported. The service was easy to use and fostered good communications with GPs and RACF staff. Some GPs preferred to provide their own care, commenting on the need for a good understanding of patient and family needs and of the local context. Other stakeholders suggested this model could be extended to palliative care settings and to normal business hours when GPs were unavailable. The reduced ambulance and hospital use suggested benefits to wider health systems, however policies and funding that remunerate GPs, support community-based care and provide additional staffing in RACFs are needed to sustain afterhours telehealth in RACFs. Use of the NASSS (non-adoption, abandonment, scale-up, spread, and sustainability) Framework provided a valuable explanatory lens for our analyses.