JCPSLP Vol 16 no 3 2014_FINAL_WEB

Clinical insight

Telehealth: Why not? Perspectives of speech-language pathologists not engaging in telehealth Jodie May and Shane Erickson

Telehealth-delivered speech-language pathology services can be effective and improve efficiency and accessibility. However, uptake of telehealth among Australian speech-language pathologists (SLPs) is low and little is known about those who do not use it. This study aimed to explore the barriers preventing SLPs from using telehealth and describe strategies to support its uptake. Eighteen SLPs participated in interviews or focus groups. Data were analysed using thematic analysis. Existing barriers and potential facilitators were reflected in the following themes: information, training, clinician attitudes and perceptions, and organisational and policy barriers. Findings suggest that further research, training, and information are required to support telehealth use across a wider range of clinical settings. D espite evidence showing that telehealth-delivered speech-language pathology services can be effective, efficient and accessible (Reynolds, Vick & Haak, 2009; Theodoros, 2012), translation into practice has been limited (Department of Health & Ageing [DoHA], 2011). A recent DoHA survey indicated that only 13% of Australian allied health professionals use telehealth (DoHA, 2011). The National eHealth Strategy states that “the challenges and issues facing the Australian health care sector will not be solved by doing more of the same, particularly given the limited nature of available human and financial resources” (Deloitte, 2008, p. 15). Strategic and effective use of communication technology is an important tool to meet growing demand for healthcare services (DoHA, 2011; Theodoros, 2012). Inconsistencies regarding telehealth terminology and definitions confuse both professionals and consumers (Brennan et al., 2010). In this paper the term telehealth is used and is consistent with DoHA and Medicare policy and documentation (however, Speech Pathology Australia [SPA] has chosen to use “telepractice” in its forthcoming position statement). Telehealth is “the application of telecommunications technology to the delivery of

professional health services at a distance by linking clinician to client, or clinician to clinician for assessment, intervention and/or consultation” (American Speech & Hearing Association [ASHA], 2005). In order to realise the potential of telehealth, SLPs will need to embrace a range of new technologies and develop new skills. However, evidence regarding clinician attitudes to telehealth and potential facilitators to increase uptake is scarce. Several studies have documented the experiences of SLPs who use telehealth. A recent survey of SLP telehealth users in Australia found that the most significant challenges to using telehealth were: lack of appropriate technology and telecommunication connections, lack of appropriate and available telehealth assessment and therapy resources, access, and information communication technology (ICT) support (Hill & Miller, 2011). A range of potential telehealth facilitators were also identified including: training and demonstrations, access to resources, funding and a SPA position paper. There may also be a disparity between SLP attitudes towards telehealth and those of their clients. Dunkley, Pattie, Wilson, and McAllister (2010) found that client attitudes to telehealth were more positive than their SLPs anticipated them to be and the clients reported better access to telehealth technology than the SLPs had perceived. To date, little is known about the perspectives and experiences of SLPs who do not use telehealth in clinical practice. This study seeks to explore this knowledge gap and inform the broader profession about (a) the existing barriers to telehealth use and (b) potential facilitators to support its uptake. Identifying these barriers and facilitators is a significant step towards broadening the availability of telehealth and increasing the access, efficiency and cost effectiveness of SLP services. Method Ethics approval was received from the La Trobe University Human Research Ethics Committee (reference FHEC 13/083) and from the SA Health Human Research Ethics Committee (reference HREC/13/SAH/60). A qualitative research design was utilised given the exploratory nature of the study and scarcity of previous related research. Participants The participants were 18 practising SLPs who self-identified as not using telehealth for clinical service provision (Table 1). Participants for individual interviews were recruited

KEYWORDS PROFESSIONAL ISSUES SPEECH LANGUAGE PATHOLOGY TELEHEALTH TELEPRACTICE THIS ARTICLE HAS BEEN PEER- REVIEWED

Jodie May (top) and Shane Erickson

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JCPSLP Volume 16, Number 3 2014

www.speechpathologyaustralia.org.au