Global Telehealth Guidelines Urgently Needed

Rob Hicks

January 07, 2022

As the role of telemedicine in healthcare continues to grow the authors of a new study warn that the currently available allied health profession (AHP) guidelines "do not adequately support AHPs delivering telehealth consultations".

The study by Staffordshire University health experts, published in BMJ Open , examined current guidelines for the 14 allied health professions in the UK, including prosthetics and orthotists, podiatry, dietitians, occupational therapists, physiotherapists, and speech and language therapists. Of the 2632 articles identified through database searches, 21 articles were eligible for review, most having been published in the last two years. Eight guidelines were included in the study, these having been obtained from the UK AHP professional bodies.

Their study identified gaps in current guidelines and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. They also highlighted how current guidelines for AHPs had similarities but also discrepancies with the guidance for non-AHP healthcare professionals and recommended that in the future guideline developers need to "address the large areas of unclarity and ambiguity present".

Acceleration In Telemedicine Use

Prof Nachi Chockalingam, director of the Centre for Biomechanics and Rehabilitation Technologies (CBRT) at Staffordshire University, commented, "Good patient satisfaction, greater accessibility, convenience, and reduced travel and wait times are some of the factors that have led to increased telehealth usage and acceptability."

The researchers commented that there was "variety in telehealth terminology" and acknowledged that COVID-19 prompted an acceleration in the use of telemedicine, with guidelines designed to "quickly respond to the need of standards for telehealth-mediated patient consultations during the COVID-19 pandemic." They recommended that available guidelines should be reviewed to ensure they meet the long-term needs of patient consultations.

Prof Chockalingam explained how although "The pandemic has accelerated the transition to technology-medicated care, concerns and limitations related to remote consultations and the unintended risks, errors and harm that can occur to patients during and/or as a result of remote consultations are still present."

Need to Solve Existing Inequalities

The study highlighted that telehealth consultations need to be adapted to meet individual needs having found that few guidelines were specifically designed for certain clinical populations. Occupational therapists, physiotherapists and speech and language therapists were the AHPs for whom most guidelines were specifically designed, leaving the other AHP groups with very few or inadequate guidelines.

"There is a clear and immediate need to solve the existing inequalities among AHP professional bodies to avoid a direct impact on the services they offer, which inevitably affects the quality of care that their patients receive.” the authors said. Within their recommendations the authors went on to emphasise the importance of reviewing the guidelines “to ensure they meet the long-term needs of patient consultations delivered through telehealth.”

Review of Use and Effectiveness Lacking

Another concern raised by the authors was about how "information was lacking about the assessment of telehealth use and effectiveness". They explained how doctors are encouraged by NHS England, for example, to "conduct self-audit of consultations, obtain daily feedback from other staff and patients, monitor impact on their workloads, hold regular team meetings and assess the effectiveness of processes/protocols".

Associate Profs Dr Aoife Healy and Dr Nicola Eddison of the Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, UK, who were both involved in the study, said, "Robust guidance should be available to assist clinicians by offering clear instructions on how to provide remote consultations, which would also help them limit inappropriate and ineffective interventions, and most importantly, harm to patients."

The GMC has issued guidelines on best practice for remote consultations, offering doctors advice on how to answer the question, "Is a remote consultation  appropriate ?" GMC Chief Executive and Registrar Charlie Massey says, "We welcome innovations in medical practice that enable good care for patients, and support the use of remote prescribing that follows our clear prescribing guidance used in consultation with a patient in person or online."

Joined Up Approach

The study authors urge AHP professional bodies to work together, in the UK as well as worldwide. "Our work highlights that future research and collaborative work across AHP groups and the world’s leading health institutions are required to establish common guidelines which will improve AHP telehealth services," said Prof Healy and Dr Eddison.

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