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Clinician Perspectives Regarding Cognitive Assessment via Telehealth for Middle-Aged and Older Adults: A Mixed-Methods Study
ABSTRACT
Background:
The continuing rise in dementia diagnoses, combined with limited growth in the clinical workforce, necessitates more efficient and accessible methods of cognitive assessment. While technological developments have allowed clinicians to deliver assessment services via telehealth, current uses, barriers, and enablers to telehealth assessment in Australia are not well understood.
Objective:
This study aimed to explore clinician experiences and opinions, including barriers and enablers, of conducting cognitive assessment via telehealth with middle-to-older aged adults in Australia.
Methods:
An online quantitative survey was distributed to clinicians with prior experience of providing cognitive assessments with middle-to-older aged adults. A subsample of survey respondents also participated in an online semi-structured interview. Respondent characteristics and quantitative data were analysed using descriptive statistics. Qualitative interview data were analysed using applied thematic analysis and results mapped to the domains of the COM-B framework (capability, opportunity and motivation).
Results:
Survey responses (n=88) were received from psychologists (56%), specialist doctors (20%), primary health clinicians (16%) and other allied health professionals (8%). A majority (88%) had some telehealth experience, with almost half (44%) using it weekly or more. Most common reasons for using telehealth included patient preferences, reduced travel and infection risk, and increased work flexibility and economic savings. The main barriers included the need for a patient support person, as well as technological issues. Most respondents (63%) had also administered a cognitive assessment via telehealth. Clinician confidence in the results obtained via a telehealth assessment were generally high; in particular, confidence was significantly higher for psychologists and those with previous cognitive assessment via telehealth experience (P<.001). Qualitative analysis resulted (n=20) in three themes mapped to the COM-B framework: 1. clinician telehealth skills and patient digital competency (capability); 2. suitability of cognitive tests, patient’s testing environment, technology and social support (opportunity); and 3. clinician opinions and approach to practice (motivation). Specific enablers and barriers within each theme were explored in greater detail.
Conclusions:
Despite current barriers, clinicians across health disciplines described several factors that can support more frequent and effective use of telehealth-based assessment. Practical recommendations are provided as a scaffold to increase clinician and patient capacity, as well as cognitive test validation, intending to facilitate effective and appropriate utilisation of cognitive assessment via telehealth. Addressing these factors can help ensure cognitive assessments for middle-to-older aged adults are more accessible while meeting clinical standards in the assessment and diagnosis of dementia. Clinical Trial: NA
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Copyright
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