Better access to specialist services

Online video consulting is a new way forward for rural health that’s dispensing with the need for people to travel long distances. By Susan Currie

Residents of remote, regional and rural Australia all must factor in the tyranny of distance when accessing health care.

Increasing access to specialist services for people in regional, rural and remote areas is the essential aim of the use of telehealth in practice. For the consumer and the specialist, there are also savings on the expense and inconvenience of travel from regional, rural and remote areas to specialist appointments in the metropolitan areas.

Telehealth on-line video consultation occurs between a health consumer, a primary care provider, such as a nurse, nurse practitioner, midwife or aboriginal health practitioner and a specialist healthcare provider through the use of audio and visual connection.

Nurses and midwives play an essential role in supporting and promoting the use of telehealth in the provision of health care.

Paediatric case study: Jodie’s story

Jodie is two years old and has had moderate to severe eczema since she was eight months old. Jodie lives with her parents Joan and Pete, and seven-year-old sister in Blackwater, 865 km west of Brisbane.

Dr Boag, a specialist dermatologist at the Brisbane Children’s Hospital (BCH), has been seeing Jodie since she was four months old. Jodie had several admissions to BCH in her first year and now her eczema is moderately well controlled with oral medications and creams. Jodie has a review appointment with Boag every three months.

Hospital appointments

The visits to Brisbane are very disruptive to Jodie’s family. Joan does not drive and Pete works full-time. The family’s options for attending the three monthly appointments are that Pete has to take three days off work to drive the family to Brisbane, or Joan has to take the bus with her two children. This second option involves a two night stay away from home. Joan and Pete have no family in Brisbane so they need to pay for accommodation.

Collaborative care

While waiting in outpatients at BCH, Joan picked up a leaflet on telehealth consultations. Boag explains to Joan that she reviews many of her patients via a telehealth clinic every Monday morning. She suggests that Joan discuss the option with her local GP. The GP is keen to facilitate Jodie’s ongoing appointments via telehealth consultation in a dedicated room.

Without telehealth

Joan and the children catch the bus to Brisbane. The trip takes 10 hours and they have to travel the day before the appointment. The eldest daughter has to take time off school and the family has to arrange for accommodation near the hospital. They attend Jodie’s appointment, which is only 10 minutes in duration. Boag changes the topical cream Jodie uses.

She also sends the family to another part of the outpatient department for the dressing to be reapplied and for Joan to be taught how to attend to the dressing at home. The family catch the bus back to Blackwater, and are exhausted by the time they get home. The specialist sends the GP a follow-up letter at the end of the week.

With telehealth

Joan and the children walk the eldest daughter to school and then Joan and Jodie walk to the GP clinic. The trip from home takes 10 minutes. They are met by the practice nurse who discusses how the telehealth consultation will be conducted.

The GP, the practice nurse, Joan and Jodie all meet with Boag via a telehealth consultation.

The practice nurse, with the assistance of Joan, moves the webcam over Jodie’s eczema patches so Boag can assess her skin. Boag discusses the new topical cream she wishes Jodie to use, and the GP writes the prescription before leaving the telehealth consultation room.

Boag, the practice nurse and Joan discuss the most appropriate type of dressing for Jodie. A date is planned for the next telehealth consultation in one month’s time and Boag signs off. The nurse attends to the dressing for Jodie’s eczema and shows Joan how to do these dressings. The family has time to call in at the pharmacy to have the prescription filled.

The GP and practice nurse write their notes in Jodie’s history and complete Jodie’s care plan. Joan requests that all of Jodie’s follow-up appointments be conducted via telehealth consultation.

Review of Jodie’s story

Benefits of telehealth:
• Joan and her family are able to continue with their daily routine around Jodie’s appointments.
• Joan and the children do not have to travel 10 hours by bus each way to attend outpatients appointments.
• The family do not have to pay for overnight accommodation in Brisbane.
• Ability for all parties to ask questions in a real time situation.

Who can “sit in “on an appointment?
• The specialist
• The GP
• The practice nurse
• The family

Who can claim?
• The specialist
• The GP
• The practice nurse

Susan Currie is the telehealth support officer at the Nursing and Midwifery Telehealth Project.

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