Evaluation of a Collaborative Telehealth Model for Eye Care Between Ophthalmology and Optometry in Western Australia

Abstract

Objective: Recent advances in technology and the impact of COVID-19 have expanded the adoption of digital health. Synchronous collaborative telehealth between optometry and ophthalmology has been used to expedite specialist eye care in Western Australia since 2011. Optometrists perform an in-person assessment and participate in videoconferencing with ophthalmology to facilitate shared decision-making. This study utilises existing implementation theory to assess factors influencing implementation success, sustainability and scalability of this telehealth model. Setting: Regional, rural, and remote Western Australia. Design: In-depth interviews were undertaken using an interview guide based on the Consolidated Framework for Implementation Research (CFIR). Deductive analysis was used to code themes to the framework, and inductive analysis was used for themes relating to sustainability and scalability. Participants: Sixteen clinical and non-clinical staff with experience in telehealth for eye care in rural Western Australia. Results: Key themes identified using the CFIR included the relative advantage of telehealth (innovation), optimising workflow and role clarification (implementation process), funding (external setting), technological infrastructure (inner setting), a champion, and ownership and adaptability (individuals). Stakeholder buy-in, resource allocation, integration into public health infrastructure, asynchronous telehealth, and artificial intelligence were themes pertaining to both sustainability and scalability. Conclusion: This study proposes key considerations in the implementation and maintenance of a collaborative telehealth model for eye care in rural areas which may be used as a basis for guideline development or to replicate the model in other contexts.