Telehealth Clinics Research Articles

Outpatient telecardiology perceptions among rural, suburban, and urban veterans utilizing in-person cardiology versus telecardiology services: A mixed methods analysis.

To better understand opportunities and barriers to implementation and adoption, this mixed-methods study qualitatively examined attitudes toward telecardiology services among veterans who use in-person (IP) outpatient cardiology service versus those using telecardiology (TC) outpatient services. Free-text responses were collected from N = 179 veterans enrolled in Veteran Health Administration (VHA) IP or TC services in 3 rural-serving, outpatient telehealth clinics and 1 large, metropolitan outpatient center. Mixed-method analyses of responses included thematic analysis, followed by comparison of code categories and themes between IP and TC groups. Fifteen thematic coding categories were identified, which comprised 4 valence categories (favorable or unfavorable attitudes toward TC and IP), as well as themes pertaining to obstacles and opportunities for TC implementation. Overall, veterans enrolled in TC held more favorable attitudes toward TC than those enrolled in IP. Veteran responses included structural concerns (eg, time demands, access, and travel), as well as humanistic qualities (rapport, competence, and face-to-face contact). Differences were observed between the responses of veterans who reported dwelling in urban, suburban, and rural communities, with rural-identifying veterans generally holding more favorable attitudes toward TC than suburban-identifying veterans. TC users had overwhelmingly positive perceptions of TC. Conversely, unfavorable attitudes from IP patients toward TC did not appear to be borne out in the responses of TC users. On the contrary, TC users' responses may indicate opportunities for allaying the concerns of TC-naïve veterans. This suggests promise for developing tailored education to dispel barriers for TC service implementation.

Video consultations during the coronavirus disease 2019 pandemic are associated with high satisfaction for both doctors and patients.

Background and AimTelehealth has become the standard of care during the COVID‐19 outbreak. This study aimed to assess doctor and patient satisfaction of endoscopy‐related telehealth clinics with video consultations.MethodsA prospective observational study of patients consecutively booked to attend two endoscopy‐related telehealth clinics at an ambulatory tertiary care setting was conducted from July to October 2020. Data collected from our previously published study using phone consultations (data collected in April–May 2020) were used as a control arm. The primary outcome (satisfaction) was assessed through the six‐question score (6Q_score) as per previous research. Secondary outcomes included failure‐to‐attend (FTA) rate and perceived necessity of physical examination/in‐person follow‐up appointment.ResultsThere were 962 endoscopy clinic appointments between July and October, of which 157 were conducted through video. Data on 127 doctor questionnaires and 94 patient questionnaires were analyzed. The median age (years) of patients reviewed via video [57, interquartile range (IQR) 48–66] was lower than those reviewed via phone (65, IQR 55–74, P < 0.01). Patient average 6Q_score was higher with video compared to phone (85.1% vs 78.4%, P = 0.01), as was doctors' 6Q_score (97.5% vs 91.9%, P = 0.02). FTA rates remained similar between the two assessments (6.4% in April/May and 4.4% between July/October, P = 0.12). The requirement for in‐person follow‐up/physical examination was identified in two video consultations (1.6%).ConclusionVideo consultations during the COVID‐19 outbreak demonstrated higher patient and doctor satisfaction compared to phone consultations. There was no significant difference in FTA rates and need for in‐person follow‐up consultations/physical examination between the telehealth two modalities.

A Mixed Methods Evaluation of the Implementation of Asthma Care in Rural School-Based Telehealth Clinics

A Mixed Methods Evaluation of the Implementation of Asthma Care in Rural School-Based Telehealth Clinics

Enhancing rheumatology education during the COVID-19 pandemic.

During the COVID-19 pandemic, rheumatology educational programs around the world, face the daunting challenge of maintaining education for their trainees. Reduced in-person clinic exposures and social distancing requirements have significantly affected trainee education. Similar to programs around the USA, in early March 2020, our program was faced with an urgent need to pivot both our clinical and educational programs to virtual platforms. Within these limitations, we harnessed innovative educational models and restructured our curriculum to ensure adequate clinical and didactic exposure. We divided trainee’s clinical rotations into four blocks, which include Inpatient consult service, Outpatient in-person and procedure clinics, Telehealth Clinics and Research/Elective week. By assigning specific rotations, we were able to ensure fellows were seeing adequate numbers of patients both through telemedicine and inperson while ensuring we complied with social distancing requirements. We further were able to ensure that trainee hands-on procedure training was not compromised. Acknowledging challenges presented by the COVID-19 pandemic and learner engagement in virtual environment, we designed an innovative educational portfolio. Utilizing synchronous and asynchronous learning methods, we have developed multiple complementary educational initiatives including: Rocket Rheumatology, Board Games, At the Elbow, Radiology Reading Rheum, Ultrasound Buddies, The History Rheum, and Rapid-Fire Journal Club. Virtual learning methods will become a cornerstone of medical education moving forwards. The GW Division of Rheumatology has rapidly incorporated innovative educational tools into our curriculum. Our approach will help Rheumatology training programs across the globe enhance rheumatology training.

Benefits of phone consultation for endoscopy‐related clinics in the COVID‐19 pandemic

Background and AimDuring COVID‐19 outbreak, restrictions to in‐person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess “failure‐to‐attend” (FTA) rate and satisfaction for two endoscopy‐related compulsory telehealth clinics during the COVID‐19 outbreak.MethodsConsecutive patients booked for endoscopy‐related telehealth clinics at a tertiary hospital were prospectively assessed. In‐person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review.ResultsThere were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in‐person follow‐up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%.ConclusionsThe use of phone consultations in endoscopy‐related clinics during the COVID‐19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in‐person follow‐up consultations and physical examination were low.

Practical Guidance for Early Identification of Barriers in Surgical Telehealth Clinics.

Practical Guidance for Early Identification of Barriers in Surgical Telehealth Clinics.

Using telehealth for rural paediatric diabetics: Does it deliver good care?

To evaluate rural paediatric diabetic telehealth clinics including whether they meet clinical standards, provide equivalent care to central clinics, families were satisfied and difficulties were encountered. An audit of a telehealth service for children and adolescents with type 1 diabetes mellitus at four rural sites was conducted. The case notes for each patient for 2019 were reviewed to determine if standards of paediatric diabetic care were met. Interviews were conducted at a clinic at each site with the child, parent(s) and staff attending the clinics. A retrospective review of difficulties in service provision was undertaken with staff. Nineteen children and adolescents were seen in the telehealth clinics over the year. Eighteen (95%) were seen four times with point-of-care measurement of glycosylated haemoglobin (HbA1c) and growth by the consultant paediatrician and diabetic nurse educator. Complication screening was achieved on time for 15 (78%) patients, with the remaining patients having had the tests ordered. Eleven (56%) patients were reviewed by a dietician, six (33%) by social worker and five (27%) by psychologist. All patients and parents reported receiving good support for their diabetes without any preferring to attend the central clinic. There were no significant technical difficulties. Providing paediatric diabetic care through a telehealth service at rural hospitals meets standards of care and was provided without technical difficulties. It is preferred by patients and their parents to attending a central clinic. A model of service is presented that may be replicated elsewhere in Australia.

Multi-Institutional Collaborative Resident Education in the Era of COVID-19.

The 2019-2020 coronavirus pandemic has had a significant impact on all aspects of health care. Decrease in clinical and operative volume and limitations for conferences has drastically decreased educational opportunities for resident trainees. We describe the formation and initial success of the Collaborative Online Video Didactics lecture series, a multi-institutional online video didactics collaboration. Zoom data extraction and postlecture evaluation surveys were used to collect data on the impact of the pandemic on local educational activities as well as feedback about the lecture series. Lectures are being given by faculty from 35 institutions. The twice daily, hour-long webinar averages more than 470 live viewers per session with an average of 33.5 questions per session and has over 7,000 YouTube views of the recordings after the first 2 weeks. Viewers reported significant decreases in outpatient (75.2%), inpatient (64.9%) and operating room (77.7%) volumes at local programs, and only half (52.7%) of the survey responders indicated an increase in didactics locally. The lectures have been well-received, with over 90% of respondents giving the lecturers and series above average or excellent ratings. A significant majority of responders indicated that the lecture series has allowed for ongoing education opportunities during the pandemic (95.0%), helped to access faculty experts from other institutions (92.3%) and provided a sense of community connectedness during this period of social isolation (81.7%). We strongly encourage other institutions and trainees to participate in the didactic series and hope that this series can continue to evolve and be of benefit beyond the pandemic.

Rural Pandemic Preparedness: The Risk, Resilience and Response Required of Primary Healthcare.

Pandemic situations present enormous risks to essential rural primary healthcare (PHC) teams and the communities they serve. Yet, the pandemic policy development for rural contexts remains poorly defined. This article draws on reflections of the rural PHC response during the COVID-19 pandemic around three elements: risk, resilience, and response. Rural communities have nuanced risks related to their mobility and interaction patterns coupled with heightened population needs, socio-economic disadvantage, and access and health service infrastructure challenges. This requires specific risk assessment and communication which addresses the local context. Pandemic resilience relies on qualified and stable PHC teams using flexible responses and resources to enable streams of pandemic-related healthcare alongside ongoing primary healthcare. This depends on problem solving within limited resources and using networks and collaborations to enable healthcare for populations spread over large geographic catchments. PHC teams must secure systems for patient retrieval and managing equipment and resources including providing for situations where supply chains may fail and staff need rest. Response consists of rural PHC teams adopting new preventative clinics, screening and ambulatory models to protect health workers from exposure whilst maximizing population screening and continuity of healthcare for vulnerable groups. Innovative models that emerge during pandemics, including telehealth clinics, may bear specific evaluation for informing ongoing rural health system capabilities and patient access. It is imperative that mainstream pandemic policies recognize the nuance of rural settings and address resourcing and support strategies to each level of rural risk, resilience, and response for a strong health system ready for surge events.

Surgical Education in the Time of COVID: Understanding the Early Response of Surgical Training Programs to the Novel Coronavirus Pandemic

ObjectiveDescribe the early impact of the COVID-19 pandemic on general surgery residency training nationwide.DesignA 31-question electronic survey was distributed to general surgery program directors. Qualitative data underwent iterative coding analysis. Quantitative data were evaluated with summary statistics and bivariate analyses.ParticipantsEighty-four residency programs (33.6% response rate) with representation across US geographic regions, program affiliations, and sizes.ResultsWidespread changes were observed in the surgical training environment. One hundred percent of programs reduced the number of residents on rounds and 95.2% reduced the size of their in-hospital resident workforce; on average, daytime staffing decreased by nearly half. With telehealth clinics (90.5%) and remote inpatient consults (26.2%), both clinical care and resident didactics (86.9%) were increasingly virtual, with similar impact across all program demographics. Conversely, availability of some wellness initiatives was significantly higher among university programs than independent programs, including childcare (51.2% vs 6.7%), housing (41.9% vs 13.3%), and virtual mental health services (83.7% vs 53.3%).ConclusionsChanges in clinical care delivery dramatically reduced in face-to-face learning opportunities for surgical trainees during the COVID-19 pandemic. While this effect had equal impact across all program types, sizes, and geographies, the same cannot be said for wellness initiatives. Though all programs initiated some strategies to protect resident health, the disparity between university programs and independent programs may be cause for action.

Transcatheter Aortic Valve Replacement in the Coronavirus Disease 2019 (COVID-19) Era.

Transcatheter Aortic Valve Replacement in the Coronavirus Disease 2019 (COVID-19) Era.

Guidelines for Resident Participation in Otolaryngology Telehealth Clinics During the COVID-19 Pandemic.

The practice of otolaryngology has changed drastically since the start of the COVID-19 pandemic. To limit exposure and maintain a reserve of caregivers, residency education ceased most clinical activities and shifted to remote lecture consortiums hosted online across the country in lieu of ambulatory and operative experiences. Many practicing university otolaryngologists have transitioned their clinics to telehealth medicine to maintain access to clinical care during the pandemic. The participation of residents in telemedicine visits has not been described. Here we present guidelines and experience-based suggestions for successful resident involvement in telemedicine. While it is unclear what role telehealth medicine may play within the field of otolaryngology beyond the pandemic, our experiences suggest better patient outreach and access. Expanding residents' skill set with telehealth medicine can enhance their education and better prepare them for future practice.

Addressing rural disparities in cancer care via telehealth.

e19090 Background: Patients in rural areas have reduced access to high-quality cancer care, which contributes to rural-urban disparities in cancer mortality. Telehealth technologies can connect providers across rural and urban communities. Methods: In 2006, one author (LH) established an oncology program in Truckee, CA, a rural community with a single critical access hospital without oncology services. The program joined with 4 other facilities comprising the UC Davis Cancer Care Network, a central element being daily participation in structured virtual tumor boards addressing the four sites (colorectal, prostate, lung, &amp; breast) that compromise ~80% of all cancer diagnoses. Remote telemedicine clinics outside the primary catchment area were also established to serve the mountain communities of Quincy, Portola, Loyalton, and South Lake Tahoe, CA. We assessed the reach and quality of the cancer program through referrals, in-migration, clinical trial accruals and accreditations. Results: The combination of virtual tumor boards and telehealth clinics associated with growth of the program to 3 medical oncologists, 1 radiation oncologist and expansion into a 20,000 ft2 facility. Total new patient visits, the percent of patients coming from zip codes outside of the primary catchment area, clinical trial enrollments, and quality accreditations steadily increased (Table). The program is accredited by the Commission on Cancer with commendation, ASTRO’s APEX, ASCO’s QOPI and CancerLinq programs, and is a G02Foundation for Lung Cancer Community Center of Excellence. Conclusions: We termed the knowledge dissemination that occurs through a telehealth connected rural oncology program involving a Comprehensive Cancer Center partner and disseminated rural telemedicine nodes a “synaptic knowledge network.” In this implementation, it enhanced the reach and quality of care as measured by volume, in-migration, clinical trial activity, and national quality accreditations. Application of synaptic knowledge networks to other rural sites is a promising strategy to reduce rural-urban disparities in cancer care. [Table: see text]

Models of Pediatric Palliative Oncology Outpatient Care-Benefits, Challenges, and Opportunities.

Although the bulk of current pediatric palliative care (PPC) services are concentrated in inpatient settings, the vast majority of clinical care, symptom assessment and management, decision-making, and advance care planning occurs in the outpatient and home settings. As integrated PPC/pediatric oncology becomes the standard of care, novel pediatric palliative oncology (PPO) outpatient models are emerging. The optimal PPO model is unknown and likely varies on the basis of institutional culture, resources, space, and personnel. We review five institutions' unique outpatient PPO clinical models with their respective benefits and challenges. This review offers pragmatic guidance regarding PPO clinic development, implementation, and resource allocation. Specific examples include a floating clinic model, embedded disease-specific PPC experts, embedded consultative or trigger-based supportive care clinics, and telehealth clinics. Organizations that have overcome personnel, funding, and logistical challenges can serve as role models for centers developing PPO clinic models. In the absence of a one-size-fits-all model, pediatric oncology and PPC groups can select, tailor, and implement the model that best suits their respective personnel, needs, and capacities. Emerging PPO clinics must balance the challenges and opportunities unique to their organization, with the goal of providing high-quality PPC for children with cancer and their families.

Decentralized care with generic direct-acting antivirals in the management of chronic hepatitis C in a public health care setting

The prevalence of anti-hepatitis C virus antibody in Punjab, India is 3.6%, with 728,000 people estimated to have viremic chronic hepatitis C (CHC). The Mukh-Mantri Punjab Hepatitis C Relief Fund, launched on 18th June 2016, provides no-cost generic direct-acting antivirals (DAAs) with sofosbuvir + ledipasvir ± ribavirin or sofosbuvir + daclatasvir ± ribavirin with the goal of eliminating CHC from Punjab. We assessed the safety and efficacy of decentralized treatment of CHC in a public health care setting. Primary care providers from 3 university and 22 district hospitals were trained to provide algorithm-based DAA treatment and supervised by telehealth clinics conducted fortnightly. The diagnosis of cirrhosis was based on clinical and radiological evidence, including aspartate aminotransferase-to-platelet ratio index (APRI ≥2.0) and FIB-4 score (>3.25), or on liver stiffness measurement ≥12.5 kPa on Fibroscan®. We enrolled 48,088 individuals with CHC (63.8% male; mean age 42.1 years; 80.5% rural; 14.8% compensated cirrhosis; 69.9% genotype [GT] 3) between 18th June 2016 to 31st July 2018. While 36,250 (75.4%) patients completed treatment, 5,497 (11.4%) had treatment interruptions and 6,341 (13.2%) patients are currently ongoing treatment. Sustained virological response at 12 weeks after treatment completion (SVR12) was achieved in 91.6% of patients per protocol, 67.6% in intention-to-treat (ITT) analysis, where all interruptions were treated as failures, and 91.2% in a modified ITT analysis where all patients with successful SVR12 in the interruptions arm were included as cured. SVR12 rates in patients with and without cirrhosis and GT3 versus non-GT3 were comparable. The SVR12 rate was 84.4% in patients who had treatment interruptions. Decentralized care of patients with CHC using generic all-oral DAA regimens is safe and effective regardless of genotype or presence of cirrhosis. ClinicalTrials.gov number: NCT01110447. We assessed the safety and efficacy of public health care using no-cost all-oral generic direct-acting antiviral drugs against hepatitis C in the state of Punjab, India. The goal is elimination of chronic hepatitis C (CHC) by 2030 and involves primary care providers at 25 sites in the state. We enrolled 48,088 individuals (63.8% male; mean age 42.1 years; 80.5% rural; 14.8% compensated cirrhotic; 69.9% genotype 3) between 18th June 2016 to 31st July 2018. Cure was achieved in 91.6% of patients, demonstrating that decentralized care of CHC with generic all-oral regimens is safe and effective.

Mobile-based insulin dose adjustment for type 2 diabetes in community and rural populations: study protocol for a pilot randomized controlled trial.

Background: Insulin initiation and/or titration for type 2 diabetes (T2DM) is often delayed as it is a resource-intensive process, often requiring frequent exchange of information between a patient and their diabetes healthcare professional, such as a credentialed diabetes educator (CDE) for insulin dose adjustment (IDA). Existing models of IDA are unlikely to meet the increasing service demand unless efficiencies are increased. Mobile health (mHealth), a subset of Ehealth, has been shown to improve glycaemic control through enhanced self-management and feedback leading to improved patient satisfaction and could simultaneously reduce costs. Considering the potential benefits of mHealth, we have developed an innovative mHealth-based care model to support patients and clinicians in diabetes specialist community outreach and telehealth clinics, that is, REthinking Model of Outpatient Diabetes care utilizing EheaLth – Insulin Dose Adjustment (REMODEL-IDA). This model primarily aims to improve the glycaemic management of patients with T2DM on insulin, with the secondary aims of improving healthcare service delivery efficiency and the patients’ experience. Methods/Design: A two-arm pilot randomized controlled trial (RCT) will be conducted for 3 months with 44 participants, randomized at a 1:1 ratio to receive either the mHealth-based model of care (intervention) or routine care (control), in diabetes specialist community outreach and telehealth clinics. The intervention arm will exchange information related to blood glucose levels via the Mobile Diabetes Management System developed for outpatients with T2DM. They will receive advice on insulin titration from the CDE via the mobile-app and receive automated text-message prompts for better self-management based on their blood glucose levels and frequency of blood glucose testing. The routine care arm will be followed up via telephone calls by the CDE as per usual practice. The primary outcome is change in glycated haemoglobin, a marker of glycaemic management, at 3 months. Patient and healthcare provider satisfaction, and time required to perform IDA by healthcare providers in both arms will be collected. This pilot study will guide the conduct of a large-scale pragmatic RCT in regional Australia.

Transforming Telehealth through Enhanced General Practices Partnerships

Introduction: In 2014, a health needs assessment conducted between a Local Health District (LHD), a local government council and a Primary Health Network showed a Chronic Obstruction Pulmonary Disease (COPD) hospitalisation rate of 105, higher than NSW benchmark (100), along with sub-optimal access to health services. Practice Change: In 2015, a new model of care via telehealth developed in partnership with General Practitioners (GP) allowing regular clinical readings at home to transmit to a telehealth coordinator, has offered benefits in terms of quicker access to patient information and less time spent performing home visits, while still maintaining that crucial ‘face-to-face’ contact. Aim / Theory: Promote wider collaboration between hospital, GP and private provider to improve a seamless and rapid access to care and coordination for the community, using telehealth technology. This proactive approach to chronic disease management will improve patient self-management capabilities, understanding of their condition and reduce presentations to Emergency Department (ED), through early recognition and intervention utilising telemonitoring in consultation with treating GP. Population: The telemonitoring project was developed for a regional area community with high rates of chronic disease hospitalisations and sub-optimal access to healthcare. Timeline: After identifying the priorities for the region through the 2014 health needs assessment, the telemonitoring initiatives commenced in 2015 and have been sustained. Highlights: Outcomes included: 1- Wider collaboration with 90% of the GP practices participating in the project with 5 Telehealth Clinics established to connect patients to specialists. Streamlined access to care and coordination for the community using telehealth technology through processes for triage and escalation based on integration of care and provision of services between patients, GP, telemonitoring nurse coordinator, and telemonitoring provider. Patient compliance (performing readings as per GP care plan) was very high. At risk readings comprised 55%, showing that health issues were appropriately detected, escalated and timely managed, preventing unnecessary hospital presentations. 2- Qualitative patient experience “Client who had up to 15 admissions has not presented since clinical intervention and care coordination via telemonitoring”, comment by treating GP. Sustainability: This initiative has transitioned as part of the LHD Chronic Disease Management Program and is now sustained within an ongoing service delivery model. Transferability: This initiative and its model of care has been scaled and rolled-out to other Local Government Areas. The target patients group has also expanded to include chronic heart failure and diabetes. Conclusions: This project provides an integrated healthcare opportunity by co-designing the solution with the GPs and telemonitoring provider, it also enhances patients and carers experience as partners. In addition, the solution is seamless connected care by providing rapid feedback and ready access to clinical support in a sub-optimal serviced locality utilising technology which transforms healthcare. Discussions: This study has served to increase understanding of practical ongoing implementation of telemonitoring in a real world integrated health neighbourhood including a large local health district, a commercial telemonitoring provider and a number of General Practices. Lessons: The missed readings / lost contacts and its interaction with usefulness and reliability of telemonitoring needs to be explored.

Innovation in pain management: connecting regional and rural community based care to specialist services

Introduction: In Australia 20% of the population live with disabling chronic pain, costing the health system $34 billion annually. Less than 0.1% are reviewed by specialist services due to limited availability of specialist consultants. Residents in Southern New South Wales (NSW) Local Health District (SNSWLHD) are challenged due to geographical isolation, travelling long distances to access specialist services. In 2015, NSW Minister for Health, provided recurrent funding of $100,000 p.a. to support the objectives of the Agency for Clinical Innovation (ACI) 2012 Pain Management Plan. The plan identified the need to improve access to pain services in rural and remote areas. The ACI and SNSWLHD collaboratively tendered to appoint a tertiary provider to deliver the service. St Vincent's Hospital Sydney was successful in the tender to establish a multidisciplinary outreach Pain Clinic in partnership with ACI, SNSWLHD, and South Eastern NSW Primary Health Network (SENSW PHN)-COORDINAIRE. The challenge is to shift the burden of chronic pain management from the hospital to a more consumer accessible community Model of Care. Practice change: The new model went live in 2016 and includes: upskilling of local primary multi-disciplinary care providers, assessment and self-management education and linking of general practice with tertiary specialists using telehealth. Aim/theory of change: The aim is to deliver evidence based, multidisciplinary pain management in primary care with access to pain specialists for complex patients. Using telehealth technology enables patients to remain close to home, reducing discomfort and costs. In theory, creating local primary care expert hubs, linked with a tertiary specialist centre, will enable early intervention thereby reducing the societal cost burden. Targeted population and stakeholders People suffering chronic pain > 6 months. Stakeholders: Patients, Families and Carers, SNSWLHD Clinicians, Primary Care providers. Timeline: The service has been operational for 12 months and formative evaluation shows that key deliverables are being met. Ongoing evaluation has been embedded in the model. Highlights: The provision of integrated pain management services in the community resulting in the positive response from both consumers and clinicians. Consumer feedback is extremely positive with a 100% satisfaction rating. Sustainability/transferability: The service agreement specifies a minimum number of multidiciplinary telehealth clinics per month plus three multidisciplinary outreach workshops per annum.The relatively low cost of service provision and simple model demonstrates ease of transferability within the region. Upskilling ensures sustainability by increasing capacity within the system together with service agreement monitoring to maintain quality. Conclusions: Since introduction there have been: a) 107 Telehealth consultations. b) Evaluation of positive patient experience = 100%. c) Evaluation of 71 Providers: Positive experience = 97%, Ability to support their patient more = 91%. Discussion/lessons learned: The move away from hospital to community care is a positive one. Skilled local multidisciplinary teams supported by telehealth enables the consumer to receive the best available service where they live. The partnership between specialists and local providers, with support of state & federal funding, is achieving outcomes through willingness to network, share new evidence and utilise technology with the consumer at the centre of the model.

Telehealth clinics increase access to care for adults with cystic fibrosis living in rural and remote Western Australia

Introduction A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Methods Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. Results In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0–6)) in the 12-month period preceding the study to 100 (5 (2–8), p < 0.001) during the intervention. Of the 100 clinics in total, 66 were delivered via telehealth. Satisfaction with telehealth was high and most (94%) participants agreed that telehealth is a good way to deliver CF care. An increase in intravenous antibiotic days (incident rate ratio (IRR) 2.3, p = 0.03) and hospital admission days (IRR 3.7, p = 0.01) was observed. There was an improvement in the vitality domain of the Cystic Fibrosis Questionnaire – Revised (p < 0.05). Discussion Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.

Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder.

Increasing access to psychotherapy for posttraumatic stress disorder (PTSD) is a primary focus of the Department of Veterans Affairs (VA) healthcare system. Delivery of treatment via video telehealth can expand availability of treatment and be equally effective as in-person treatment. Despite VA efforts, barriers to establishing telehealth services remain, including both provider acceptance and organizational obstacles. Thus, development of specific strategies is needed to implement video telehealth services in complex healthcare systems, like the VA. This project was guided by the Promoting Action on Research Implementation in Health Services framework and used external facilitation to increase access to psychotherapy via video telehealth. The project was conducted at five VA Medical Centers and their associated community clinics across six states in the South Central United States. Over a 21-month period, 27 video telehealth clinics were established to provide greater access to evidence-based psychotherapies for PTSD. Examination of change scores showed that participating sites averaged a 3.2-fold increase in unique patients and a 6.5-fold increase in psychotherapy sessions via video telehealth for PTSD. Differences between participating and nonparticipating sites in both unique patients and encounters were significant (p=0.041 and p=0.009, respectively). Two groups emerged, separated by degree of engagement in the facilitation intervention. Facilitation was perceived as useful by providers. To our knowledge, this is the first prospective study of external facilitation as an implementation strategy for telehealth. Our findings suggest that external facilitation is an effective and acceptable strategy to support providers as they establish clinics and make complex practice changes, such as implementing video telehealth to deliver psychotherapy.