JMIR Publications

ABSTRACT

Background:

Evidence of implementation processes for interventions to address frequent potentially avoidable presentations to the emergency department (ED) are scarce in rural and regional settings. Patient Watch (PW), a telehealth case management program modelled on a metropolitan service, was implemented in a rural context to support ED users with frequent potentially avoidable presentations.

Objective:

We aimed to understand the spread, scale-up and sustainability of PW in a rural context to inform the potential for transferability to other contexts.

Methods:

We used a multiple methods approach collecting and synthesising data obtained from qualitative interviews (n=10), document review, and observation. The data were categorised into themes using thematic analysis and data source triangulation applied.

Results:

Three themes were constructed from the data: (1) health system complexity; (2) context drives adaptation and innovation; and (3) autonomy. Pre-existing health system factors including financial resources, workforce constraints, and infrastructure challenges influenced organisational capacity to scale PW. Continuous adaption in response to health system factors was essential for tailoring PW. Self-organisation, or local autonomy, facilitated adaptation to address variations across local contexts, in contrast, restrictive governance impeded the ability to respond to local challenges.

Conclusions:

Our findings emphasised how rural contextual factors influenced the spread, scale-up and sustainability of PW and provided a greater understanding of implementing and adapting a metropolitan model in a rural context. The rural workforce focused on their assets and strengths to successfully implement PW at scale.