Patterns in the Use of Emergency Telemedicine Support in the Management of Traumatic Road Crashes.

Objective: The introduction of emergency telemedicine care models is a common theme in health jurisdictions that include rural and remote populations. How the availability of these models influences the way clinicians manage traumatic road crashes is not yet fully understood. This study seeks to compare road crashes where telemedicine was and was not used and to identify any variables that may increase the likelihood of telemedicine usage by treating clinicians. Methods: Road crashes reported in the state Department of Transport and Main Roads (Queensland, Australia) crash database between January 1, 2019, and November 30, 2020 (n = 23,734) were compared to videoconferencing call logs to determine which crashes resulted in treatment that was supported by telemedicine (n = 204). Analysis was performed to examine differences in characteristics related to the crash depending on whether telemedicine support was requested. Results: Road crashes where telemedicine support was requested on average involved more casualties (1.6 vs. 1.41; t(11,287) = -3.26, p < 0.001, relative risk = 1.13). Crashes that occurred in rural settings accounted for most requests for telemedicine (65.68%; X2 = 159.2, p < 0.001) and a greater percentage of crashes in remote locations (3.36% vs. 2.35%; X2 = 256.97, p < 0.001, relative risk = 1.43). The use of telemedicine support for crashes was associated with a 13% increase in the mean number of casualties, compared to crashes where telemedicine support was not used. Conclusion: Telemedicine support is requested by clinicians providing emergency treatment in the management of road crashes that produce more severe injuries, involve multiple casualties, and take place in more rural settings or remote locations.

Comparison of patient responses to telehealth satisfaction surveys in rural and urban populations in Queensland.

Objective Telehealth has for many years been identified as a potential contributor to reducing healthcare access inequality. For these benefits to be realised, patients must be accepting and satisfied with the delivery of healthcare in this manner. Measuring patient satisfaction across a large geographical area is important to ensure that investments in telehealth are delivering the benefits that are intended. Methods A brief survey was automatically issued on completion of a patient's telehealth appointment, requesting patient feedback on their experience and information on the location of where they participated in the appointment. These results were compared to an article review which sought examples of other patient satisfaction measures that compared rural and urban populations. Results No significant correlations between survey responses and established demographic indices were found. When stratified by the Modified Monash Model band from which the patient participated in their telehealth appointment from, an ANOVA test determined that rurality was not a predictor of survey response. A review of articles found four articles that compared rural and urban satisfaction responses. Conclusion No evidence of a patient's location influencing their satisfaction with telehealth was observed. This may be attributed to a variety of technical improvements introduced over the past 5-10 years that have made participating in telehealth appointments less technically demanding and more accessible. Telehealth is likely to be contributing to a reduction in healthcare access inequality in Queensland.

Telemedicine or In-Person: Referral Letter Content Influencing How a Patient Receives Treatment.

Objective: This study investigated hospital-based specialist services that provide both traditional hospital outpatient appointments (in-person) or through a live videoconferencing session (telehealth) to referred patients. Referral letters submitted to these clinics were assessed against an inclusion criterion and grouped according to which of delivery method the patient received for their appointment (in-person or telehealth). These groups were then compared for differences to see what factors, if any, influence the likelihood of a patient being offered a telehealth appointment. Methods: An extract of all referral letters meeting inclusion criteria between July 01, 2019 and June 30, 2020 were collected (n = 441). Letters were grouped according to delivery modality (in-person or telehealth) and differences between the groups, including variables such as patient demographics, clinical condition, and urgency and the reviewing clinician were assessed for associations. Results: This study observed that where the referring clinician suggested a telehealth appointment for their patient, this was more likely to be offered (38.25%) compared with referrals that did not (7.36%) (x 2 1 = 28.33, p = 0.1857, odds ratio = 2.77). Patients were more likely to be offered a telehealth appointment the further they lived from the treating facility (T = -4.51 on 106.59 df, p = 1.622 e-05). Variation in the selection of delivery modality among reviewing clinicians was also observed (x 2 1 = 42.334, p < 1.42e-08). Discussion: Existing research indicates there is a strong link between the perceptions clinicians as individuals have of telehealth and a willingness to offer this modality to patients. Despite this, specific information about a patient contained within a referral letter may influence the delivery modality that the patient will be offered for their initial appointment. It is important that this information is more routinely included in letters sent by referring clinicians to hospital-based specialist services. It is equally important that when included, this information is identified and actioned by reviewing clinicians in a consistent way. Doing so will benefit patients by increasing the likelihood that they will receive specialist outpatient care in a manner that suits them best.

Road deaths relating to the attendance of medical appointments in Queensland.

Objective This study sought to estimate and observe the risks imposed on patients as they travel to hospital for referred treatment. Factors such as distance and remoteness were compared to understand how they affect this risk. Methods This study focused on Queensland residents attending specialist out-patient appointments in a Queensland public hospital throughout 2016. Deidentified information on all recipients of a specialist out-patient appointment in 2016 (n=2946584) were included in the study. This study also contained a theoretical component: using a data model to estimate the number of fatalities that could be expected from a travelling population of this size and complexity. The modelling results were compared with the frequency of actual fatalities among individuals travelling to receive treatment, as determined by a review of the Queensland Police Road Database. The data model and empirical values from police reports were used to independently measure what risk, if any, individuals travelling to obtain specialist out-patient treatment are exposed to. Differences between the model and observed values were evaluated using statistical tests. Results A direct relationship between increasing remoteness and travel risk was established in both the model and observed data (CV(RMSD)=0.660773). Conclusion Fatal risk is present in any road journey regardless of distance, duration or the purpose of travel. Individuals living in regional and remote Queensland are exposed to a larger risk than those living in the major cities of Queensland when travelling to obtain public health care. What is already known on this subject? Road safety remains one of Australia's most serious public health issues, with 1295 road-related fatalities recorded throughout Australia in 2016. Although the potential dangers of road travel are well understood, extended journeys by road to attend hospital appointments are often undertaken despite available alternatives to travel in some instances. What this paper adds? Travelling to attend medical appointments exposes a patient to a small but potentially catastrophic risk that can be observed in state road crash data. This risk is measurably greater for individuals in regional Queensland. What are the implications for practitioners? Clinical models of care that reduce patient travel may represent a new standard in patient safety when of the risks associated travel are considered.