Telehealth provision across allied health professions (AHP): An investigation of reimbursement considerations for its successful implementation in England

The use of telehealth is not new, however, its recent ubiquity in the National Health Service (NHS) led to the realization that telehealth can offer people a more tailored elective pathway. Resulting in the UK government declaring that digital technology is fundamental to future patient care with a commitment to deliver “at-scale virtual consultations.”1 This ambitious plan requires strategic financial plannin

Do UK Allied Health professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations?

Objectives The COVID-19 pandemic caused a rapid shift to remote consultations. United Kingdom (UK) NHS Allied Health Professional (AHP) services may have been unprepared for telehealth implementation. This study explored these services’ organisational readiness regarding telehealth guidelines implementation and staff training. Methods A cross-sectional online survey exploring available telehealth guidelines and staff training was distributed among UK AHPs and AHP service managers between May and June 2021. Results 658 participants answered the survey (119 managers and 539 clinicians). Most services, in which telehealth was in place, had implemented telehealth guidelines (clinicians, 64%; managers, 82%), with most guidelines produced by the NHS staff who use them for their consultations. Most clinicians reported that guidelines had ambiguous areas (e.g., regarding protection from litigation and dealing with emergencies), whereas most managers reported the opposite opinion. Guidelines most frequently reported on appropriate telehealth technology and environment for staff and patients, while recommended consultation length and how to conduct telehealth with certain population groups were least reported. Clinicians lacked training in most telehealth aspects, while managers reported that staff training focused on telehealth software and hardware. For both clinicians and managers, training is needed on how to deal with emergencies during telehealth. Conclusion UK NHS AHP services are not fully equipped with clear and comprehensive guidelines and the skills to deliver telehealth. Vulnerable people are excluded from current guidelines, which may widen health inequalities and hinder the success of the NHS digital transformation. The absence of national guidelines highlights the need for uniform AHP telehealth guidelines

Framework to guide Allied Health Professional telehealth patient consultation guidelines and training

Purpose AHPs make up the third largest healthcare workforce in the UK NHS and with their wide range of skills make a significant contribution to the health and care of people using their services. Current telehealth guidelines and training programmes for AHPs are not sufficiently comprehensive and lack information on key telehealth aspects, meaning AHPs may not be adequately supported in the delivery of remote patient consultations. Therefore, a policy brief to guide the development of AHP telehealth patient consultation guidelines and training was developed to meet the needs of policymakers, AHP professional bodies, and clinical services. The intended purposes of this policy brief are to: (1) present key telehealth domains that should be considered when designing telehealth guidelines for patient consultations, and (2) present areas in which AHPs should be trained prior to providing telehealth consultations. This policy brief aims to provide guidance and facilitate further discussion on the essential components of telehealth guidelines and staff training, it is not an exhaustive list of recommendations. Recognising the diversity of telehealth applications and the differences between and within individual allied health professions, this policy brief is not profession specific and may require adaptation to the context of use and individual circumstances. Policy brief development This policy brief was developed in four phases, which include: (1) a scoping review to synthesise available evidence; (2) a survey to explore the opinions of UK AHP clinicians and service managers on their telehealth service guidelines and training; (3) formulation of the draft policy brief; (4) consultation with stakeholders and formulation of the final policy brief. Patient users of telehealth were not involved in the development of this policy brief. However, the policy brief considers patient users’ suitability, needs and requirements. Audience This policy brief is intended to inform the development of telehealth consultation guidelines and training for AHP patient consultations. Therefore, the target audience includes policymakers, AHP professional bodies, AHP service managers, and professional societies involved in the planning and management of AHP training, clinical and academic staff involved in training AHPs, and independent AHPs requiring support in their telehealth patient consultations. Telehealth definition Telehealth is defined by the World Health Organization (WHO) as “The delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities” (1). For this policy brief, telehealth was defined as a telephone or video consultation with a patient

Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: A scoping review including UK AHP professional bodies’ guidance

Objectives The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK Allied Health Professionals (AHPs) and compare them with the UK AHP professional bodies’ guidelines. Design Scoping review following Aksey and O’ Malley methodological framework. Data Sources CINHAL and MEDLINE were searched from inception to March 2021 using terms related to “telehealth”, “guidelines” and “AHPs”. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. Study selection: Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites, were considered eligible for review. Data extraction: One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. Results 2,632 articles were identified through database searches with twenty-one articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of twenty-nine included articles/guidelines. Most articles were published in the last two years, there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family’s and caregiver’s roles, and the costs. There was lack of clarity on the AHPs’ registration requirements, costs and coverage, and legal aspects. Conclusion This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth. Future research and collaborative work across AHP groups and the world’s leading health institutions are suggested to establish common guidelines which will improve AHP telehealth services

The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment

Background The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. Methods Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May – June 2021. Results 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient’s ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. Conclusions The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment

The potential impact of allied health professional telehealth consultations on health inequities and the burden of treatment

Background The COVID-19 pandemic resulted in a rapid shift to remote consultations. The study aimed to explore the prevalence of telehealth consultations amongst allied health professional (AHP) services in the UK National Health Service (NHS), and the potential impact on health inequities and burden of treatment for patients. Methods Cross-sectional online survey. Participants were practising UK registered AHP and/or AHP service manager in an NHS/social care/local authority service. Data was collected between May – June 2021. Results 658 participants took part in this study, including 119 AHP service managers, managing a total of 168 AHP services, and 539 clinicians. 87.4% of clinicians and 89.4% of services represented were using telehealth consultations as a method of delivering healthcare, the majority reported their services were planning to continue using telehealth post COVID-19 restrictions. Participants reported a lack of technological skills for patients as the most prevalent barrier affecting the patient’s ability to conduct a telehealth consultation, followed by a lack of technology for patients. These were also reported as the biggest disadvantages of telehealth for patients. The majority of clinicians reported a reduction in the cost of parking/transport to attend hospital appointments as a patient benefit of telehealth consultations. Reported benefits for clinicians included saving travel time/costs and allowing flexible working, while benefits to the AHP service included patient flexibility in how their appointments are conducted and reducing the potential exposure of staff to communicable diseases. Conclusions The current large-scale implementation of telehealth in NHS AHP services may increase disparities in health care access for vulnerable populations with limited digital literacy or access. Consequently, there is a danger that telehealth will be considered inappropriate and thus, underutilised, negating the potential benefits of sustainability, patient empowerment and the reduction in the burden of treatment

Additional file 1 of Do UK Allied Health Professionals (AHPs) have sufficient guidelines and training to provide telehealth patient consultations?

Additional file 1. Survey questions

Improving personalised care, through the development of a service evaluation tool to assess, understand and monitor delivery

Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool. The tool offers a process through which healthcare systems can better understand the current delivery of personalised care and the factors influencing this. With a focus on implementation, the development of the tool was informed by the Consolidated Framework for Implementation Research, and its content is structured using behaviour change theory (COM-B Theory of Behaviour Change Model). The tool consists of four mirrored surveys, which were developed using an iterative exploratory design. This included a series of testing cycles, in which its structure and content were continually refined. To date, it has been used by 24 clinical services, involving 397 service users, 313 front-line practitioners, 73 service managers and 40 commissioners. These services have used the evaluation process to initiate quality improvement, targeted at one of the more aspects of personalised care. The use of the COM-B model increases the likelihood of those improvements being sustained, through identification of the core factors that enable or limit personalised care behaviours among healthcare staff. We have shown this process to be applicable in a wide range of settings, thus it potentially has broad applicability as a tool for cultural change and quality improvement. The next stage of this work will focus on implementation and evaluation, to fully understand if and how the tool can be used to drive improvements in personalised care delivery

Improving personalised care, through the development of a service evaluation tool to assess, understand, and monitor delivery

Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool. The tool offers a process through which healthcare systems can better understand the current delivery of personalised care and the factors influencing this. With a focus on implementation, the development of the tool was informed by the Consolidated Framework for Implementation Research, and its content is structured using behaviour change theory (COM-B Theory of Behaviour Change Model). The tool consists of four mirrored surveys, which were developed using an iterative exploratory design. This included a series of testing cycles, in which its structure and content were continually refined. To date, it has been used by 24 clinical services, involving 397 service users, 313 front-line practitioners, 73 service managers and 40 commissioners. These services have used the evaluation process to initiate quality improvement, targeted at one of the more aspects of personalised care. The use of the COM-B model increases the likelihood of those improvements being sustained, through identification of the core factors that enable or limit personalised care behaviours among healthcare staff. We have shown this process to be applicable in a wide range of settings, thus it potentially has broad applicability as a tool for cultural change and quality improvement. The next stage of this work will focus on implementation and evaluation, to fully understand if and how the tool can be used to drive improvements in personalised care delivery