neoRehab service delivery trial within TCP Toowoomba

Samantha Donohoe1, Brioh Guffin2

 

1 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, samantha.donohoe@health.qld.gov.au

2 Transition Care Program, Baillie Henderson Hospital, Browne House, Level 1 PO BOX  Toowoomba, QLD, 4610, brioh.guffin@health.qld.gov.au

 

Background:

Within the Toowoomba Transition Care Program (TCP), the use of neoRehab clinically validated videoconference software is enabling real time service delivery via iPads. Within this model, the multidisciplinary community-based rehabilitation team of allied health professionals, nursing, case management staff, and allied health assistants, are alternating weekly home visits with videoconference consults, for appropriate clients. A staff member sits with the client and operates the neoRehab software on the TCP iPad in the client’s home, whilst the clinician is able to provide his/her review consult from the team office, with purpose-designed clinical measurement tools on-screen to assist in monitoring progress.

A three month pilot study was undertaken to review and update the existing Toowoomba TCP neoRehab service delivery resources (user guide and clinical guidelines) and review the implementation and service delivery of neoRehab within Toowoomba TCP. This innovative change to service delivery for clients in Toowoomba and surrounds has, in its initial stages, demonstrated time, resource and cost effectiveness.

 

Method:

Data focussed on capturing occasions of service (OOS) and additional parameters to identify the overall clinical service advantages of the integration of neoRehab into our existing service delivery model has been collected and analysed from a period including March, May and June, 2016. In addition, we have obtained staff feedback during informal interviews within the TCP team.

 

Data collection results (summary):

  • 23 of 26 sessions in three months substituted face-to-face consultations (~88.46%)
  • In 12 weeks, TCP saved approximately $1,574.35 using neoRehab as an alternate to face-to-face consultations
  • In 12 weeks, Toowoomba TCP completed 26 neoRehab sessions which saved an overall amount of $1,893.41
  • Overall, TCP saved $735.05 in staff costs
  • Overall, TCP saved $1,158.36 in car travel costs
  • In 12 weeks, the overall saving per OOS was approx. $69.43, with an average of 58.58km saved per OOS
  • 16 out of 26 neoRehab sessions had no episodes of disconnection or disruptions

 

Aspects that made the TCP team less inclined to use neoRehab included; technical difficulties, reception black spots particularly in the rural areas. Further, neoRehab isn’t as hands on as regular service delivery, and the poor sound quality at times when full reception isn’t available has been a barrier to use with our older clients at times.

All staff members were able to identify how neoRehab is useful in their area of practice and identified that it saves both staff and client time, and reduces the travel time, thus making the service more efficient and more responsive. Additionally staff indicated that neoRehab was beneficial for building teamwork by being a useful learning tool for both clients and staff. The team has identified that they would like to know more about the application of features of neoRehab.

 

Future Direction/consideration:

Please note: due to the preliminary nature of our data, we are aware that the following is representative of data collected as part of a series of first steps in a longer-term plan to integrate neoRehab into our team’s service delivery model. In future, we hope to conduct formal research to obtain reliable evidence in support of the feasibility of neoRehab within a community-based rehabilitation setting. We anticipate this data will be applicable to health services beyond our own, across our district, and further afield.

 

Conclusion

NeoRehab is showing promising potential as a feasible, cost effective advancement with further integration into our existing model of service delivery. Further scope for formal research over a six months period exists to quantify the feasibility, cost and clinical effectiveness of this service model within our team.

Delivering virtual speech language pathology to school children in the Western Downs

Mrs Ruth Taylor1, A/Prof Anthony Smith2, Dr Liam Caffery3, Dr Danette Langbecker4

 

1 University of Queensland, Centre for Online Health, Ground floor, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, 4102. r.saunders4@uq.edu.au

2 University of Queensland, Centre for Online Health, Ground floor, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, 4102. asmith@uq.edu.au

3 University of Queensland, Centre for Online Health, Ground floor, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, 4102. l.caffery@uq.edu.au

4 University of Queensland, Centre for Online Health, Ground floor, Building 33, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, 4102

 

How does a speech pathologist support a rural child without ever setting foot in their town? Families throughout the Western Downs in Queensland are finding out through a project introduced by the University of Queensland (UQ). In the latest development of the UQ Health-e-Regions program, five schools have been connected by videoconference to health professionals in Brisbane. Through the Health-e-Regions experience program, supported by natural gas company QGC, children living in the Western Downs who require speech language pathology (SLP), may now access these specialist services without leaving the familiar surroundings of their school.

The program was piloted last year with the Tara Shire State College and is now being implemented into a further four schools in Tara, Chinchilla, Miles and Wandoan. A collaborative effort between the Department of Education and Training (DET), Diocese of Toowoomba: Catholic Schools Office (TCSO), UQ’s Centre for Online Health and UQ’s Tele-Rehabilitation Unit, the program is also piloting occupational therapy via Telehealth.

The Health-e-Regions telehealth program is designed to complement the SLP services already provided to students from DET and TCSO. School children are selected for the program based upon need and assessments conducted by the teachers and DET/TCSO speech language pathologists. Third and fourth year students from UQ, supervised by a clinical educator, provide the service from Brisbane as part of their clinical rotation. The school students receive weekly sessions ‘virtually’ using an iPad and specialised software which enables interaction in other ways such as drawing on the screen and manipulating digital images used during the therapy session.

When a child’s speech and language development is delayed and they cannot be understood during a conversation, they may become reluctant to speak and resort to communicating in other ways.  This can include disruptive behaviour, withdrawal or poor participation in class. Some children simply don’t have the vocabulary needed to learn.

In the context of a busy school and classroom environment, students benefit from individual learning opportunities and support.  The telehealth program with its motivating and interactive learning platform allows positive individualised learning experiences, and an opportunity to make a real difference for students.

A further advantage for the school is the ability to develop teacher capacity. Teaching staff are also receiving support and professional development sessions to increase their knowledge and skills, which are then translatable in the classroom.

As the sessions are delivered by SLP students, they too are increasing knowledge and skills that will soon be translated into the workforce when they graduate in the future with additional experience in alternative health delivery methods.

The program will allow schools to expand the services available and to better cater for the needs of the students. It is hoped that the positive experiences associated with the telehealth program already may be shared with other schools throughout the country where access to specialist services are limited.

Assistive Technology @ Home: using telehealth to support collaborative service delivery

Chris Sweeney1,

1 LifeTec, Level 1 Reading Newmarket Centre, Cnr Newmarket & Enoggera Rds, Newmarket, 4051, chrissweeney@lifetec.org.au

 

People living outside a metropolitan area often find it difficult to access a wide range of services or health professionals with specific experience and expertise. This is especially true for people with complex health conditions who require sophisticated assistive technologies. Telehealth provides a useful platform for supporting clients and their health care team in selecting, using and reviewing assistive technology. It also affords opportunities for a team of professionals to work collaboratively across services to achieve good outcomes for clients and their families.

This presentation will describe how telehealth has been integrated into one community organisation, enabling services to be provided equitably across the state. LifeTec has a skype service that people can call into for information and advice on assistive technology (AT).  People can also arrange a telehealth appointment to discuss their needs and review potential AT solutions.  Telehealth appointments prior to an outreach trip have also proved valuable in making the most of the face-to-face time, allowing needs to be clearly identified and suitable trial devices to be selected prior to the visit.

With the use of video-call software, staff are able to deliver services to people in their own homes and communities, eliminating the need for difficult and costly travel. Mobile technologies also allow staff in the field access to other team members with dedicated expertise who may be located back at base.  This has allowed the service to maximise the use of staff and quality of service delivery. Case examples will be used to discuss the benefits and challenges in providing telehealth services. Strategies to optimise the effectiveness of telehealth events will also be described.

Telehealth has become a routine mode of service delivery for staff within the service improving the coverage and effectiveness of services offered in rural and remote areas.

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