'It Cuts Both Ways': A Qualitative Analysis of Stakeholders' Views on the Emerging and Potential Unintended Consequences of Telehealth in Rural Australia

Rationale: Telehealth has been consistently viewed as a viable solution for addressing healthcare inaccessibility and mitigating the impact of health workforce shortages in rural areas. However, despite high utilisation in rural areas, little is known about the unintended consequences of telehealth in terms of unexpected benefits and drawbacks.

Aims and objectives: This study aimed to investigate the unintended consequences of telehealth in rural Australia.

Methods: A qualitative exploratory design was employed. Semi-structured interviews were conducted to examine the views of various stakeholders across Australia. Twenty participants were interviewed across Australia, including six telehealth consumers, six providers, six state government representatives and two primary health network representatives.

Results: Findings on the unintended consequences of telehealth fell under three overarching themes with both reported unexpected benefits and drawbacks across each theme: (1) person-centred healthcare, (2) safety and quality of healthcare and (3) sustainability of rural healthcare. Under these themes, nine sub-themes were identified.

Conclusion: This study provides insights into the unintended consequences of telehealth. While telehealth has improved certain aspects of healthcare in rural areas such as the improved support for rural clinicians and the reduced disruption to patients' daily routines, it has also introduced unforeseen challenges such as the transfer of medicolegal burden to local clinicians in rural emergency care facilities to compensate for the absence of physical examinations. These findings feed into decision-making useful for informing and improving telehealth implementation in rural Australia to maximise unexpected benefits, minimise risks, and ensure the long-term viability of telehealth services.