Telehealth in remote Australia: a supplementary tool or an alternative model of care replacing face-to-face consultations?

Tele-otology for Aboriginal and Torres Strait Islander People Living in Rural and Remote Areas

OBJECTIVE

To evaluate a referral-based, tele-otology service in rural and remote areas of the Northern Territory, Australia.

METHODS

A retrospective observational cohort study was performed of a tele-otology service in 93 Aboriginal and Torres Strait Islander communities (2011 to 2019). Assessments included face-to-face examinations performed by Clinical Nurse Consultants and audiologists, and asynchronous reviews performed by otolaryngologists. Multivariable logistic regression was performed to determine the likelihood of ear disease, adjusted for age and gender. Intra- and inter-rater agreement was assessed between otolaryngologists.

RESULTS

A total of 3,950 patients were reviewed (6,838 encounters, 13,726 ear assessments). The median age of patients was 9.8 years (interquartile range: 7.2 years). Overall, 62.2% of patients were identified with ear disease and 62.5% identified with hearing loss. Substantial intra- and inter-rater agreement in diagnosis was found between otolaryngologists (κ = 0.71 and κ = 0.78, respectively). The most common ear conditions identified were chronic otitis media (COM, 28.1%) and otitis media with effusion (OME, 16.5%). Topical or oral antibiotics were initiated in 14.1% of all encounters, most often for acute otitis media or COM. Surgery was recommended in 27.7% of all encounters, most often myringoplasty, adenoidectomy, and myringotomy with insertion of tympanostomy tubes.

CONCLUSION

Tele-otology is a critical component of an integrated approach to evaluating ear disease in Indigenous people living in rural and remote areas. The high prevalence of OME, COM, and surgical recommendations highlights the need for community engagement, regular follow-up, and early interventions to prevent long-term hearing loss.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2024.

Primary health care utilisation and delivery in remote Australian clinics during the COVID-19 pandemic

INTRODUCTION

The COVID-19 pandemic period (2020 to 2022) challenged and overstretched the capacity of primary health care services to deliver health care globally. The sector faced a highly uncertain and dynamic period that encompassed anticipation of a new, unknown, lethal and highly transmissible infection, the introduction of various travel restrictions, health workforce shortages, new government funding announcements and various policies to restrict the spread of the COVID-19 virus, then vaccination and treatments. This qualitative study aims to document and explore how the pandemic affected primary health care utilisation and delivery in remote and regional Aboriginal and Torres Strait Islander communities.

METHODS

Semi-structured interviews were conducted with staff working in 11 Aboriginal Community-Controlled Health Services (ACCHSs) in outer regional, remote and very remote Australia. Interviews were transcribed, inductively coded and thematically analysed.

RESULTS

248 staff working in outer regional, remote and very remote primary health care clinics were interviewed between February 2020 and June 2021. Participants reported a decline in numbers of primary health care presentations in most communities during the initial COVID-19 lock down period. The reasons for the decline were attributed to community members apprehension to go to the clinics, change in work priorities of primary health care staff (e.g. more emphasis on preventing the virus entering the communities and stopping the spread) and limited outreach programs. Staff forecasted a future spike in acute presentations of various chronic diseases leading to increased medical retrieval requirements from remote communities to hospital. Information dissemination during the pre-vaccine roll-out stage was perceived to be well received by community members, while vaccine roll-out stage information was challenged by misinformation circulated through social media.

CONCLUSIONS

The ability of ACCHSs to be able to adapt service delivery in response to the changing COVID-19 strategies and policies are highlighted in this study. The study signifies the need to adequately fund ACCHSs with staff, resources, space and appropriate information to enable them to connect with their communities and continue their work especially in an era where the additional challenges created by pandemics are likely to become more frequent. While the PHC seeking behaviour of community members during the COVID-19 period were aligned to the trends observed across the world, some of the reasons underlying the trends were unique to outer regional, remote and very remote populations. Policy makers will need to give due consideration to the potential effects of newly developed policies on ACCHSs operating in remote and regional contexts that already battle under resourcing issues and high numbers of chronically ill populations.

An After-Hours Telemedicine Urgent Care Service May Not Improve Access to Care for Underserved Populations

Background: After-hours telemedicine services for emergency care are thought to offer a solution for patients who live at a distance from traditional face-to-face emergency services. This study evaluates such a service in a Health Maintenance Organization, focusing on the differences between central and peripheral populations. Methods: In this cross-sectional database study, we collected data regarding the encounter and patient characteristics, including prescriptions, referrals for further evaluation in a traditional emergency department (ED), and the distance from a traditional ED. Other outcome measures included health care utilization after the encounter such as primary care physician (PCP) encounters, additional telemedicine encounters, ED visits, and hospitalization. Results: In total, 45,411 patient visits were analyzed. Medication was prescribed in 25% of the encounters, and a referral to an ED was given in 22%. In total, 17.7% of the patients visited an ED within 24 h of the index encounter. In total, 64.8% of patients visited a PCP in the following 30 days. No further care was needed in 32.4% of the encounters. In multivariable logistic regression, the odds of using the service were lower for low socio-economic status groups and inhabitants of the periphery than the central areas. A weak reverse correlation was observed in Jewish sectors regarding distance from traditional ED, whereas no correlation was found in the Arab sector. Conclusion: It is commonly believed that telemedicine overcomes geographical barriers. The results of this research do not support this hypothesis.

Prevalence of technology and connectivity issues in general practices in rural New South Wales and their impact on staff capability to perform their job

OBJECTIVE

To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff's capability to perform their job.

METHODS

An annual cross-sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was undertaken to determine factors independently associated with connectivity issues that negatively impact staff's capability to perform their job.

PARTICIPANTS

One hundred sixty-eight general practice managers from rural and remote New South Wales.

RESULTS

The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff's capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bivariate analysis, practices that had a total clinical staff headcount between 5 and 7 (OR 0.27; 95% CI 0.10-0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI 0.16-0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff's capability to perform their job, compared with practices with a total clinical headcount of less than five.

CONCLUSIONS

Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff's capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff's capability to do their job than larger practices. Further research is required to find solutions to address these challenges.

A corporeal conundrum: Challenges posed by remote consultation for postgraduate medical education

BACKGROUND

The COVID-19 pandemic accelerated the use of remote consultation in hospital outpatient clinics. Remote consultation alters the clinical environment and the learning environment in ways that are incompletely understood. This research sought to explore how trainees negotiate training and learning in such an environment when it is novel to them.

METHODS

Purposive sampling was used to recruit eight doctors from the gastroenterology department of an academic teaching hospital. Four consultants and four trainees participated in individual, semi-structured interviews. Interpretative phenomenological analysis of interview transcripts was employed and themes developed from the analysis, to characterise the experience of learning and teaching in remote consultation clinics, as described by participants.

RESULTS

Participants described how they try to create mental representations of each patient they review by remote consultation. Whilst consultants found this task relatively easy, trainee physicians found remote consultation more challenging and highlighted the importance of the physical presence of the patient to help them form a holistic sense of the patient's condition. Doctors in training also struggled to develop a workable mental model of the patient's condition when physical examination was precluded by remote consultation.

CONCLUSIONS

This study highlights the place of the patient's physical presence as an essential educational stimulus to facilitate teaching and learning. Further research is needed to characterise the processes clinicians use to formulate mental models of patients who are physically absent from the consultation room.

Novel ENT live telehealth and live video-otoscopy clinics in remote Australia: outcomes and comparisons to traditional clinic models

BACKGROUND

Coronavirus disease 2019 challenged the delivery of healthcare in Australia, disproportionately impacting vulnerable patients, including Aboriginal and/or Torres Strait Islander peoples and those living in remote regions. The otolaryngology service provided to remote Western Australia adapted to these barriers by altering clinical consultations to a digital model.

METHODS

A review was undertaken of patients in regional Western Australia. Demographics and clinical outcomes from 20 live telehealth clinics were retrospectively reviewed and compared to 16 face-to-face clinics.

RESULTS

The demographics of patients reviewed in both live telehealth and face-to-face clinics were similar, except for a larger proportion of Aboriginal and/or Torres Strait Islander patients utilising telehealth. The outcomes of patients reviewed through each model of care were comparable. Live video-otoscopy provided diagnostic quality images in 92 per cent of cases.

CONCLUSION

The findings of our review suggest that, despite its limitations, a large proportion of ENT patients may be safely assessed through a live telehealth model.

Healthcare professionals' experiences and perceptions of artificial intelligence in regional and rural health districts in Australia

INTRODUCTION

A greater understanding of Australian healthcare professionals' perceptions of artificial intelligence (AI) is needed to identify the challenges ahead as this new technology finds its way into healthcare delivery.

OBJECTIVE

The aim of this study was to identify healthcare professionals' perceptions of AI, their understanding of this technology, their education needs and barriers they perceived to its implementation.

DESIGN

Healthcare professionals in eight local health districts in New South Wales Australia were surveyed using the Shinners Artificial Intelligence Perception (SHAIP) tool.

FINDINGS

The study surveyed 176 participants from regional (59.5%), rural (36.4%) and metropolitan (4.0%) healthcare districts in Australia. Only 27% of all participants stated they are currently using AI in the delivery of care. The study found that Age, Discipline, Use of AI and Desire for Education had a significant effect on perceptions of AI, and that overall healthcare professionals believe AI will impact their role and they do not feel prepared for its use. The study showed that understanding of AI is varied and workforce knowledge is seen as the greatest barrier to implementation. More than 75% of healthcare professionals desire education about AI, its application and ethical implications to the delivery of care.

CONCLUSION

The development of education is needed urgently to prepare healthcare professionals for the implementation of AI.

The Significance of Physician-Patient Communication on Telemedicine Patients' Health Outcomes: Evidence from Indonesia

The importance of physician-patient communication on patient health outcomes has been globally known. Poor communication in clinical settings, including in telemedicine visits, has been identified as a key barrier to successful medical consultation. This barrier is even more prevalent among people from linguistically and culturally diverse communities. This study investigated the influence of physician-patient communication on telemedicine patient health outcomes in Indonesia, a developing country with great linguistic and cultural diversity. This study utilized secondary data from a telemedicine utilization survey conducted during the coronavirus disease 2019 (COVID-19) pandemic. Socioeconomic factors and communication features were included as predictors of patients' health improvement. Logistic regressions were utilized to examine the significance of the communication features on patients' health. The analysis results indicated that five communication features including the adequacy of consultation length, a timely physician response, the provision of an explanation of the medication and possible side effects, the patient's ability to utter their physical condition and opinion regarding medication goals, and the patient's ability to comprehend physician explanations and instructions were significantly associated with the patient's health outcomes. Physicians and healthcare providers should focus on the provision of communication features revealed in this study to elevate the likelihood of improved health conditions in telemedicine patients.