Volume 190 - Issue 12
Telemedicine across the ages
Authors: Sabe S Sabesan, Pieter Nel and Suresh C Varma
Med J Aust 2009; 190 (12): 719. || doi: 10.5694/j.1326-5377.2009.tb02658.x
Published online: 15 June 2009
Published online: 15 June 2009
To the Editor: We agree with Smith and Gray that the uptake of telemedicine is slow despite the availability of hardware in many facilities.1
Not every field in medicine is amenable to videoconferencing consultations. Specialties in which the physical examination needs to be performed by the specialist, such as cardiology, are not suitable. However, decisions in medical oncology are based on history, pathology and imaging studies, making the specialty well suited to telemedicine. If physical examination is needed, it can be performed by a proxy examiner. Towns with high patient loads are probably not suited, but towns with fewer patients would be ideal for this method.
For the past 2 years, Townsville Hospital’s Department of Medical Oncology has managed cancer patients in Mount Isa (800 km — a 2-hour flight or 10-hour drive — from Townsville, one way) using weekly videolinked clinics. The team comprises a medical oncologist in Townsville, and a senior medical officer (SMO), a chemotherapy nurse, patients and families in Mount Isa. Except for the initial period of familiarisation, running the clinics has been smooth. Forty patients have been managed in Mount Isa in over 200 consultations. Consultations have included new cases, ward consultations and reviews. Four patients were considered for palliation only and were managed in Mount Isa without being transferred to Townsville, which was particularly helpful for those at terminal stages.
In 2008, we conducted a survey to assess the level of patient satisfaction and assessed the safety of chemotherapy delivery. We found that all 25 patients who participated in the survey were satisfied with the service, with scores of more than 80% on a five-point Likert scale (ie, “agree” or “strongly agree”).2 Ninety-two per cent of patients would rather “see” the specialist via videoconference than travel to Townsville. All three SMOs and both nurses felt they were able to communicate more effectively with and receive support from the specialists.
Thirty-two patients received active chemotherapy between 2006 and 2008. Rate of occurrence of severe side effects among patients in Mount Isa was similar to that of patients treated in Townsville (< 5%). Four patients were admitted for complications, but there were no treatment-related deaths.
We believe that this technology is safe and appreciated by patients. The technology can be adopted by medical oncologists to manage patients in rural areas, where travel by specialists and patients is not cost- or time-effective. The major advantages are that the patients have the opportunity to be treated closer to home, and doctors receive specialist support on a weekly basis.
References
- Smith AC, Gray LC. Telemedicine across the ages. Med J Aust 2009; 190: 15-19.
- Marr I, Sabesan S, Piliouras P, Nel P. Patient satisfaction, safety of chemotherapy delivery and cost-effective analysis of video-linked clinics — a North Queensland experience [abstract 403]. Asia Pac J Clin Oncol 2008; 4 Suppl 2: A29-A83. 0_i1091839
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