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Teamed up for telehealth

A collaboration is set to direct $2.5 million to improve remote access to healthcare.

Just under one-third of Australians, 29 per cent, live in regional and rural areas, an Australian Bureau of Statistics study completed in June 2013 states.

Of this 29 per cent, 23 per cent live in remote areas, which makes seeking urgent medical attention difficult, not only due to the people’s general location, but also because many of them live on big rural properties that are not easily accessible.

This is why many should welcome the partnership between the Australian Government and The University of Queensland to invest $2.5 million into the Centre for Research Excellence (CRE) in Telehealth. The collaboration will focus on improving access for people living in regional and rural areas.

The government funded the CRE through the National Health and Medical Research Council to help ensure more Australians can access high-quality health services.

Communication between doctors and patients is an important factor for diagnosis, treatment and prevention of poor health. Telehealth uses video-conferencing, email, image and data transfer and other electronic technologies to enhance communication in the rural and remote setting.

The technology has proven useful in improving access, but its adoption has been largely confined to specialist areas such as radiology and dermatology, with limited uptake amongst general practice professionals such as nursing and allied health.

The $2.5 million CRE, hosted by the University of Queensland and led by professor Len Gray, will focus on settings where access to health services is especially challenging, such as small rural hospitals, residential aged-care facilities, home care for disabled and older Australians, and Aboriginal and Torres Strait Islander communities.

UQ Centre for Online Health deputy director, associate professor Anthony Smith, said the telehealth centre would focus on connecting city-based specialists with patients across the state.

“Telehealth will connect people living in remote places with specialist services not readily available in rural and remote areas,” Smith says. But the key question will be what role will nurses play? And how can they become more involved in regional and rural healthcare?

“Practice nurses and community-based nurses could provide initial assessments on the phone and then refer the patients to GPs or other services as required,” says Bronwyn McPherson, who has more than 30 years of experience as a nurse and is now general operations manager for Prestige Inhome Care. “Nurses would need to be endorsed as nurse practitioners to be able to do this well. Those with the relevant level of skill and experience to work as nurse practitioners may have young families or be working part time and, therefore, need scholarships and financial incentives to up-skill. Scholarships exist in some states but are not well promoted and are quite complicated to access.”

McPherson also says creating more local GP services and encouraging more GPs to relocate would help regional and rural communities whilst the telehealth services get rolled out. She also believes a bank of semi-retired GPs doing leave placements would help with the lack of locum cover.

“Telephone services, like telehealth, that can provide initial screening then referral for home and community care for older people are great, but the difficultly lies in the fact that this is a centralised number, so the information provided is simply from a database, with little local knowledge,” McPherson explains. “We need training incentives for nurse practitioners. These nurses are educated to a master’s degree level and authorised to function autonomously and collaboratively in an advanced and extended clinical role.

“The nurse practitioner role includes assessment and management of patients using nursing knowledge and skills and may include (but is not limited to) the direct referral of patients to other healthcare professionals, prescribing medications and ordering diagnostic investigations. Nurse practitioners would, I believe, relieve some of the strain on GP services.”

UQ’s Smith says the human factor in telehealth is vitally important and that has equal significance to the technology involved.

“There has been a huge focus on the technical aspects of telehealth but we can’t underplay the importance of the human factor,” he says. “It is important that we have the right people on the phone and that the service provides important healthcare.”

Smith says the centre would support collaboration between research teams working to develop capacity in telehealth for everyone in Queensland.

“However, it will have a significant focus on Indigenous Australian healthcare, working to improve the health status of Indigenous Australians, who have a lower expectancy than their non-Indigenous counterparts, mainly due to a higher prevalence of chronic health conditions,” he says.

Smith adds that some specialist teams travelled to remote communities to deliver healthcare services, but such trips were intermittent.

“Some patients don’t receive the care they require because of the difficulties of having to leave their community for an appointment or treatment,” he said. “One example of highly effective telehealth is the mobile telemedicine program in Cherbourg, which delivers routine ear and hearing screening services and a visiting outreach program that delivers surgical services in the community.”

The program collects patient information and digital images that a team of specialists assesses at Brisbane’s Royal Children’s Hospital.

The CRE will seek to identify the reasons for the slow uptake in these settings in the context of general practice, and will work with a number of service providers to develop, implement and evaluate a telehealth program suitable to their needs.

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