Background The availability of rheumatology consultations is taken for granted in many parts of the world, but are less readily available in others, the principal barriers being either geographical or absence of suitably trained specialists. One way by which these two barriers can be overcome is by taking the consultation to the patient but in many circumstances this is not very practical. The development of telehealth technology using high quality land-line or satellite linkages can result in bring specialty consultation to patients where such barriers make them inaccessible.
Objectives This project was undertaken to evaluate the feasibility, practicality and acceptability of telehealth consults to a remote area where availability of traditional consults has not previously been available.
Methods A University urban-based rheumatologist has been linked to a family physician in a remote area 750 km from the consultant’s location and which is normally only accessible by land assuming good weather conditions. The specialist and referring physician are linked by satellite transmission for a period of two hours on a monthly basis. During each time period a minimum of 6 patients are reviewed. The physician presents the reason for the consultation, which is supplemented by the patient. Appropriate examination is undertaken by the referring physician under observation and direction from the consultant. Issues relating to diagnosis and management of the problem are dealt through 3-way communication between the referring physician, the consultant and the patient. Each of the 3 parties fills in an evaluation form as to the perceived effectiveness and acceptability of the process.
Results Over 100 patient consultations are available for evaluation. The distribution of diagnoses in the telehealth clinics does not differ significantly from those seen in the urban university referral centre. On no occasion was it felt necessary for the patient to be transferred to the referral centre and allmedical issues were appropriately dealt with through the telehealth consultation. All 3 parties felt that the process was an effective and acceptable alternative to the traditional consultation. A time and cost benefit analysis showed that there was savings in time, both for the specialist and/or the patient. A cost analysis demonstrated that a total number of 250 consultations per year resulted in cost savings using the telehealth consult rather than the traditional consultation. Additional benefits were seen to be the enhanced 3-way communication between the referring physician, the specialist and the patient, and a significant continuing professional development activity for the referring physician. The disadvantage of the consultation not being able to have direct physical contact with the patient was largely overcome assuming appropriate clinical skill of the referring physician.
Conclusion Telehealth technology has been used by a wide variety of subspecialties for delivering consultations to remote areas, but has not been evaluated in rheumatology. We conclude that this technology is both feasible, practical and acceptable as a means of delivery of Rheumatology specialists consultations and could significantly facilitate dissemination of accessibility to rheumatologists on a global scale particularly to remote areas where the subspecialty is not now available.
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