Telehealth

Telehealth as an Important Climate Change Adaptation Strategy

Telehealth is defined as the use of digital and telecommunication technologies in providing healthcare remotely and is a powerful rural health services adaptation strategy.⁹⁶ With the COVID-19 pandemic and the associated restrictions on travel and patient transport, virtual healthcare has dramatically increased in demand. This trend has continued, with doctors offices continuing to offer telehealth or virtual appointments, as it has been met with wide acceptance and positive support by both practitioners and patients.

Listed below are examples of how telehealth enhances access to care and in turn, contributes to building healthy and resilient communities.⁹⁶

• The remote management of chronic diseases can improve the quality of life and increase the independence of rural patients who might otherwise lack access to care.
• Remote public health education can increase knowledge, thereby reducing health vulnerability and increasing adaptation capacity.
• Virtual family visits during long-term hospital stays can allow patients to remain connected with their community while enhancing cultural support and psychological wellbeing.
• Enhanced access to remote diagnostics and specialist consultations can increase access for patients in remote communities and can increase the resilience of communities’ healthcare systems.

Clinical Applications of Telehealth

Telehealth use is well established for various specialities in rural Canada, including orthopaedics, oncology care, and daily hemodialysis rounds. The COVID-19 pandemic has necessitated a dramatic expansion of telehealth services across the spectrum of patient and physician support including advanced support in response to critical conditions.⁹⁷ In BC, the RCCbc provides a suite of Real-Time Virtual Support (RTVS) services in areas such as primary care, emergency medicine, paediatrics, and maternity care. The Rural Urgent Doctor in-aid (RUDi) is a real-time support for physicians needing a second opinion. Physicians experienced in rural and emergency medicine are available 24/7 through Zoom and by phone.⁹⁸ The First Nations Virtual Doctor of the Day is a virtual support network for Indigenous communities in Island Health and Northern Health Authorities intended to provide primary care in regions with a lack of local health care providers. Patients can call to book an appointment with a physician trained to provide culturally appropriate and safe care.^99,100

The benefits of telehealth can be significant for Indigenous communities as access to care is one of the most significant gaps in the social determinants of health between non-Indigenous and Indigenous Canadians.¹⁰¹ Telehealth can mitigate the issues of transportation and long wait times, which can increase the efficiency of care.^102,103 In addition, providing virtual care as a form of house call or through local community clinic services can keep patients within their social support network during treatment. This approach can support a respect for an integration of allopathic medicine into the cultural and traditional values and lifestyle of Indigenous people.¹⁰⁴ 

Another important use of telehealth is its utility in provisioning mental health services to rural communities. The COVID-19 pandemic has only added further stress to the strain of climate change events and economic challenges on rural communities. Telepsychiatry services can respond in a timely way to rural needs for mental health care.¹⁰⁵ The Ontario Telemedicine Network reported that as far back as 2013, 71% of their provincial therapeutic areas of care was dedicated to mental health.¹⁰⁶

Next Steps in Telehealth: Overcoming the Challenges

With the growing consequences of climate change, the healthcare issues made apparent by the COVID-19 pandemic, and the projected increases in rural telehealth needs, there are a number of important challenges and gaps that must be considered. Listed below are some of the key issues in implementing telehealth services in rural communities:

• The digital divide in internet access may limit the feasibility of telehealth services. For example, between 2019 to 2020, download speed in urban Canada was up to 11.7 times faster than that of rural.¹⁰⁷ Shortages in other core internet infrastructures and equipment will exacerbate this barrier.^108,109
• Patient-physician communication challenges may be amplified by telehealth resulting in delays in diagnosis and definitive treatment. Learning the utility of new modes of communication both synchronous and asynchronous will need to be supported by appropriate evidence and training.¹¹⁰
• Issues of cultural sensitivity need to be considered in telehealth communication strategies and appropriately integrated.
• Financial issues related to the associated change in practice model may impact local health care workers.¹¹¹
• Preparation for rural practice enabled by telehealth will impact education and training at the undergraduate- and postgraduate-level.

Telehealth is a multi-faceted, innovative technology that may produce significant benefits to patient care in rural communities. Further research should consider effective implementation strategies and continuous quality improvement to ensure that telehealth can develop as one of the major responses in rural health services to the health impacts of climate change.