A comparison study between metropolitan and rural hospital-based telehealth activity to inform adoption and expansion

Abstract

Introduction In Queensland, Australia, the public hospital system has used telehealth for almost three decades. Although telehealth activity has been growing consistently, there are substantial variations across geographic regions. We explored factors which contribute to this variation in telehealth adoption. Methods This was a multi-method comparative study of two matched metropolitan health services and two matched rural health services. The health services were matched according to the number of providers and hospitals but had different rates of telehealth use. Comparative rates of telehealth visits were analysed using descriptive statistics. Qualitative data was obtained from 63 semi-structured interviews with telehealth administrators, clinicians and senior managers involved in telehealth policies and procedures. Data were analysed using a framework analysis. Results The metropolitan health service that had more telehealth use had greater investment in telehealth, higher population referral areas, highly developed communication strategies and understanding of the value proposition for telehealth, and reported fewer information technology and administration systems difficulties. In rural health services, telehealth activity was influenced by onboarding processes, clinician willingness to practice, strategic challenges and primary care activity. Discussion Telehealth adoption can be influenced by funding, cross-organisational strategic policies and a multi-faceted approach to address clinician reluctance to use telehealth.