Telehealth on trial (again)

Northern NSW Local Health District became the second NSW health service to trial telehealth as a way of managing chronic disease.

Above: A client measures their blood-oxygen level with a wireless pulse oximeter.

By Stephen Easton

Northern NSW Local Health District (NNSWLHD) has become the second NSW health service to trial the use of telehealth equipment to support people living in the community with chronic diseases, in partnership with local North Coast non-profit aged care provider Feros Care.

The Hunter New England district undertook a similar trial last year as part of the government’s efforts to showcase the National Broadband Network in pilot towns Armidale and Kiama. 

Between now and December, groups of up to 15 people with chronic diseases in the Tweed and Murwillumbah areas will have their vital signs monitored by the equipment for six to eight weeks at a time, with the data sent to a secure website to be viewed by a triage nurse.

Any unusual spikes in the readings catalyse a quick response from the nurse, who usually contacts the client and asks appropriate questions before contacting the patient’s GP, who in some cases can provide advice over the phone, or make simple clinical decisions like adjusting medication.

Medicare rebates do not currently exist for this type of consultation, which telehealth supporters say limits how widely the service can be offered, and the quality of its outcomes.

Feros Care CEO, Jennene Buckley, described the Medicare rebates for doctors’ consultations through video link that will take effect on 1 July as “a great step forward that needs to expand now into the next stage”.

“We’re only in week two of this trial and we’ve put on five clients in the first week,” she said. “Letters have gone out to the GPs; it will be interesting to see what the responses will be this time.”

The trial will mainly target patients from three broad disease groups, including cardiac conditions like hypertension, respiratory illnesses such as chronic obstructive pulmonary disease (COPD) and diabetes, all of which are common among older Australians.

NNSWLHD coordinator of cardiac services, Kerrie Wilcox, said the idea was to give the patients more control and responsibility in managing their own ongoing conditions.

“The aim is to get people who could benefit from improving their self-management – taking ownership of their disease – to be able to monitor themselves successfully from home … and respond to any changes with their results according to their action plans,” she said. “And, to get them to see the benefits of daily monitoring, and so be able to take it on board in the long term, to improve their ability to stay at home and stay well.”

Ms Wilcox added that through their telehealth arm, Lifelink, Feros Care had provided “a really good model for how that works on the ground”.

Above: With telehealth, it’s simple to have someone checking your blood pressure every day.

Jennene Buckley described the partnership as an exciting opportunity to work with the local health district, (formed of several area health services) and share Feros Care’s knowledge and experience gained through providing the service to their own community care clients, the vast majority of which she said have one or more chronic diseases. 

“This is the area health service dipping their toes into the water,” Ms Buckley said, adding that Feros Care were now “telehealth veterans”, having provided the service since completing their own pilot study lat year.

“This isn’t another a trial for us; this is really the area health service’s first go at telehealth. This is their pilot; we’re ready to provide services now.”

“What will happen after six months?  I’m pretty positive, but I don’t know.”

The Feros Care Chief Executive said that based on data from theirs and other pilot studies, including a larger one she recently travelled to Denmark to observe, one registered nurse could monitor around 300-400 clients every day, on average.

“In Denmark they have 56 COPD clients, and it takes them just over an hour to triage all of them, so we think an RN can be triaging just under 50 an hour.”

Kerrie Wilcox agreed this was acheiveable, and said that assuming the success of other trials was repeated, more chronic disease patients would be able to use the service and play a larger role in the management of their own condition.

“We certainly hope that it will be successful and we’ll be able to look at putting more patients onto this program,” Ms Wilcox said. “We’ll have to monitor the trial and make sure we don’t have any issues – watch this space.”

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