ABSTRACT
The fifth in a series of papers on practical aspects of telehealth, this paper discusses telehealth models that can facilitate the provision of specialist services to rural and remote patients closer to home. Some of the barriers to successful implementation of these models relates to workforce, funding and infrastructure at rural sites, as well as the traditional mindset of healthcare professionals. Therefore, the rural sector needs to be adequately resourced for telehealth models to be substantive and successful. This paper describes the development of a large teleoncology network over a vast geographical area in North Queensland. Adequate resourcing for the rural sites and undertaking quality improvement activities has continually enhanced the model over a 5- to 6-year period. The benefits of this model of care are twofold: (i) patients received their care closer to home and (ii) the workforce, service capabilities and infrastructure for the hospital in Mt Isa (a rural town 900 km away from its tertiary centre) has improved.
Subject(s)
Medically Underserved Area , Oncology Service, Hospital/organization & administration , Rural Health Services/organization & administration , Telemedicine , Attitude of Health Personnel , Humans , Models, Organizational , Patient Preference , Quality Improvement , Queensland , Rural Population , Telemedicine/methods , Telemedicine/organization & administrationABSTRACT
The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.
Subject(s)
Physician-Patient Relations , Telemedicine , Adenocarcinoma/drug therapy , Adenocarcinoma/psychology , Adenocarcinoma/secondary , Anger , Australasia , Colorectal Neoplasms/pathology , Communication Barriers , Diabetes Mellitus, Type 2/psychology , Emotions , Female , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/psychology , Lung Neoplasms/secondary , Male , Middle Aged , Negotiating , Professional-Family Relations , Truth Disclosure , VideoconferencingABSTRACT
The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.
Subject(s)
Telemedicine/methods , Telemedicine/standards , Videoconferencing/standards , Humans , Medical Records Systems, Computerized/standardsABSTRACT
The second in a series of articles about the practical aspects of telehealth, this paper includes information and a case history on the cost-benefits for patients and practitioners using telehealth. The case history demonstrates that telehealth can save travel time for patients, carers and specialists, and can reduce out-of-pocket expenses. The practical aspects of telehealth article series considers the contextual, clinical, technical and ethical components of online video consultations.
Subject(s)
Automobile Driver Examination , Referral and Consultation/economics , Rural Population , Telemedicine/economics , Aged , Humans , Male , Telemedicine/methodsABSTRACT
The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.
Subject(s)
Rural Population , Telemedicine/methods , Aged , Female , Humans , Male , Middle Aged , Remote Consultation/methodsABSTRACT
BACKGROUND: Telehealth could be a medium for the provision of cognitive assessments to distant sites. AIMS: The aims of the present study were to determine the interrater reliability of the Standardized Mini Mental State Exam (SMMSE) and the Geriatric Depression Scale (GDS) through Telehealth as compared to face-to-face administration. METHODS: Duplicate interviews of subjects with crossover of interview modality were carried out. Twenty patients were interviewed between two sites 11 km apart. Subjects were persons older than 65 years (mean age 82 years) who consented to Telehealth assessments. The outcome measures were the differences in assessment scores between the two media. RESULTS: The average SMMSE score by remote assessment was 24.0 (range 11.0-30.0) and by direct assessment was 24.3 (range 9.0-30.0). The correlation between direct and remote SMMSE scores was 0.90. The mean difference between direct and remote SMMSE scores was -0.3 (95% confidence interval (CI): -4.6 to 4.0). In 8 of 20 participants (40%) the difference between Telehealth and direct assessments was two points or more on the SMMSE. The average GDS by remote assessment was 6.1 (range 1.0-14.0) and by direct assessment was 5.8 (range 2.0-13.0). The correlation between direct and remote GDS scores was 0.78. The mean difference between direct and remote GDS assessment was 0.3 (95% CI: -3.8 to 4.4). CONCLUSION: Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate difference between face-to-face and Telehealth assessments in some subjects, which could influence clinical decision-making.
Subject(s)
Cognition Disorders/diagnosis , Dementia/diagnosis , Geriatric Assessment/methods , Psychiatric Status Rating Scales , Telemedicine/methods , Telephone , Aged , Aged, 80 and over , Cross-Over Studies , Female , Humans , Male , Observer Variation , Reproducibility of ResultsABSTRACT
The increasing use of health services by the older population has placed significant stresses on the health system of Western Australia. This is a report of the development of a linked administrative database of health resource utilisation by the aged population of metropolitan Perth. Hospital administrative databases linked to clinical or administrative databases of other health providers are reviewed. Length of stay data is linked to aged care assessments, referrals to nursing homes and community services. The linked databases approach allows the study of resource allocation and can pinpoint systemic stress in aged care. It is a tool for reducing the duplication of services, the pressure on beds in health institutions, and cost by improving efficiencies.
Subject(s)
Databases, Factual , Health Services for the Aged/statistics & numerical data , Hospitals, Urban/statistics & numerical data , Medical Record Linkage , Medical Records Systems, Computerized , Aged , Disabled Persons , Health Services Research , Humans , Information Storage and Retrieval , Length of Stay/statistics & numerical data , Needs Assessment , Population Dynamics , Resource Allocation , Western Australia/epidemiologyABSTRACT
We performed a feasibility study to test the validity of conducting two standard cognitive assessments via videoconferencing. There was a high correlation between the scores from a face-to-face assessment and those from a videoconference. A second trial was conducted with patients living in a rural community, examined both face to face and via videoconferencing. Again, the validity and reliability of the assessment tools were demonstrated for videoconferencing. The acceptability of the technology to patients and clinicians was also shown. As a result of the trials and at the request of rural participants, geriatric telehealth services are now being provided to a rural aged care assessment team (ACAT) on a fee-for-service basis. The success of this project is reflected in its senior clinical and academic 'champions', the establishment of a dedicated telehealth resource and the development of protocols.
Subject(s)
Alzheimer Disease/diagnosis , Health Services for the Aged/standards , Remote Consultation/organization & administration , Telecommunications/standards , Aged , Attitude of Health Personnel , Feasibility Studies , Humans , Patient Satisfaction , Reproducibility of Results , Rural Health Services/standards , Telecommunications/instrumentation , Western AustraliaABSTRACT
We performed a feasibility study to test the validity of conducting two standard cognitive assessments via videoconferencing. There was a high correlation between the scores from a face-to-face assessment and those from a videoconference. A second trial was conducted with patients living in a rural community, examined both face to face and via videoconferencing. Again, the validity and reliability of the assessment tools were demonstrated for videoconferencing. The acceptability of the technology to patients and clinicians was also shown. As a result of the trials and at the request of rural participants, geriatric telehealth services are now being provided to a rural aged care assessment team (ACAT) on a fee-for-service basis. The success of this project is reflected in its senior clinical and academic 'champions', the establishment of a dedicated telehealth resource and the development of protocols.
ABSTRACT
We describe an audit using Gastroenterology Clinical Indicators (CIs) to measure quality of care for older patients with gastrointestinal haemorrhage. The gastroenterology CI for gastroscopy within 24 hours of admission was 60%, it was 70% for diagnosis of a cause of acute gastrointestinal bleeding after upper gastroscopy, and it was 30% for death after blood transfusion in a geriatric restorative unit. We discuss whether it is appropriate for a hospital department (Geriatric Medicine) to use the CIs for the specialty (Gastroenterology) providing the service to measure the quality of service being provided. This may be a useful approach given the trend towards cost recouping between different clinical departments.
Subject(s)
Gastroenterology/standards , Health Services for the Aged/standards , Medical Audit/methods , Quality Indicators, Health Care , Rehabilitation Centers/standards , Aged , Endoscopy, Gastrointestinal/standards , Gastrointestinal Hemorrhage/therapy , Humans , Medical Audit/standards , Western AustraliaSubject(s)
Activities of Daily Living , Geriatric Assessment , Aged , Aged, 80 and over , Chi-Square Distribution , Female , Humans , Male , Middle Aged , Nursing Assessment , Prospective Studies , PsychometricsABSTRACT
Clinical indicators are an important component of quality assessment of clinical services. We outline the strategies used in the department of Geriatric Medicine at Royal Perth Hospital (RPH) to report on and improve the results. The clinical indicator for assessment of cognitive function had improved from 19% in September 1998 to 64% in February 1999. The clinical indicator for assessment of physical function has been maintained at 80%. There have been revisions to the definitions of the clinical indicators for 1999. The current clinical indicators used in this department can be modified for comparison nationwide amongst geriatric units.