Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study

Alla Melman; Simon P Vella; Rachael H Dodd; Danielle M Coombs; Bethan Richards; Eileen Rogan; Min Jiat Teng; Chris G Maher; Narcyz Ghinea; Gustavo C Machado

doi:10.2196/47227

Clinicians' Perspective on Implementing Virtual Hospital Care for Low Back Pain: Qualitative Study

JMIR Rehabil Assist Technol. 2023 Nov 21:10:e47227. doi: 10.2196/47227.

Authors

Alla Melman^#¹, Simon P Vella^#¹, Rachael H Dodd^#², Danielle M Coombs^#^{1

3}, Bethan Richards^#^{1

4}, Eileen Rogan^#⁵, Min Jiat Teng^#^{1

6}, Chris G Maher^#¹, Narcyz Ghinea^#⁷, Gustavo C Machado^#¹

Affiliations

¹ Sydney Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Camperdown, Australia.
² The Daffodil Centre, Faculty of Medicine and Health, a joint venture between The University of Sydney and Cancer Council New South Wales, Sydney, Australia.
³ Physiotherapy Department, Royal Prince Alfred Hospital, Sydney, Australia.
⁴ Rheumatology Department, Royal Prince Alfred Hospital, Sydney, Australia.
⁵ Canterbury Hospital, Sydney, Australia.
⁶ RPA Virtual Hospital, Sydney, Australia.
⁷ Department of Philosophy, Macquarie University, Sydney, Australia.

^# Contributed equally.

PMID: 37988140
PMCID: PMC10698644
DOI: 10.2196/47227

Abstract

Background: Alternate "hospital avoidance" models of care are required to manage the increasing demand for 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 use qualitative interviews with stakeholders to develop and refine the model.

Objective: We aim to explore clinicians' 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: We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework.

Results: A total of 10 Theoretical Domains Framework 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, and 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 health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk.

Conclusions: The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.

Keywords: back; barrier; barriers; care model; e-Health; eHealth; enabler; enablers; facilitator; facilitators; health services research; healthcare delivery; implementation; interview; interviews; low back pain; model of care; pain; qualitative; remote care; service; service delivery; services; telehealth; telemedicine; virtual care; virtual hospital.

©Alla Melman, Simon P Vella, Rachael H Dodd, Danielle M Coombs, Bethan Richards, Eileen Rogan, Min Jiat Teng, Chris G Maher, Narcyz Ghinea, Gustavo C Machado. Originally published in JMIR Rehabilitation and Assistive Technology (https://rehab.jmir.org), 21.11.2023.