Australian utilisation of TeleHealth to assist inthe management of chronic leg ulceration. IMPORTANCE and SCOPEOutlier populations.Disadvantaged Populations.Common problem,aged and diabetic populationImportant health consequences(amputation) Colin STYLES 2012
Proof of Concept.(Literature Review)1.Ulcer Assessment.(Bowling 2011)2. Clinical outcome, telehealth assisted nurse intervention.(Wilbright 2004) Utilisation.(Literature Review) 78 citations “ehealth skin ulcer” ,steady flux over last 5-10 years.
Relevant eHealth QuestionsFor Whom?For what Clinical Problem(s)?Is it reliable(safe)?Which program?How to implement the program?Is it Economically justified?
Australian Examples.1.Bega N.S.W. Podiatrist initiated study,patient acceptance and preference. Access to expert consultation in Sydney.(Devine 2007)2.Kimberley.W.A. Randomised control Study in remote indigenous communities, better ulcer healing rates and fewer amputations. (Santamaria 2004)3.Queensland. Example of Telehealth integrated to a Health Information System,”Auscare”. Six target groups,3 metropoloitan Brisbane and others distance sites.(Lazzarini 2010)
Overview of eHealth and the Electronic Deloitte Health Record Strategy. 2006Beware that telehealth does not fragment patient records andcreatea profusion of special interest groups.Opportunities with the National BroadBand. Monash Uni. Pub.2011
Conclusion—A Process.1.Identify the needs of a Target Group2.Is the Telehealth solution an(possible)improvement on what exists?3.What is the Telehealth solution? Technical,Staff and training,acceptance, capital outlay and operating costs.4.Integration into Health informatics profile.Common standard.5.Are there improved Health Outcomes?6.Program evaluation.Modification.Abandonment.7.Economic Evaluation.8.Tolerance for Evolution.9.Risk Analysis. Loss of direct patient contact,skilled hands on care , loss of personalisation,legal,remunerative,Overview.
References.1. Remote assessment of diabetic foot ulcers using a novel wound imaging system. Bowling F, King L, Paterson J. et al. Wound Rep. Reg 2011; 19:25–302. The Use of Telemedicine in the management of Diabetes-Related Foot Ulceration: A Pilot StudyWilbright W, Birke J, Patout . et al.Adv skin wound care 2004; 17:232-38.3. User satisfaction and experience with atelemedicine service for diabetic foot disease in an Australian rural community.Devine J.Greater Southern Area Health Service (GSAHS).NSW Health.4. The effectiveness of digital imaging and remote expert wound consultation on healing rates inchronic lower leg ulcers in the Kimberley region of Western AustraliaSantamaria N, Carville K, Ellis I et al. Primary Intention 2004; 12(2): 62-70.5. Does the use of store-and-forward telehealth systems improve outcomes for cliniciansmanaging diabetic foot ulcers? A pilot studyLazzarini A, Clark D, Mann D, et al.Wound Practice and Research 2010;18(4):164-172.