Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

R L Jessup; N Awad; A Beauchamp; C Bramston; D Campbell; Al Semciw; N Tully; A M Fabri; J Hayes; S Hull; A C Clarke

doi:10.1186/s12913-022-08173-1

Staff and patient experience of the implementation and delivery of a virtual health care home monitoring service for COVID-19 in Melbourne, Australia

BMC Health Serv Res. 2022 Jul 13;22(1):911. doi: 10.1186/s12913-022-08173-1.

Authors

R L Jessup^{1

2

3

4}, N Awad⁵, A Beauchamp^{5

6

7}, C Bramston^{5

8}, D Campbell^{9

10}, Al Semciw^{5

8}, N Tully⁹, A M Fabri⁹, J Hayes⁹, S Hull⁹, A C Clarke⁹

Affiliations

¹ Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. Rebecca.jessup@nh.org.au.
² Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia. Rebecca.jessup@nh.org.au.
³ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia. Rebecca.jessup@nh.org.au.
⁴ School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia. Rebecca.jessup@nh.org.au.
⁵ Allied Health Research, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.
⁶ School of Rural Health, Monash University, Sargeant St, Warragul, 3820, Australia.
⁷ Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia.
⁸ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Melbourne, 3086, Australia.
⁹ Hospital Without Walls Directorate, Northern Health, 185 Cooper Street, Epping, Melbourne, 3075, Australia.
¹⁰ Faculty of Art, Design and Architecture, Monash University, Clayton, Victoria, Australia.

Abstract

Background: Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic.

Methods: A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews.

Results: All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data.

Conclusion: Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.

Keywords: COVID-19; Home monitoring; Implementation science; Patient experience; Staff experience.

MeSH terms

Australia
COVID-19* / epidemiology
Delivery of Health Care
Humans
Pandemics
Patient Outcome Assessment
Qualitative Research