How do you collaborate through telehealth?

What we already know

Despite its clear limitations, telehealth has the potential to influence how podiatrists deliver care, particularly in remote and underserved areas where access to specialised services may be limited. Yet arguably, one of the most transformative aspects of telehealth lies in its ability to facilitate collaborative care models.

Firstly, what is the difference between shared care and collaborative care?

So, what is the difference between shared care models and collaborative care models? Especially given a shared care model is described as: “where there is joint responsibility for planned care that is agreed between healthcare providers, the patient and any carers they would like to engage.”

It may be reasonable to suggest there are little, if any, differences between the two models; since they are frequently used interchangeably in the literature.

However, through the example of telehealth, collaborative care enables a health care provider, such as a podiatrist, to work remotely with an on-site support person. This on-site support can help to facilitate the practical requirements of an appointment – such as removing a patient’s shoe, ensuring the camera angle is focused, aiding a patient to safely stand, or clearing the space for them to walk.

In this collaborative care context, the ultimate responsibility for the patient is not shared but instead maintained by the podiatrist.

How can the collaborative care model work in a telehealth context?

In the context of telehealth, this model can enable collaboration that may not otherwise be possible in-person.

Here are some ways this can work.

• Podiatrist + health professional:  If another health professional is in the same location as a patient, the podiatrist can dial in remotely through video conferencing to guide the other professional to support the podiatrist’s component of the consultation.
• Podiatrist + family member/s:  It is not uncommon for healthcare providers to ask a patient whether they wish anyone else to attend their telehealth session now that the location of the patient’s loved ones or support network is no longer a barrier.
• Podiatrist + patient: Shifting this approach further, the patient’s location can provide added insights during a video telehealth consult; compared to being in the clinic. If a podiatrist can see a patient’s living room for example, it may indicate some previously unknown social determinants of health and perhaps guide your decisions around social prescribing. Or you may see which available structures are nearby that can help support your session (such as a coffee table to lean on or a hazard to avoid). Sessions can become far more collaborative between the patient and podiatrist, increasing the relevance of treatment plans and the likelihood of self-efficacy.
• Podiatrist and colleague or other healthcare professional: Finally, the ability for telehealth to record sessions means that a podiatrist, with the patient’s permission, can share footage from the assessment or treatment session with other healthcare providers who can then work collaboratively across their separate areas of special interest. This collaboration extends to opportunities for mentoring and student learning, with new graduates for example likely to be more engaged through such practical learning opportunities.

What the research shows

Studies show that the impact of collaborative care models has potentially far-reaching effects such as targeting areas such as existing workforce challenges, low levels of  engagement, and workplace longevity.

The Rural Doctors Network is close to completing an in-person collaborative care program that brings health professionals together from nearby areas who may not otherwise have the opportunity or means to collaborate. The goal being to address primary health care challenges in remote and regional NSW, such as recruitment and retention issues. Given the universal nature of these challenges, widespread learnings are still valuable no matter where your location.

Takeaways to bear in mind

The overarching takeaway from such explorations is a reminder that in this post-Covid-enforced isolation era we live in, telehealth still holds such potential for podiatrists, particularly when viewed through a collaborative lens.

There is scope to reach patients who may otherwise not be able to access podiatric services, such as those in remote or rural areas, or who are unable to physically attend an appointment and cannot access in-home care.

The first step is to think outside the box and consider how telehealth can help you to fulfill your role but in a different way; to see it as a truly collaborative tool that expands your patients’ horizons, your colleague’s engagement, and even your own networks.