JMIR Publications

ABSTRACT

Background:

Alternate ‘hospital avoidance’ models of care are required to manage the increasing demand on acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a Virtual Hospital model of care called ‘Back@Home’ and to use qualitative interviews with stakeholders to develop and refine the model.

Objective:

To explore clinician perspectives on a virtual hospital model of care for back pain (‘Back@Home’), and identify barriers to, and enablers of, successful implementation of this model of care.

Methods:

Semi-structured interviews were conducted with 19 purposively sampled clinicians involved in delivery of acute back pain care at three metropolitan hospitals. Interview data were analysed using the Theoretical Domains Framework (TDF).

Results:

Ten TDF domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, as well as difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased healthcare resource efficiency, clinician familiarity with Telehealth, as well as perceived reduction in over-medicalisation and infection risk.

Conclusions:

Our study raises important questions regarding how the introduction of virtual models of care may inadvertently introduce new types of inequity, and suggests strategies to support effective and equitable delivery. Participant concerns about managing risk have been addressed through co-design of the Back@Home model of care, which will include strict admission criteria, escalation plan for clinical deterioration, linking with community services and daily clinician contact whilst admitted. Despite multiple challenges, participants could see the potential benefits of delivering virtual care for acute back pain in healthcare cost-saving and improved patient flow, reducing inappropriate bedrest that could lead to deconditioning, and reducing the risk of hospital-acquired infection. Purposive sampling of clinicians likely to be involved in referring to the proposed virtual hospital model of care is a strength of this study. Further investigation of barriers to, and enablers of, introducing virtual hospital back pain care in other settings, including rural and regional health centres, would help inform implementation in those areas. The successful implementation of ‘Back@Home’ relies on key stakeholder ‘buy-in’. Addressing barriers to implementation, and building on enablers, is crucial in clinician adoption of this model of care. Based on clinician input, the ‘Back@Home’ model of care will incorporate loan of internet-enabled devices, healthcare interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalised groups. Clinical Trial: N/A