Telehealth for paediatrics
This is a brief article about telehealth for paediatricians.
‘Telehealth’ video consultations use videoconferencing to conduct medical consultations in real time. Medicare payments for this service are now available for patients living outside major metropolitan areas as well as all Aboriginal Health Services (it is also available for residents in long-term care facilities). It is another means by which specialist care can be provided and offers an alternative to face to face consultations, providing more information than could be obtained by a telephone call. Telehealth video consultations improve specialist access, reduce travel time and costs for families and are generally well accepted by patients. It can also provide support and education for health workers at the patient end. Telehealth consultations can be conducted between specialists and patients (with or without a supporting health worker at the patient end). The minimum requirement is equipment to transfer audio and visual data in real time.
Considerations about the appropriateness of a telehealth consultation include the urgency of the clinical problem, the availability of resources at the patient end and the potential impact on relationships with local health-care providers. Limitations of telehealth consultations include the inability of the specialist to conduct a physical examination (although if there is a doctor at the patient end, that person can do so) and the potential for technical problems with the equipment.
A paediatric example
PC (a paediatrician) was recently consulted about a 6-year-old boy who had treatment resistant daytime urinary incontinence, nocturnal enuresis and faecal incontinence. The family lived 2 h away. After the initial face-to-face consultation, the family was asked to complete a bladder and bowel diary. Using telehealth consultations, the child's treatment was able to be tailored and his progress monitored fortnightly resulting in resolution of his problems over four visits without requiring the family to travel to Sydney each time, saving much inconvenience and family disruptions. PC has found telehealth quite easy to set up and very convenient for her patients. It has enabled her to follow up patients living at a distance more easily, without burdening them with frequent visits to see her.
Telehealth consultations are useful for assessment, clarification of diagnosis and recommendations for treatment and review. They can be used by specialists to follow up as well as to see new and urgent patients and for shared care. There are also capabilities to use telehealth for health promotion, primary care, diagnostic, allied health and tertiary care.
Where can I find out more?
There will be a series of articles about telehealth for RACP Fellows that will be published in the Internal Medicine Journal (http://onlinelibrary.wiley.com/doi/10.1111/imj.2013.43.issue-5/issuetoc). Topics will cover:
- Are my patients suited for telehealth?
- How do I set up my clinics?
- Technological considerations
- Financial considerations and
- Medico-legal and ethical issues.
The RACP is encouraging fellows to embrace telehealth. The RACP Guidelines and Practical Tips for telehealth can be accessed via the RACP website http://www.racptelehealth.com.au/.
Diana Withnall, Telehealth Support Officer from The Royal Australasian College of Physicians, can also be contacted on +61 2 9256 5432 or email firstname.lastname@example.org.