Telehealth in school-based practice: viability to bridge global OT practitioner shortages

Abstract

Telehealth, an emerging occupational therapy (OT) service delivery model, is defined as “the application of evaluative, consultative, preventative, and therapeutic services delivered through information and communication technology” (AOTA, 2018, p.1). Many of the positive attributes of telehealth include improved access and timing for care, care coordination, decreased travel and more (Cason, 2015). Telehealth use has the potential to offset well-documented occupational therapy practitioner (OTP) shortages globally (AAEE, 2016; BLS, 2018; WFOT, 2018). However, unlike other medical professions, the evidence literature lacks substantiation of wide-spread adoption and acceptance of telehealth for OT service delivery (Hersh, Kao, Melton & Pancheri, 2015), particularly in school-based practice. A comprehensive training program for the use of telehealth in the school setting was proposed as a solution to increase OTPs’ positive perceptions and ultimately adoption of telehealth. The Diffusion of Innovation theory posits that conveying an innovation’s attributes of relative change, complexity, compatibility, observability, and trialability can influence potential adoption (Rogers, 2003). To depict detailed attributes of telehealth in OT, perceptions of OTPs experienced in and new to telehealth in school-based practice were measured via surveys and used to inform development of an online educational program. Following the completion of the New to Telehealth Pre-training survey, only OTPs new to telehealth were invited to complete the OT Telehealth Primer: School-based Practice training program. Analysis of pre- and post-training surveys yielded information about attitudinal changes experienced post-training. Results from the OTP Experienced telehealth-user survey identified the top telehealth benefits as improved: 1) service access, 2) collaboration and carry-over with team members, 3) efficiency themes, and 4) student engagement and comfort. Results from the OTP New to Telehealth survey identified the same top benefits post-training. Most perceived barriers decreased significantly from pre- to post-training. Perceived barriers not significantly reduced post-training, therefore yielding future education and protocol development included: unreliable internet, lack of hands-on opportunity and e-helpers’ decreased comfort with technology. Post-training, 80% of participants reported a positive likelihood of adding telehealth to future OT practice. While the OT Telehealth Primer: School-based Practice training program yielded improved perceived benefits and reported likelihood of adoption into practice by OTPs, ongoing education is required for both OTPs and school administrators to achieve more widespread adoption and use of telehealth in school-based practice to offset global OTP shortages.