Collaborative practice competencies needed for telehealth delivery by health and social care professionals: a scoping review

Figures & data

Figure 1. Number of documents including compentencies from the National Interprofessional Competency Framework.

Table 1. Description of included studies.

Author (s)	Country	Study design	Population	Description of collaboration	Collaborative competencies
Allen, Aylott (2015)	Canada	Theorical article	Nurses, different specialists	Remote specialists and senior nurses collaborated with nurses in real-time to conduct assessments or help for technical task	Interprofessional communication Patient-centered care Team functioning
Avey and Hobbs (Crumley et al., 2018)	United States	Qualitative design	Direct staff working with clients, administrative staff and IT professionals	Referrals between healthcare providers	Interprofessional communication Patient-centered care Team functioning
Barakat, Woolrych (L’Esperance & Perry, 2016)	Netherlands	Workshop	Staff and IT professionals	The workshop consisted of two days of presentations and collaborative discussions to clarify the role of healthcare professionals in the application, development, and integration of eHealth technologies to support older adults to age in place.	Interprofessional communication
Barbosa and Silva (Galpin et al., 2020)	Brazil	Qualitative design	Doctors and nurses	Doctors and nurses working in telehealth.	Interprofessional communication Team functioning
Brandt, Søgaard (Barbosa & Silva, 2017)	Denmark	Qualitative design	Clinical dieticians, physiotherapists, nurses, nurse assistants, occupational therapists	Hybrid eHealth lifestyle coaching using a combination of synchronous face-to-face meetings and asynchronous eHealth coaching through a collaborative eHealth tool	Patient engagement
Brunacini (Filipova, 2015)	United States	Quality improvement study	International satellite clinicians from many health disciplines	There were international satellite clinicians from many health disciplines within the entire organization, spanning medicine, dietetics, health psychology, exercise science, and pharmacy, who worked together virtually for collaborations, consultations, and referrals based on patient needs. Interventions to improve patient engagement included an initial intake form used by the team for new patient consultations	Interprofessional communication Patient-centered care Team functioning Patient engagement
Bruneau, Bier (Allen et al., 2015)	Canada	Mixed-method design	Nurses, social workers, general physicians, general psychiatrists, specialized educators	During teleconsultation, the IUGM team members first met with the patient, a family member, a member of the direct care team and the staff member (pivot) from the MIHC’s BPSD team who was responsible for the consultation. The geriatric psychiatrist and geriatric psychologist conducted a formal assessment during the consultation. Then the patient left and all members of the MIHC BPSD team joined in.	Interprofessional communication Patient-centered care Team functioning Collaborative leadership Interprofessional conflict resolution Patient engagement
Corriveau, Couturier (Vessey et al., 2015)	Canada	Mixed-method design	Community nurses, doctors or other health professionals	Healthcare managers implemented a new service delivery model including teleassistance. Teleassistance is defined as a clinical act performed by a doctor or a health professional intervening with a patient or his or her family under the assistance of an expert, via videoconference. In the current project, teleassistance was provided by virtual clinics.	Role clarification
Crumley, Blom (Nelson et al., 2011)	South Africa	Qualitative design	Physicians	“mHealth for Burn Diagnostics and Care in South Africa” is a telemedicine project, specifically developed to help improve outcomes for acute burns patients, through its deployment in trauma and emergency setting. Using smart phone technology, the project involved the development of an app which allows doctors in rural, resource poor areas, or secondary level emergency departments, to send images and textual descriptions of burn cases to an on-call tele-expert, who then replies via the app with management and referral advice.	Interprofessional communication Role clarification Collaborative leadership
Filipova (Peters, Sousa, et al., 2015)	United States	Cross-sectional design	Nurses and physicians	Telehealth can improve convenience for both patients and clinicians, while potentially reducing healthcare system costs. For example, a physician may provide consultation at an offsite location using audiovisual equipment to perform a clinical wound assessment or interpret an electrocardiogram.	Interprofessional communication
Fraser, Mackean (Barakat et al., 2013)	Australia	Systematic review	Healthcare professionals working with Indigenous people	Relationship development between Indigenous clients and healthcare professionals. Culturally competent healthcare professionals and health service delivery may facilitate culturally acceptable telehealth. For the non-Indigenous health professionals, working at the cultural interface requires critical questioning of professional assumptions.	Patient-centered care
Galpin, Sikka (Pappas et al., 2019)	United States	Delphi study	Any healthcare professionals	N/A	Interprofessional communication Patient-centered care
Gifford, Niles (World Health Organzation, 2018)	United States	Quasi-experimental design	Counselors, social workers, psychologists, physicians	Development and implementation of behavioral telehealth services with paraprofessionals health aides in rural villages of Alaska.	Role clarification
Goran (Avey & Hobbs, 2013)	United States	Descriptive study	Critical care nurses and intensivists	The tele-ICU nurse’s work tends to be focused on 4 areas: (1) virtual rounding, (2) alert recognition and response, (3) providing bedside team support, and (4) coaching and collaboration.	Interprofessional communication Role clarification Team functioning Interprofessional conflict resolution
Henry, Billingsly (Fraser et al., 2017)	United States	Multi-stage iterative approach	Practitioners (audiology, medicine, nursing), educators, administrators	N/A	Interprofessional communication Patient-centered care Role clarification
Hilty, Chan (D. M. Hilty et al., 2018)	United States	Scoping review	Any healthcare professionals working in behavioral health	In behavioral health, coordination and collaboration may involve different associations.	Interprofessional communication Team functioning
Hilty, Maheu (Lazzara et al., 2015)	United States	Literature review	Peer provider, social workers, primary care providers, pharmacists, psychologists, nurses, psychiatrists	Telepsychiatric and Telebehavioral Health Competencies	Interprofessional communication Patient-centered care
Kujala, Heponiemi (D. Hilty et al., 2020)	Finland	Mixed-method design	Nurses, social workers, physicians, supervisors, leaders	In this study, we examine the current state of eHealth competencies of clinical leaders in two public healthcare organizations	Interprofessional communication Patient-centered care
L’Esperance and Perry (Smith-Strøm et al., 2016)	United States	Mixed-method design	Healthcare providers who work in diabetes clinics	MyCareTeam, an online diabetes management system	Patient engagement
Lazzara, Benishek (R. Wong et al., 2020)	United States	Quasi-experimental design	Healthcare providers working in Trauma Intensive Care Unit (nurses, attending physicians, residents, fellows, nurse practitioners)	Healthcare providers conduct rounds (i.e., a formal, daily meeting comprising healthcare providers who discuss the status of the patient and evaluate the treatment plan) remotely (i.e., not in immediate proximity of the patient).	Interprofessional communication
Lewis and Wyatt (Henry et al., 2021)	United Kingdom	Literature review	Any healthcare providers	Clinicians, patients and others use mobile medical apps	Interprofessional communication Patient-centered care
Nelson, Bui (Bruneau et al., 2020)	United States	Descriptive study	Psychology graduate students, social work students, counseling students, psychiatry fellows, pediatrics residents, medical students, and others	We developed an interdisciplinary telemedicine clinic (TeleHelp clinic) to evaluate and treat youth depression. Real-time videoconferencing is used to bridge the gap between evidence-supported youth depression treatment and limited/no access to specialty mental health providers.	Interprofessional communication Collaborative leadership
Pappas, Vseteckova (Brunacini, 2019)	United Kingdom	Qualitative design	General practitioners, nurses, and consultants	In order to overcome the fact that the specialist cannot directly assess the patient’s symptoms, active collaboration is established between the professionals during physical examination through telemedicine.	Interprofessional communication Role clarification Team functioning Collaborative leadership
Shortridge, Steinheider (Brandt et al., 2018)	United States	Quasi-experimental design	Nurse practitioners, physical therapy and occupational therapy students	The distant participant connects to a telehealth cart or substitute equipment while the other students in each group interact directly with the standardized patient and use the telehealth cart equipment.	Interprofessional communication Patient-centered care Team functioning
Skiba, Barton (Goran, 2012)	United States	Experimental design (RCT)	Advanced practice nurses, physicians’ and pharmacists’ students	The overall goal of the iTEAM Project is to provide enhanced technology IP learning experiences through the use of simulations with standardized patients (physical and virtual), e-health (telehealth & mobile health) experiences, the integration of informatics and the use of Electronic Health Records (EHRs) within graduate education.	Interprofessional communication Patient-centered care Team functioning Role clarification
Slovensky, Malvey (Kujala et al., 2019)	United States	Theorical article	Healthcare providers (especially physicians and nurses)	Collaboration among members of an interprofessional team with diverse knowledge, experience, and skills is paramount to design, implementation, and evaluation of telehealth programming just as it is with any facet of healthcare delivery.	Interprofessional communication Patient-centered care Team functioning
Smith-Strøm, Iversen (Skiba et al., 2014)	Norway	Experimental design (RCT)	Home care nurses	The home care nurse would take a digital image of the patients’ ulcers and would send it to the expert wound care team at the outpatient clinic for assessment and feedback.	Interprofessional communication Patient-centered care Team functioning Collaborative leadership
Thye, Shaw (Thye et al., 2018)	Germany	Cross-sectional design	International experts: Academic or non-academic teaching and/or education, health data management, physician, clinical CEOs, nursing, technical CEOs, pharmacist, clinical CIOs Other health care professions (e.g. physiotherapy, technical CIOs Other healthcare institution worker or staff, science & research, engineering or IT specialist	As health IT supports processes along the entire patient trajectory it involves different types of professional groups that are interacting to achieve the patient outcomes targeted. Thus, in principle, eHealth is inter-professional by nature and must also be reflected in education and training, e.g., of physicians, nurses and other professionals working in direct patient care.	Interprofessional communication Collaborative leadership
van Houwelingen, Moerman (Lewis & Wyatt, 2014)	Netherlands	Delphi study	Nurses	N/A	Interprofessional communication Patient-centered care Collaborative leadership
Vessey, McCrave (Slovensky et al., 2017)	United States	Quality improvement	Clinical nurses, nurse scientists	Patient and family-initiated calls fall into two categories. The first are “hot lines” where patients and families seek advice and clinical guidance on common health concerns. The second is patient or family-initiated telephone encounters (PiTEs) where they are seeking advice for the management of complex chronic conditions. Individuals answering the calls may be either professional nurses or adjunct personnel with specific training in call management. Computer decision support systems (CDSS) have been developed to help nursing and non-nurse personnel provide clinical guidance	Patient-centered care Role clarification Team functioning
Wong, Ng (Shortridge et al., 2016)	United States	Mixed-method design	First and third-year internal medicine residents, social work, pain management, psychiatry/addiction medicine and nursing	A longitudinal simulation to teach interdisciplinary telemedicine and e-communication skills. It was a simulation of interdisciplinary collaboration in telehealth.	Interprofessional communication Team functioning

Figure 2. The number of documents referring to the competencies included in the National Interprofessional Competency Framework.

Table 2. Facilitators and barriers to interprofessional collaboration in a telehealth context.

Facilitators	Barriers
Inclusion of a champion in the clinical setting (Allen et al., 2015; Bruneau et al., 2020; Crumley et al., 2018; D. Hilty et al., 2020; Peters, Sousa, et al., 2015)	Lack of knowledge regarding technology (Crumley et al., 2018; Galpin et al., 2020; L’Esperance & Perry, 2016; Skiba et al., 2014; Smith-Strøm et al., 2016; Vessey et al., 2015)
Activities to promote engagement among interprofessional team members (Filipova, 2015; Peters, Sousa, et al., 2015)	Lack of time (Galpin et al., 2020; Smith-Strøm et al., 2016)
Frequent assessment of needs and requirements regarding training in changing emerging technologies and provision of targeted training to professionals (Avey & Hobbs, 2013; Galpin et al., 2020; L’Esperance & Perry, 2016; Shortridge et al., 2016; Vessey et al., 2015)	Lack of confidence of professionals regarding their abilities (Avey & Hobbs, 2013)
Promotion of the pros of using technology to show positive leadership in collaboration and confidence regarding technology (Avey & Hobbs, 2013; D. Hilty et al., 2020; L’Esperance & Perry, 2016; Vessey et al., 2015; Virtual Care Task Force, 2020)	Challenges in the creation of a trust-based relationship (Barakat et al., 2013; Barbosa & Silva, 2017; Brandt et al., 2018; D. M. Hilty et al., 2018; Galpin et al., 2020; Virtual Care Task Force, 2020)
Availability of reliable and precise technological devices (The College of Family Physicians of Canada, 2021; Virtual Care Task Force, 2020)	Reluctance to collaboration/Reluctance to change (Allen et al., 2015; Avey & Hobbs, 2013; L’Esperance & Perry, 2016; The College of Family Physicians of Canada, 2021)
Availability of professional support from a qualified person to fix any problems linked to the technology (e.g. IT expert) (Shortridge et al., 2016)	Technological issues (sound quality, network delays) (Allen et al., 2015; Galpin et al., 2020; L’Esperance & Perry, 2016; Shortridge et al., 2016; Smith-Strøm et al., 2016; The College of Family Physicians of Canada, 2021)
	Inadequate level of initial training among professionals (Allen et al., 2015; Brandt et al., 2018; D. Hilty et al., 2020; Galpin et al., 2020; Goran, 2012; Kujala et al., 2019; Skiba et al., 2014; Smith-Strøm et al., 2016)

Table 3. Recommendations to promote interprofessional collaboration in the telehealth context.

Health government policy

To allow healthcare facilities to invest in state-of-the-art telecommunication devices through major financial incentives enabling their acquisition and adequate IT support.

Post-secondary educational institutions delivering health programs

To offer training on technologies in their initial educational path.

Healthcare facilities

To offer more continued education to professionals, depending on their specific needs.

To ensure that professionals can access good quality and modern equipment to promote their use, in addition to adequate IT support.

To show a positive attitude toward technology to favor positive leadership related to the different types of virtual collaboration

To determine a follow-up and interprofessional conflicts resolution plan tailored to the virtual context for each establishment.

To improve abilities related to conflicts.

To offer clear and complete practical guides to support them in collaborating efficiently with the interprofessional team.

Healthcare professionals

To engage in improving their digital literacy.

To set up strategies that put forward the different aspects of interprofessional collaboration in virtual care.

To acquire skills in risk management for patients’ safety and ethical challenges linked to telehealth and interprofessional collaboration.

Researchers

To study unexpected effects (e.g. referrals to emergencies) of telehealth on patients and health and social services professionals.

To study the cognitive impacts of working remotely on interprofessional collaboration.

Patients

To prepare adequately for virtual appointments using available tools.

Health technologies providers

To facilitate the learning of technological tools and the interoperability between existing tools.

To create apps and software that allow professionals and patients to use different essential skills in interprofessional collaboration.

To support the development of integrative technologies (e.g. Teams, ZOOM, etc.) to support interprofessional collaboration by ensuring that IT experts have access to the required equipment.

To ensure that virtual care remains accessible and the platforms are user-friendly for this modality of care to be permanent and not only a passing trend.

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