Trialling telehealth – an aged care view

Macedon Ranges and North Western Melbourne Medicare Local (MRNWM-ML) set up a telehealth program last year to link the area’s 40-odd residential aged care facilities and 130 general practices with out of area specialists.

MRNWM-ML has been working with a number of general practices and RACFs who have since taken their first steps into telehealth, with many finding that the technology is easy to use with measurable benefits to patients.

The Macedon Ranges and north-west Melbourne area includes a mixture of rural towns and outer metropolitan suburbs, and as such many of its GPs still qualify for the federal government's telehealth incentive. All aged care facilities also qualify for the incentive when hosting a video conference with a specialist.

Wendy Lacey, director of nursing at Reg Geary House in Melton South, helped organise a day of telehealth consultations last December, involving six residents who were assessed by a mixture of geriatricians, a dermatologist and a neurologist.

Reg Geary House is a 30-bed high care facility run by Western Health, but that does not mean the facility has easy access to specialists, Ms Lacey said.

“We are as distant from hospitals as any others,” she said. “We do have wound consultants and infection control consultants that we can source, but they are generally nurse consultants, not doctors. When it comes to medical specialists, we would be in the same boat as everyone else.”

Ms Lacey said the experience was interesting and was valuable to the residents, but she does feel that low-care residents would benefit more from telehealth as they have a tendency to see more specialists.

“I think it would be much more value added to a facility that has low care, not just high care, because often low-care people have more appointments than high-care,” she said.

“Mind you, the high-care people are harder to get to their appointments, but low care have more of them. We had a look over the last 12 months to see how many people had appointments, and we would probably do about 10 or 12 a year. With low care it would be double.”

That being said, the experience was a positive one for the residents and for their families. The dermatology consultation was particularly interesting, involving a lady with a skin cancer-like growth on her head.

“It is now quite large and has been there for a long time,” Ms Lacey said. “Because she is so frail and bed-ridden, the family didn't want to put her through unnecessary treatments, but it looks unsightly on the top of her head.”

Reg Geary House used a laptop equipped with a camera and teleconferencing software, which Ms Lacey said was very useful as most residents are bed-bound. The facility is too small to allocate a private room for consultations, so the laptop is taken straight to the bedside.

“It was lovely for [the resident] because we were able to take the laptop over and show the specialist what the growth was. He was able to change the treatment and also gave us a good understanding of whether she would have pain from it. The GP said he actually learned a lot and it was good for him to hear these things.”

Another resident, who in the past had been capable of seeing his specialist at hospital when transported in a wheelchair, was able to see a neurologist through telehealth.

“He is now beyond sitting in a wheelchair and his wife is having surgery so she is not able to manage taking him either, so they dropped off going to the appointments because it was too hard,” Ms Lacey said. “He had been part of a research trial that he'd been doing for many years so he's now able to stay with that project.”

The Coliban Medical Centre in Kyneton has also taken its first steps into telehealth, with two of the five GPs at the surgery having conducted video consultations for their patients with a specialist.

Practice manager Jackie Turner said the GPs had found the process extremely useful and would continue to use it, particularly for elderly patients.

“We traditionally are a farming community although that is changing as we have a lot of young people moving into the area, but we still have a lot of elderly people with complex needs,” Ms Turner said. “Families are too busy to drive their parents [to Melbourne], so for them it's much easier to come to the surgery and have a telehealth conference.”

Ms Turner said that in addition to saving on time travelling to Melbourne – which is an hour each way by car – telehealth could help overcome the anxiety many patients have about attending a specialist appointment.

“One lady I'm thinking of, she's a youngish lady, it's too hard for her to go to Melbourne to see her doctors. Part of the issue is that she gets very stressed going to the city.

“It's also good for patients who get really anxious about going to see a psychiatrist or a psychologist. This way, they can come to the surgery, they are familiar with the surgery, they can talk to the specialist and they can do it with their doctor. It's less of an anxious experience and they are more likely to attend.”

Ms Turner said the GPs themselves were enjoying the experience. “They think it's great. They get to have a say rather than just communicating through letters or emails or whatever. They are able to bring up issues with the patient there – it's normally just the patient going to see the specialist, but now the GPs can be involved and they really love that.”

The practice has not invested in any proprietary software and uses Skype, which Ms Turner said works perfectly well. “It's cheap as chips and there's no extra cost. Most people are familiar with Skype so it's very easy to implement.”

The practice has only just started offering telehealth services and so far has only done about a dozen consultations, but Ms Turner said that would quickly grow. “It is picking up momentum and more and more specialists are saying they'd like to get involved with it. I think there's a huge future for this, I really do. I think it's a great idea.”

Posted in Aged Care


0 # Ben Johnston 2013-04-10 13:23
This is great example of where telehealth (video consultations) can deliver significant benefits in aged care. There are significant benefits in aged care through the use of video conferencing and these benefits are highly visible from a patient care perspective. Despite this, uptake and use of telehealth in aged care remains low. It is good to see the positive feelings of the patients and GPs receiving and supporting the specialist consultations - but we need to focus on uncovering the business case for aged care telehealth to take off. What is the motivation for a busy specialist when those in serious need will come to them? What is the motivation for the RACF when it is the families' responsibility to arrange and/or cover the cost of getting the resident to their appointment? What business need outcome will drive the GP to travel to the RACF to attend a VC consult with the resident? These are heartless questions, but the benefits of answering them are huge for RACF resident care.

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