Using videoconferencing to deliver a health education program to women health consumers in rural and remote Queensland: an early attempt and future plans

The role of telemedicine in the care of children in under-served communities

Children living in rural and other medically under-served areas are confronted with a shortage of paediatric specialists. Telemedicine has become increasingly popular as a means of providing health education and medical care to people living in rural areas of the United States and other countries. Some US hospitals have had experience with the use of telemedicine to provide subspecialty services to rural children with special health-care needs and health education for immigrant parents. The Medical Missions for Children, a non-profit organization, aims to provide a ‘virtual information bridge’ between sponsoring hospitals in the United States and hospitals located in developing nations. The organization serves children in hospitals in 58 countries throughout Latin America, eastern Europe, South Africa, Nigeria and India, and delivers three to four videoconferences per month. Since its inception, the programme has provided teleconsultations and services to approximately 18,000 children annually. In addition, there are on average 50 educational videoconferences per month, during which physicians at the mentoring hospitals exchange ideas with physicians in the developing countries. About 600 educational videoconferences are conducted annually.

The reported benefits of telehealth for rural Australians

Objective.A literature review was conducted to identify the reported benefits attributed to telehealth for people living and professionals working in rural and remote areas of Australia. Data sources.Scopus and relevant journals and websites were searched using the terms: telemedicine, telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory. Publications since 1998 were included. Study selection.The initial search resulted in 176 articles, which was reduced to 143 when research reporting on Australian rural, regional or remote populations was selected. Data synthesis.A narrative review was conducted using an existing ‘benefits’ framework. Patients are reported to have benefited from: lower costs and reduced inconvenience while accessing specialist health services; improved access to services and improved quality of clinical services. Health professionals are reported to have benefited from: access to continuing education and professional development; provision of enhanced local services; experiential learning, networking and collaboration. Discussion.Rural Australians have reportedly benefited from telehealth. The reported improved access and quality of clinical care available to rural Australians through telemedicine and telehealth may contribute to decreasing the urban–rural health disparities. The reported professional development opportunities and support from specialists through the use of telehealth may contribute to improved rural medical workforce recruitment and retention. What is known about the topic?An extensive international literature has reported on the efficacy of telehealth, and to a lesser extent the clinical outcomes and cost-effectiveness of telemedicine. Systematic reviews conclude that the quality of the studies preclude definitive conclusions being drawn about clinical and cost-effectiveness, although there is some evidence of effective clinical outcomes and the potential for cost-benefits. Little attention has been paid to the benefits reported for people who live in rural and remote Australia, despite this being a rationale for the use of telehealth in rural and remote locations. What does this paper add?Patients in rural and remote locations in Australia are reported to benefit from telehealth by increased access to health services and up-skilled health professionals. Health professionals are reported to benefit from telehealth by up-skilling from increased contact with specialists and increased access to professional development. The review findings suggest that one strategy, the increased use of telehealth, has the potential to reduce the inequitable access to health services and the poorer health status that many rural Australians experience, and contribute to addressing the on-going problem of the recruitment and retention of the rural health workforce. What are the implications for practitioners?The use of telehealth appears to be a path to up-skilling for rural and remote practitioners.

Exploring the feasibility and efficacy of a telehealth stroke self-management programme: a pilot study

PURPOSE

Moving On after STroke (MOST) is an established self-management programme for persons with stroke and their care partners. Through 18 sessions over 9 weeks, each including discussion and exercise, participants learn about goal-setting, problem-solving, exercise, and community-reintegration skills. This study was undertaken to evaluate the feasibility and efficacy of telehealth delivery of MOST.

METHOD

Efficacy was evaluated using an experimental non-randomized trial comparing a telehealth MOST intervention group (T-MOST) (n = 10) with a waiting list control group (WLC) (n = 8). Outcome measures included the Berg Balance Scale (BBS), the Reintegration to Normal Living Index, the Stroke-Adapted Sickness Impact Profile, Goal Attainment Scaling, and the Geriatric Depression Scale. The feasibility evaluation included attendance rates, focus groups, and facilitator logs. In MOST Telehealth, one co-facilitator was local and the other was connected by videoconference.

RESULTS

Attendance rates for persons with stroke (83.9%, SD = 2.6) and care partners (76.7%, SD = 2.9) and participant and facilitator experiences indicated feasibility of this mode of programme delivery. There was a significant difference in BBS scores between the T-MOST group and the WLC group (mean difference -4.27, 95%CI: -6.66 to -1.87). Participants reported additional benefits, including increased motivation and awareness of partners' needs. Videoconferencing was reported to decrease their sense of isolation.

CONCLUSION

It appears feasible to deliver the MOST programme with two facilitators, one connected by videoconference and one in person. In addition, preliminary evidence suggests that the programme is associated with improved well-being in persons with stroke and their care partners. Practitioners delivering self-management programmes may consider wider dissemination using videoconferencing.

Asthma educational videoconferencing for parents: a case-control study

We used a case-control, pre-post study to determine the effectiveness of educational videoconferencing in the delivery of an asthma education programme. The participants were immigrant parents attending scheduled classes on English as a second language. The cases participated in the educational videoconferences, while the controls attended a class on American civics. Knowledge in both groups was assessed with 10 true/false statements. Ninety subjects participated (47 cases and 43 controls). Controls showed no significant post-test improvement in knowledge scores (6.6 for pre-test, 6.4 for post-test). In contrast, cases demonstrated significant knowledge gain after the videoconference (7.3 vs 8.3). Educational videoconferencing was an effective tool for the delivery of health education in asthma.

The use of international videoconferencing as a strategy for teaching medical students about transcultural psychiatry

Videoconferencing is an innovative method that potentially allows medical students exposure to international teachers in refugee mental health who would otherwise be inaccessible. This article reports a pilot study using videoconferencing with international teachers from Australia, Sweden and the USA participating in the training of ten senior Swedish medical students. Interviews with an actual and a simulated patient were conducted at the U.S. and Australian sites respectively, followed by discussions involving those two sites with students and their supervisors in Sweden. Students evaluated the method favourably, as did the teachers, although the brevity of the program was seen as a limitation. Teachers noted the importance of preparing students and patients and ensuring that the technology operates smoothly to ensure success. Although cost-effective in teaching medical students in developed countries, videoconferencing may still be out of the reach of training programs in many developing countries where it is most needed.