Telehealth Consultations Access to Health Care and Less Carbon Emissions

J Ldo Campo MD FRACP; JLutterall MBBS, SGopal, B.Sc, Dipl. Informatik; CPava, MD FRACGP, TJ Hannan MBBS FRACP

Department of Medicine Launceston General Hospital Tasmania

INTRODUCTION
Telehealth is defined as the delivery of health-related services and information via telecommunications technologies. It therefore is a significant component of the e-health revolution to improve health care delivery.This study was design to evaluate the use of Tele Health consultations (TH) and portable devices by a General Medicine Physician (GMP) to improve the team work between himself, the General Practitioners (GP) and the patients.
METHODS
Following initial phone calls with the GP the TH consultations were arranged. Full patient consent was obtained. All communications were carried out via Skype either on a Portable Computer, iPad or iPhone. The GP practices were located between 70 to 80 Km from the main teaching hospital.The patient was always present and they had an equal level of input into the communications. There was always GP participation during the TH and provided additional information useful for the complete discussion of the case. Several weeks after the TH feedback was obtained from the patients by home phone call (TH consultations total 61 able to obtain feedback 46).
RESULTS
A total of 61 Skype consultations were performed. Eleven (11) were first consultation and forty two (42) were follow up. The quality of the image and sound communications met the standards required for an effective consultation. Immediate advice and feedback from the GMP allowed the GP to implement changes in medication or booking investigations in real time. / ADVANTAGES FOR THE GP [GP statements]
Making an appointment in a shorter time.”
“Being present during the consultation and using the consultation as a learning experience.”
“The ability to provide the specialist with all the information which might not have been provided in the referral letter.”
ADVANTAGES FOR PHYSICIAN [GMP statements]
Incorporate GP to the Department of Medicine.
Detect deteriorating patients early.
Potential reduction of patient presenting to A&E.
Chronic disease to be review together with GP.
TH works as a triage and can anticipate investigations and give directions to the GP of what to do for the patient before seen them in person.
ADVANTAGES FOR THE ENVIRONMENT
A surprising finding that lies outside the standard measures of inter-hospital and inter-clinician and inter-patient communications is the potential benefit to climate change factors with a reduction in significant carbon emissions relating to reduced patient transportation. When a 200Km distance round trip per patient the average of carbon emissions estimated in 225g/Km for 100 consultations will be a saving in 4.5 tons of carbon emissions.
ADVANTAGES FOR PATIENTS [Patient statement]
“Ability to consult a specialist irrespective of the specialist's location without the need to travel for hours.” / TH FEEDBACK QUESTIONED TO PATIENTS
Questions / Answer YES
Was TH helpful to your medical condition? / 45/46
After the TH did your (believe your condition improved? / 46/46
Were you able to ask questions during the TH? / 46/46
Was TH helpful in reducing travel waiting and cost? / 46/46
Would you use TH again? / 45/46
Would you recommend TH to others? / 46/46
Questions / Answer NO
Were you worried about your confidentiality using TH? / 46/46
CONCLUSIONS:
TH using iPad, iPhone, other mobile devices and laptop increases the versatility related to when and where do TH.
TH feedback from patientswas consistently very positive without concerns about confidentiality.
TH gave the GMP the opportunity to integrate GP and patient as a team work.
TH has potential benefit to climate change preventing carbon emissions from unnecessary patient travelling.