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Policy framework to guide allied health professional telehealth patient consultation guidelines and training

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Allied Health Professionals (AHPs) make up the third largest healthcare workforce in the UK National Health Service (NHS) and play a vital role in the health and care of patients. However, new research shows that current telehealth guidelines and training programmes for AHPs are not sufficiently comprehensive and lack information on key telehealth aspects.

A program of work, conducted by a team of researchers at Staffordshire University, found that many AHPs are not adequately supported in the delivery of remote patient consultations. This is a concern as telehealth has become increasingly important in the current climate, with the pandemic forcing many healthcare providers to shift to remote consultations.

Based on these studies a policy brief has been created in partnership with various stakeholders to guide the creation of telehealth patient consultation guidelines and training for AHPs.

This policy brief, which was launched on 18th January 2023 aims to outline crucial telehealth elements to consider when creating guidelines for patient consultations and to highlight areas where AHPs should receive training before conducting telehealth consultations.

Download the policy brief here.

The publications which informed this policy can be found at:

  • Leone E, Eddison N, Healy A, Royse C, Chockalingam N. Exploration of implementation, financial and technical considerations within allied health professional (AHP) telehealth consultation guidance: a scoping review including UK AHP professional bodies’ guidance. BMJ Open. 2021 Dec 27;11(12):e055823. doi: 10.1136/bmjopen-2021-055823. https://bmjopen.bmj.com/content/11/12/e055823.long

This work uncovered deficiencies in current guidelines for telehealth consultations by allied health professionals (AHPs). These guidelines demonstrated both similarities and discrepancies with the guidance for non-AHP healthcare professionals. The findings indicated that the current guidelines do not provide sufficient support for AHPs to deliver telehealth consultations. It is suggested that future research and collaboration among AHP groups and leading health institutions be undertaken to develop common guidelines that will enhance AHP telehealth services.

In this study, 658 participants were surveyed (119 AHP service managers overseeing 168 AHP services, and 539 clinicians). Among the clinicians and services represented, 87.4% and 89.4%, respectively, were using telehealth consultations to deliver healthcare, and most of these services planned to continue using telehealth after COVID-19 restrictions were lifted. The most significant barrier reported by participants as impacting a patient’s ability to conduct a telehealth consultation was a lack of technological skills, followed by a lack of technology for patients. These were also identified as the primary disadvantages of telehealth for patients. Many clinicians reported that telehealth consultations reduced the cost of parking and transportation for patients attending hospital appointments. The benefits reported by clinicians included saving on travel time and costs and enabling flexible working, while the benefits to AHP services included increased flexibility for patients in how appointments are conducted and reduced potential exposure of staff to contagious diseases. We concluded that widespread adoption of telehealth in its current form in NHS AHP services may exacerbate inequalities in healthcare access for vulnerable groups with limited digital literacy or access. As a result, telehealth may be deemed inappropriate and underutilized, nullifying the potential benefits such as sustainability, patient empowerment, and reduced treatment burden. This could increase disparities in healthcare.

In this paper we examined the organizational readiness of AHP services regarding the implementation of telehealth guidelines and staff training. Results showed that UK NHS AHP services lack clear and comprehensive guidelines and the necessary skills to effectively deliver telehealth. Vulnerable individuals are excluded from current guidelines, which could exacerbate health inequalities and hinder the success of the NHS digital transformation. The lack of national guidelines underscores the need for consistent AHP telehealth guidelines.

  • Eddison N, Royse C, Healy A, Leone E, Chockalingam N. Telehealth provision across allied health professions (AHP): An investigation of reimbursement considerations for its successful implementation in England. Health Sci Rep. 2022 Dec 13;6(1):e991. doi: 10.1002/hsr2.991. https://onlinelibrary.wiley.com/doi/10.1002/hsr2.991

This study investigated the potential barriers to the adoption of telehealth posed by differences in the NHS tariff. To understand the effect of these changes on reimbursement for AHP telehealth consultations because of the pandemic, a Freedom of Information (FOI) request was sent to all Clinical Commissioning Groups (CCGs) in England in April 2021, to request information on the current tariffs for face-to-face and telehealth consultations for AHP services. Findings showed significant variations across the NHS in England, with some CCGs paying the same amount regardless of the mode of delivery, some paying 6.5 times more for in-person consultations, and only a few paying more for telehealth consultations.

Devices that help people function in every day life are costly in Africa: here’s why

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More than 200 million Africans need at least one assistive device. Lucian Coman/Shutterstock

Tolu Olarewaju, Keele University; Aoife Healy, Staffordshire University, and Nachiappan Chockalingam, Staffordshire University

Everyone has a right to certain products and devices that can help them function in everyday life. This is the stance of the World Health Organisation (WHO), which has published a list of the most important of these devices. It includes things like walking aids, wheelchairs and braille displays.

But assistive technologies, as they are called, are difficult to access in many parts of Africa. This is a huge problem because the prevalence of disabilities on the continent is estimated at 15.6%. With a population of more than one billion, the number of people in need of at least one assistive product in Africa stands at over 200 million, and that figure is projected to double by 2050.

The WHO estimates that only about 15% to 25% of those in need of assistive technology products in Africa currently have access to them.

Our research sought to find out why and to offer solutions to this problem.

Human rights

Assistive technologies are functional, adaptive, and rehabilitative devices. Not only does the WHO support a global commitment to making them more easily available, the United Nations also regards them as a basic human right. This is because some people need them in order to exercise their rights.

Without access to the assistive technology they need, people can face exclusion and are at risk of poverty. They may also be perceived as a burden to their families and society. The positive impact of assistive technology products goes far beyond improving the health and well-being of users. There are also the socio-economic benefits of reducing direct health costs and having a more productive labour force, indirectly stimulating economic growth.

The 2006 UN Convention on the Rights of Persons with Disabilities and its optional protocol was negotiated quickly and well supported by member states. It was also the first human rights convention to be open for signature by regional integration organisations. But its implementation has been shaky, particularly in Africa.

We believe this is best explained by the idea of economic and political institutional voids. These are basically gaps in political and economic systems, trade policies and markets. An absence of specialised intermediaries, regulatory systems and contract enforcing mechanisms creates higher transaction costs for doing business or even entering markets.

Seeing the problem in this way also helps to show how to solve it and achieve fair access to assistive technologies.

Institutional voids

First, there is little production of assistive technologies in Africa because the parts are generally expensive to make. Many indigenous producers use crude and unstandardised materials.

Second, assistive technologies that are not produced locally are expensive to import. There are no unified tariff structures for them within the continent. This means that costs vary widely from country to country. Often, when assistive technologies do get imported despite high tariffs, they might need to be adapted for the local environment. This increases the costs even further.

Third, assistive technologies are mostly excluded from health financing and insurance schemes on the continent. They are not often included in central medical store catalogues.

Fourth, there aren’t enough people at all levels of the health system with the required knowledge and skills to provide assistive technology services and products.

Fifth, and most crucially, there is no unified governance framework for assistive technologies on the continent. And there’s a widespread lack of awareness about why they are needed and how they can improve the lives of people who need them.

Most African countries do not have national assistive technology policies or programmes. As a result, access to assistive products is difficult and many are left behind.

Solutions

African governments need to provide leadership, coordination and resources to plan and implement policies that increase access to assistive technologies.

Acting on the WHO African regional framework is a good place to start. The framework has modest aims. For instance, it calls for 40% of African member states to have assessed their assistive technology situation and developed a national strategy to improve access by 2024. This will help 40% of the population in Africa that needs assistive products to get them without suffering financial hardship.

The African Union can learn from the European Union. The European Parliamentary Research Service has commissioned and published an in-depth report of assistive technologies. The report covers economic, political and socio-ethical perspectives and it tries to implement the declarations that assistive technologies are a basic human right. Such a focused and thorough evaluation is missing in Africa.

To produce technologies on the continent, the African Union should develop a market strategy. The current market is one where the players are left to fend for themselves, and so face high operating costs. These costs ultimately make assistive technologies expensive.

Producers should also embrace frugal innovation – the process of reducing the complexity and cost of an item and its production, usually by removing nonessential features.

Qualified personnel are another part of the solution.

Finally, but maybe most importantly, there is a need for a structured enquiry to highlight the gaps in economic, political, scientific, and clinical knowledge for assistive technology development and deployment in Africa – and a unified approach to solving the problems.

This would help millions of people in Africa to achieve their basic rights such as access to education, freedom to live, and the right to work.The Conversation

Tolu Olarewaju, Lecturer in Management, Keele University; Aoife Healy, Associate Professor of Human Movement Biomechanics, Staffordshire University, and Nachiappan Chockalingam, Professor of Clinical Biomechanics, Staffordshire University

This article is republished from The Conversation under a Creative Commons license. Read the original article.