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.

Maintaining Mature Mouths utilising tele-dentistry

Debra McKenzie1, Eilleen Shepherd2, Jacinta Pitt3, Carolyn Bourke4

 

1 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

debra.mckenzie@health.qld.gov.au

2 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

eilleen.shepherd@health.qld.gov.au

3 Rural Health and Aged Care, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 jacinta.pitt@health.qld.gov.au

4 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 carolyn.bourke@health.qld.gov.au

 

Background:

Maintaining mature mouths utilising teledentistry is an innovative model of care enabling Darling Downs Hospital and Health Service’s (DDHHS) Residential Aged Care Facility (RACF) residents to have oral checks and dental reviews via a live streaming videoconference appointment with a Dentist. This integrated approach is between DDHHS’ Oral Health Clinic (OHC), Telehealth Team, seven RACFs, as well as RACF residents and their families.

Methods:

DDHHS’ TeleDentistry program was initially trialled in January 2014 using a dental probe connected to video conference equipment. The trial highlighted some technical issues which had to be overcome and also provided the opportunity to fine tune operational, administrative and nursing processes. Once the issues were addressed, the trial was recommenced at DDHHS’ Mt Lofty Nursing Home in Toowoomba in November 2014.

The Oral Health Therapist (OHT) visits the RACF and performs a chart audit, reviewing dental care plans. Each consenting resident receives an oral review in the privacy of their own room. The oral health therapist records the dental review and management plan in the resident’s record in collaboration with the Registered Nurse (RN).  If the OHT finds an issue that requires further investigation, a referral is made by the RN for the resident to be reviewed by a Dentist via Tele Dentistry. A time is scheduled where the Oral Health Therapist uses live streaming of the RACF resident via an inline camera. The Dentist views the live feed from their office and advises on appropriate treatment to commence locally, or advises that the resident is required to be seen in person at the OHC.

Results:

The following outcomes have been achieved:

  • 204 residents have had a dental assessment, 57 have had a tele-dental referral/consultation and 16 have required further appointments at the dental clinic.
  • Increased awareness of residents’ oral health needs and oral health requirements
  • Reduction in QAS and nurse escort time and costs for transporting residents to Oral Health Clinics
  • Addresses a major barrier for residents accessing appropriate oral health care
  • Reduction in the number of inappropriate referrals to a dentist by first screening residents
  • More efficient use of Dentist time
  • Minimum disruption to resident’s daily routine
  • Patient comfort maintained
  • All residents are up to date with yearly visits
  • Proactive approach finding areas of concern before they become a problem to the residents i.e. pain
  • Staff are becoming more in-tune with technological advances

Discussion:

TeleDentistry has allowed residents to receive optimal dental care while remaining in their own surroundings and eliminated the need for frail residents to be transported to the OHC via ambulance with a nurse escort. To improve the knowledge, skills and attitude of RACF staff in oral health, each nurse working in a RACF is required to undertake mandatory online training regarding oral health via the DDHHS online learning portal “Darling Downs Learning Online” (DDLOL). Future objectives include introducing the program into private aged care facilities and investigating different technology.

Maintaining mature mouths utilising teledentistry

Debra McKenzie1, Eilleen Shepherd2, Jacinta Pitt3, Carolyn Bourke4

 

1 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

debra.mckenzie@health.qld.gov.au

2 Toowoomba Oral Health, Darling Downs Hospital & Health Service, PMB2 Toowoomba 4350.

eilleen.shepherd@health.qld.gov.au

3 Rural Health and Aged Care, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 jacinta.pitt@health.qld.gov.au

4 Telehealth Service, Darling Downs Hospital & Health Service, Mt Lofty Nursing Home, Rifle Range Road, Toowoomba,4350 carolyn.bourke@health.qld.gov.au

 

Background:

Maintaining mature mouths utilising teledentistry is an innovative model of care enabling Darling Downs Hospital and Health Service’s (DDHHS) Residential Aged Care Facility (RACF) residents to have oral checks and dental reviews via a live streaming videoconference appointment with a Dentist. This integrated approach is between DDHHS’ Oral Health Clinic (OHC), Telehealth Team, seven RACFs, as well as RACF residents and their families.

Methods:

DDHHS’ TeleDentistry program was initially trialled in January 2014 using a dental probe connected to video conference equipment. The trial highlighted some technical issues which had to be overcome and also provided the opportunity to fine tune operational, administrative and nursing processes. Once the issues were addressed, the trial was recommenced at DDHHS’ Mt Lofty Nursing Home in Toowoomba in November 2014.

The Oral Health Therapist (OHT) visits the RACF and performs a chart audit, reviewing dental care plans. Each consenting resident receives an oral review in the privacy of their own room. The oral health therapist records the dental review and management plan in the resident’s record in collaboration with the Registered Nurse (RN).  If the OHT finds an issue that requires further investigation, a referral is made by the RN for the resident to be reviewed by a Dentist via Tele Dentistry. A time is scheduled where the Oral Health Therapist uses live streaming of the RACF resident via an inline camera. The Dentist views the live feed from their office and advises on appropriate treatment to commence locally, or advises that the resident is required to be seen in person at the OHC.

Results:

The following outcomes have been achieved:

  • 204 residents have had a dental assessment, 57 have had a tele-dental referral/consultation and 16 have required further appointments at the dental clinic.
  • Increased awareness of residents’ oral health needs and oral health requirements
  • Reduction in QAS and nurse escort time and costs for transporting residents to Oral Health Clinics
  • Addresses a major barrier for residents accessing appropriate oral health care
  • Reduction in the number of inappropriate referrals to a dentist by first screening residents
  • More efficient use of Dentist time
  • Minimum disruption to resident’s daily routine
  • Patient comfort maintained
  • All residents are up to date with yearly visits
  • Proactive approach finding areas of concern before they become a problem to the residents i.e. pain
  • Staff are becoming more in-tune with technological advances

Discussion:

TeleDentistry has allowed residents to receive optimal dental care while remaining in their own surroundings and eliminated the need for frail residents to be transported to the OHC via ambulance with a nurse escort. To improve the knowledge, skills and attitude of RACF staff in oral health, each nurse working in a RACF is required to undertake mandatory online training regarding oral health via the DDHHS online learning portal “Darling Downs Learning Online” (DDLOL). Future objectives include introducing the program into private aged care facilities and investigating different technology.

Telehealth Home Monitoring

Lay Yean Woo1

 

Djerriwarrh Health Services, PO Box 330, Bacchus Marsh, Victoria, 3340, LayY@djhs.org.au

 

Background

Managing the rising cost of delivering healthcare is a major challenge for Australia. Telehealth is the delivery of health related services and information via telecommunication strategies. The widespread proliferation of the internet, the capabilities offered by fast broadband infrastructure and rapid advances in health technologies have revolutionised delivery of health services possible especially in remote communities In partnership with CSIRO, Djerriwarrh Health Service participated in Australia’s first large scale telehealth clinical trial, funded by the Australian Government Broadband Enabled Telehealth Pilots Program..

Aim

Individuals with poorly controlled diabetes are a high cost to the health system as they typically have a combination of complex medical conditions, and in many cases frequently visit the hospital. The 12 month trial of telehealth services is to improve people with chronic disease such as diabetes to self-manage their conditions at home and reducing hospital admissions. This system uses a home monitor with a large screen to help guide the client through different procedures to take their blood pressure, record their blood oxygen, blood glucose, electrocardiogram, body temperature, body weight, spirometry and answer a number of clinical questionnaires.

Methodology

Twenty five patients with different chronic diseases such as diabetes, cardiac failure, chronic obstructive pulmonary disease, hypertension and asthma were recruited for home-monitoring to assess the impact of telehealth services. Patient data which was uploaded daily to a server was accessible by a clinician who then remotely provided appropriate care interactions.

Result

Results show that clients involved in the study are uniformly positive on the benefits of the telemonitoring and report increasing awareness of their conditions and a much greater capacity for self-management. Many examples where an exacerbation in the patient’s condition has been detected and early intervention either avoided hospitalisation or resulted in a better outcome of HbA1C have been observed.

Conclusion

Timeous intervention can prevent hospitalisations, reduce length of stay, reduce social dislocation and improve quality of life. Home telemonitoring enables clients to monitor their own health variables in their own homes. This has shown to deliver cost-effective, timely and improved access to quality care. Improvements in technology are reducing the need for travel, providing timely access to services, improving the ability to identify developing conditions and providing new ways to educate and support management of chronic conditions. Consequently it has the potential to reduce the burden on the healthcare system by providing more affordable strategies to support individuals to effectively self-manage their conditions such as diabetes.

MyOnlineClinic: A novel solution for connecting patients to health care providers using mobile devices

Gillian Alexis1, Ash Collins2, Farhad Fatehi3

1 MyOnlineClinic Pty Ltd, Australia, gillian@myonlineclinic.com.au

2 MyOnlineClinic Pty Ltd, Australia, ash@myonlineclinic.com.au

3 Centre for Online Health, The University of Queensland, Brisbane, Australia, f.fatehi@uq.edu.au

 

Background

MyOnlineClinic (MOC) is a Telemedicine platform which provides access to primary care from general practitioners, specialists and Allied Health to Australian patients. It is designed primarily to improve access to primary care for the patients who find distance, mobility, or travel cost as a barrier. MOC enables patients to connect to their regular General Practitioner (GP) as well as other GPs using information and communications technology. The aim of this presentation is to demonstrate the functionalities of the system, describe the service model, and report the up-to-date usage status of the system by Australian patients and GPs.

Methods

MOC is mobile-based platform that has been developed originally by Telemedicine Australia Pty Ltd with support from the University of NSW and NSW Trade & Investment. It uses the latest video technology, Bluetooth devices and file-sharing solutions without the need for any additional software, to connect patients to GPs, pharmacies, pathology, and radiology. Under MOC, the patient downloads the App from the IOS/Android store, sets up their details and can consult directly by booking a doctors through their own App without need for Medical Receptionists. Should the patient need to speak to medical administration this is available through online chat function or calling a 1800#. Repeat consults, allows the patients history to be available to the doctor to better diagnose and offer more informed treatment and scripting.  Additionally the doctor can view past history and live diagnostic data during the consult.

Results

MOC makes it possible for patients to use their own desktop computer, laptop, tablet, or smart-phone to make an appointment with a doctor, have video-consultation with the doctor and receive clinical advice, have their prescription sent to their local pharmacy and pay for the consultation online. MyOnlineClinic enables patients to collect their medical data such as temperature, blood pressure and blood glucose and communicate those information to their doctors. Doctors who use MOC can benefit from working remotely while being away from their clinic or surgery. This platform allows them to take care of their patients’ remotely as well as visit new patients who are seeking medical services. MOC allows the patient to have autonomy over their own medical records thus providing them freedom to choose the doctor, specialist or allied health professional of their choice.

Conclusion

MyOnlineClinic exhibits a unique telemedicine service and business model that can efficiently connect patients to Health Professionals, and improve access to primary medical care for Australians.

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