The ability to deliver allied health services and information to patients in rural and remote communities is made possible by telehealth.

Telehealth has many important functions, including long-distance patient care, advice, education, and monitoring. It has far-reaching benefits for isolated communities and offers allied health professionals the chance to reach them where they are.


What is telehealth?

Telehealth is the use of telecommunication and virtual technologies to deliver health care services outside of traditional health care facilities.

Psychologist Dr Karen Phillip says telehealth is beneficial for those in rural and remote communities and also is an opportunity for clinicians.

"Telehealth is about using electronic tools to provide care remotely as it brings access to care and convenience to those needing support.

"Clinicians have the opportunity to expand their services to those living outside their practice area.

"Client reach can expand to all over Australia and the world as they have the opportunity to receive treatment or sessions from a specialised professional clinician," said Dr Phillip.

Telehealth isn't impersonal with the assistance of modern technology, which bridges the gap for those who use it.  

"Some clients feel uncomfortable speaking to a faceless therapist; however, given Facetime, Skype and a variety of video apps, telehealth can be conducted face-to-face without being directly in person."

Why set-up telehealth?

Though clinicians may baulk at providing telehealth, they can expand their business by gaining these skills, said Dr Phillip.

"Allied health providers should consider providing and expanding their service to include telehealth.

"Many people are time poor or are unable to attend regular sessions due to location, health restrictions, disability, transport issues, so telehealth is a growing service industry to satisfy the changing needs of our community."

Considerations for implementing telehealth

It is crucial to explain to clients how telehealth works as it can be unclear, said Dr Phillip.

"It remains confusing for some consumers to understand how a non-personal appointment can work, how payment is made, and what confidentiality issues may present.

"It is imperative the health clinician ensures their telehealth service is conducted in a private room just the same as if a client is in the room with the clinician.

"Setting up a telehealth service means access to good internet service, confidentiality issues considered, and accessibly of telehealth preference of client met."

If telehealth is phone-based without the aid of visual, it's vital to have excellent phone rapport, explains Dr Phillip.

Tips for developing a rapport over the phone

• Listen to what your client is saying; this includes tonality change, speed of voice adjustment, specific words expressed and pauses used.

• Empathise with their situation or issue.

• Adjust your vocal tone to match and connect with your client.

• Paraphrase to ensure you understand your client correctly, and they know you are listening accurately.

• Ask relevant questions and allow the client to expand in whatever area they need.

• Collaborate with your client about their treatment.

Dr Clinton Moore, a psychologist providing telehealth services, says it's interesting that telehealth is sometimes preferred even when access to a tradition service is available.

"This may be due to client concerns about visiting a physical psychologist's practice, or out of convenience if they work from home and are unable to leave due to other commitments such as children."

While convenience and accessibility are apparent gains, one of the most significant benefits of telehealth for clients in rural areas is anonymity, explains Dr Moore.

"For those living in small towns, it can be difficult to maintain confidentiality when there may only be one psychology practice and other members of the community will be able to see you entering their office.

"Although it would be wonderful to have no stigma around accessing mental health treatment, the reality is that it is still very much present and can prevent people from seeking help.

"Telehealth means that clients in remote areas can still share their story with a professional without having to worry about their neighbours knowing."

There are several barriers to telehealth, though, according to Dr Moore, which include:

Inability to gauge body language across a digital medium

"By having to interact across either a web conferencing program such as Skype or a telephone, many subtle nuances are lost that might otherwise have informed the process of therapy."

Access to high quality and high-speed telecommunication networks

"Australia is a vast country, and large sections are still not well covered in terms of internet connections.

"This is particularly a problem given that mobile devices are increasingly replacing landlines.

"It's not uncommon for Skype sessions to freeze or drop out even when directly connected to a wired connection. But mobile data networks can be even more temperamental."

Clients at increased risk of suicide

Telehealth poses a significant challenge for psychologists treating those in remote areas, as the risk of suicide is high.

"As you can imagine, a dropout is annoying at any time but can mean life or death if dealing with a crisis such as a suicidal client.

"Clients in extremely remote areas are often unable to receive the emergency responses that we are used to in the city, but the psychologist still has a duty of care to ensure client safety.

"This can mean calling an ambulance that may be over an hour away after a client leaves a telehealth session with no notice - a nerve-racking experience for everyone involved."

Strict requirements to access telehealth

Australians living in highly remote areas (classified as MMM regions 4-7) face the additional challenge of meeting access requirements for telehealth services under Medicare.

"Young adult males living in highly isolated areas are up to six times more likely to suicide than their urban counterparts.

"These same people are required to attend a GP in person before receiving rebated telehealth sessions.

"For many, this requirement may be a deterrent to attending therapy if they are required to take off the better part of a day to travel to the nearest town with a GP to obtain a Mental Health Treatment Plan.

"It's wonderful that people in rural and remote areas can access subsidised mental health assistance, but there's still a way to go before some of the most vulnerable in our country can truly call it accessible," said Dr Moore.

Telehealth just as effective as face-to-face

A study, 'Telehealth delivery of memory rehabilitation following stroke,' by Monash University researcher Dr Dana Wong showed that telehealth was as effective as face-to-face, group-based rehabilitation programs.

"Not only did we find that people improved just as much on our key measures of memory function, but in some areas, our participants using telehealth improved even more than those being treated face-to-face.

"We believe a key reason for this is in the integration of clinicians and the rehabilitation sessions into the patient's everyday environment.

"This provides the clinician with extra information and context about the patient's everyday life.

"It helps the clinician focus treatment, and it also maximises the relevance for the patient and aids in the generalisation of strategies and skills.

"Telehealth is unlikely ever completely to replace face-to-face rehabilitation treatment but provides a feasible way to expand services into regional and rural areas to reach people in need of stroke rehabilitation support," said Dr Wong.

Simone Dudley, an occupational therapist with Therapy Connect, believes telehealth is key to increasing choice for those in rural and remote areas.

"There can be difficulties recruiting allied health professionals with specific skills in thin market regions which subsequently affects participant choice and outcomes and reduces consistency and continuity of supports.

"Telepractice is an evidence-based, innovative solution to providing access to person-centred high-quality allied health therapy supports in thin market regions," said Ms Dudley.

Advice on setting up telehealth as an allied health professional 

• Research the various platforms and get to know the technology and capabilities (screen sharing, use of digital features, etc.). Practice with friends and colleagues.

• Start with one client in an area that you are confident and work on problem-solving around how to adapt delivery to an online method.

• Allocate resources to planning for session delivery and adapting methods to suit an online service delivery.

• Be willing to offer the client a "proof of concept" trial to test equipment, platform and environment and you as a clinician.

• Be prepared for a lot of behind the scenes work to facilitate the delivery of services via telehealth.

• Support the client with the "set up" phase to ensure adequate connection, space for sessions, positioning for sessions, resources are available, others in the team are connected, confidentiality and consent issues addressed.

• Work hard on communications with the client and relevant others before sessions to ensure all required resources are available.

• Work with family members, support workers or allied health assistants to facilitate interventions into a client's routine.

• Be prepared for fails.