Practical aspects of telehealth: doctor-patient relationship and communication

The fourth in a series of articles about the practical aspects of telehealth, this paper provides advice and information for specialists to communicate effectively with patients during a telehealth video consultation.

Practical aspects of telehealth: set-up and preparation for video consultations

The third in a series of articles about the practical aspects of telehealth, this paper gives guidance on suitable setup for video consultations, including layout of rooms, managing sound and image quality, scheduling, testing and best practice in telehealth videoconferencing.

Practical aspects of telehealth: are my patients suited to telehealth?

The first in a series of articles that demonstrate the practical aspects of telehealth, this paper provides three case studies that examine the suitability of telehealth for patients living in rural and remote areas who require ongoing specialist care.

Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments

BACKGROUND

Telehealth could be a medium for the provision of cognitive assessments to distant sites.

AIMS

The aims of the present study were to determine the interrater reliability of the Standardized Mini Mental State Exam (SMMSE) and the Geriatric Depression Scale (GDS) through Telehealth as compared to face-to-face administration.

METHODS

Duplicate interviews of subjects with crossover of interview modality were carried out. Twenty patients were interviewed between two sites 11 km apart. Subjects were persons older than 65 years (mean age 82 years) who consented to Telehealth assessments. The outcome measures were the differences in assessment scores between the two media.

RESULTS

The average SMMSE score by remote assessment was 24.0 (range 11.0-30.0) and by direct assessment was 24.3 (range 9.0-30.0). The correlation between direct and remote SMMSE scores was 0.90. The mean difference between direct and remote SMMSE scores was -0.3 (95% confidence interval (CI): -4.6 to 4.0). In 8 of 20 participants (40%) the difference between Telehealth and direct assessments was two points or more on the SMMSE. The average GDS by remote assessment was 6.1 (range 1.0-14.0) and by direct assessment was 5.8 (range 2.0-13.0). The correlation between direct and remote GDS scores was 0.78. The mean difference between direct and remote GDS assessment was 0.3 (95% CI: -3.8 to 4.4).

CONCLUSION

Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate difference between face-to-face and Telehealth assessments in some subjects, which could influence clinical decision-making.

The clinical achievements of a geriatric telehealth project in its first year

We performed a feasibility study to test the validity of conducting two standard cognitive assessments via videoconferencing. There was a high correlation between the scores from a face-to-face assessment and those from a videoconference. A second trial was conducted with patients living in a rural community, examined both face to face and via videoconferencing. Again, the validity and reliability of the assessment tools were demonstrated for videoconferencing. The acceptability of the technology to patients and clinicians was also shown. As a result of the trials and at the request of rural participants, geriatric telehealth services are now being provided to a rural aged care assessment team (ACAT) on a fee-for-service basis. The success of this project is reflected in its senior clinical and academic 'champions', the establishment of a dedicated telehealth resource and the development of protocols.

Developing a linked administrative database of health service utilisation by the aging population of Metropolitan Perth

The increasing use of health services by the older population has placed significant stresses on the health system ofWestern Australia. This is a report of the development of a linked administrative database of health resource utilisationby the aged population of metropolitan Perth. Hospital administrative databases linked to clinical or administrativedatabases of other health providers are reviewed. Length of stay data is linked to aged care assessments, referrals tonursing homes and community services. The linked databases approach allows the study of resource allocation and canpinpoint systemic stress in aged care. It is a tool for reducing the duplication of services, the pressure on beds in healthinstitutions, and cost by improving efficiencies.

The clinical achievements of a geriatric telehealth project in its first year

We performed a feasibility study to test the validity of conducting two standard cognitive assessments via videoconferencing. There was a high correlation between the scores from a face-to-face assessment and those from a videoconference. A second trial was conducted with patients living in a rural community, examined both face to face and via videoconferencing. Again, the validity and reliability of the assessment tools were demonstrated for videoconferencing. The acceptability of the technology to patients and clinicians was also shown. As a result of the trials and at the request of rural participants, geriatric telehealth services are now being provided to a rural aged care assessment team (ACAT) on a fee-for-service basis. The success of this project is reflected in its senior clinical and academic 'champions', the establishment of a dedicated telehealth resource and the development of protocols.

Using non-geriatric clinical indicators in a department of rehabilitation and aged care

We describe an audit using Gastroenterology Clinical Indicators (CIs) to measure quality of care for older patients with gastrointestinal haemorrhage. The gastroenterology CI for gastroscopy within 24 hours of admission was 60%, it was 70% for diagnosis of a cause of acute gastrointestinal bleeding after upper gastroscopy, and it was 30% for death after blood transfusion in a geriatric restorative unit. We discuss whether it is appropriate for a hospital department (Geriatric Medicine) to use the CIs for the specialty (Gastroenterology) providing the service to measure the quality of service being provided. This may be a useful approach given the trend towards cost recouping between different clinical departments.

Improving clinical indicators in acute admissions to the Department of Geriatric Medicine, Royal Perth Hospital

Clinical indicators are an important component of quality assessment of clinical services. We outline the strategies used in the department of Geriatric Medicine at Royal Perth Hospital (RPH) to report on and improve the results. The clinical indicator for assessment of cognitive function had improved from 19% in September 1998 to 64% in February 1999. The clinical indicator for assessment of physical function has been maintained at 80%. There have been revisions to the definitions of the clinical indicators for 1999. The current clinical indicators used in this department can be modified for comparison nationwide amongst geriatric units.