Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol

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Abstract

Background

Virtual healthcare solutions are proposed as a way to combat the inequity of access to healthcare in rural and remote areas, and to better support the front-line providers who work in these areas. Rural provider-to-provider telehealth (RPPT) connects rural and remote clinicians to a ‘hub’ of healthcare specialists who can increase access to emergency and specialised healthcare via an integrated model. Reported benefits for the place-based provider include enhanced knowledge, expanded professional development opportunities, improved scope of practice, and increased confidence in treating more complex cases. These reported benefits could have implications for supporting and futureproofing our health workforce in terms of productivity, burnout, recruitment, and retention.

Methods

The research uses an explanatory sequential mixed methods approach across multiple phases to evaluate the current implementation of Western Australia Country Health Service's (WACHS) Command Centre (CC) services and explore factors associated with their differential use. The primary population of interest and participants in this study are the place-based providers in country Western Australia (WA). Patient data constitutes the secondary population, informing the access and reach of CC services into country WA. Data collection will include service data, an online survey, and semi-structured interviews with the primary population. The data will be interpreted to inform evidence-based strategies and recommendations to improve the implementation and sustainment of RPPT.

Discussion

Innovative and sustained workforce models and solutions are needed globally. Virtual healthcare, including provider-to-provider models, demonstrate potential, especially in rural and remote areas, designed to increase access to specialised expertise for patients and to support the local workforce. This research will generate new data around behaviour, perceptions, and value from the WACHS rural and remote workforce about provider-to-provider telehealth, to explore the implementation and investigate strategies for the long-term sustainment of RPPT services.

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Most cited references 52

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Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

Enola Proctor, Hiie Silmere, Ramesh Raghavan … (2010)

An unresolved issue in the field of implementation research is how to conceptualize and evaluate successful implementation. This paper advances the concept of “implementation outcomes” distinct from service system and clinical treatment outcomes. This paper proposes a heuristic, working “taxonomy” of eight conceptually distinct implementation outcomes—acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability—along with their nominal definitions. We propose a two-pronged agenda for research on implementation outcomes. Conceptualizing and measuring implementation outcomes will advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.

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RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review

Russell E. Glasgow, Samantha Harden, Bridget Gaglio … (2019)

The RE-AIM planning and evaluation framework was conceptualized two decades ago. As one of the most frequently applied implementation frameworks, RE-AIM has now been cited in over 2,800 publications. This paper describes the application and evolution of RE-AIM as well as lessons learned from its use. RE-AIM has been applied most often in public health and health behavior change research, but increasingly in more diverse content areas and within clinical, community, and corporate settings. We discuss challenges of using RE-AIM while encouraging a more pragmatic use of key dimensions rather than comprehensive applications of all elements. Current foci of RE-AIM include increasing the emphasis on cost and adaptations to programs and expanding the use of qualitative methods to understand “how” and “why” results came about. The framework will continue to evolve to focus on contextual and explanatory factors related to RE-AIM outcomes, package RE-AIM for use by non-researchers, and integrate RE-AIM with other pragmatic and reporting frameworks.

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Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period

Konstantina Vasileiou, Julie Barnett, Susan Thorpe … (2018)

Background Choosing a suitable sample size in qualitative research is an area of conceptual debate and practical uncertainty. That sample size principles, guidelines and tools have been developed to enable researchers to set, and justify the acceptability of, their sample size is an indication that the issue constitutes an important marker of the quality of qualitative research. Nevertheless, research shows that sample size sufficiency reporting is often poor, if not absent, across a range of disciplinary fields. Methods A systematic analysis of single-interview-per-participant designs within three health-related journals from the disciplines of psychology, sociology and medicine, over a 15-year period, was conducted to examine whether and how sample sizes were justified and how sample size was characterised and discussed by authors. Data pertinent to sample size were extracted and analysed using qualitative and quantitative analytic techniques. Results Our findings demonstrate that provision of sample size justifications in qualitative health research is limited; is not contingent on the number of interviews; and relates to the journal of publication. Defence of sample size was most frequently supported across all three journals with reference to the principle of saturation and to pragmatic considerations. Qualitative sample sizes were predominantly – and often without justification – characterised as insufficient (i.e., ‘small’) and discussed in the context of study limitations. Sample size insufficiency was seen to threaten the validity and generalizability of studies’ results, with the latter being frequently conceived in nomothetic terms. Conclusions We recommend, firstly, that qualitative health researchers be more transparent about evaluations of their sample size sufficiency, situating these within broader and more encompassing assessments of data adequacy. Secondly, we invite researchers critically to consider how saturation parameters found in prior methodological studies and sample size community norms might best inform, and apply to, their own project and encourage that data adequacy is best appraised with reference to features that are intrinsic to the study at hand. Finally, those reviewing papers have a vital role in supporting and encouraging transparent study-specific reporting. Electronic supplementary material The online version of this article (10.1186/s12874-018-0594-7) contains supplementary material, which is available to authorized users.

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Author and article information

Journal

Journal ID (nlm-ta): Digit Health

Journal ID (iso-abbrev): Digit Health

Journal ID (publisher-id): DHJ

Journal ID (hwp): spdhj

Title: Digital Health

Publisher: SAGE Publications (Sage UK: London, England )

ISSN (Electronic): 2055-2076

Publication date (Electronic): 1 April 2024

Publication date Collection: Jan-Dec 2024

Volume: 10

Electronic Location Identifier: 20552076241242790

Affiliations

[1 ]School of Population Health, Faculty of Health Sciences, Ringgold 168274, universityCurtin University; , Perth, Western Australia, Australia

[2 ]enAble Institute, Ringgold 1649, universityCurtin University; , Perth, Western Australia, Australia

[3 ]WA Country Health Service, Command Centre, Perth, Western Australia, Australia

[4 ]Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Ringgold 2104, universityDeakin University; , Geelong, Victoria, Australia

Author notes

[*]Kaylie Toll, Curtin University, GPO Box U1987, Bentley, WA Australia 6845. Email: kaylie.toll@ 123456curtin.edu.au

Author information

Kaylie Toll https://orcid.org/0000-0002-4553-2188

Timothy A Carey https://orcid.org/0000-0003-2882-1508

Article

Publisher ID: 10.1177_20552076241242790

DOI: 10.1177/20552076241242790

PMC ID: 10989039

PubMed ID: 38571877

SO-VID: 1fce85d7-3874-4f35-9f48-26b0b0108a25

License:

This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

History

Date received : 1 December 2023

Date accepted : 12 March 2024

Funding

Funded by: Western Australian Future Health Research and Innovation Fund;

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typesetter ts19

cover-date January-December 2024

Keywords: digital health < general,telehealth < general,telemedicine < general,emergency medicine < medicine,mixed methods < studies

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Keywords: digital health < general, telehealth < general, telemedicine < general, emergency medicine < medicine, mixed methods < studies

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Enhancing the implementation of provider-to-provider telehealth in rural and remote areas: A mixed methods study protocol

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Most cited references 52

Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda

RE-AIM Planning and Evaluation Framework: Adapting to New Science and Practice With a 20-Year Review

Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period

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