School of Medicine, University of Queensland, Australia
QIMR-Berghofer Medical Research Institute, Australia.
J Telemed Telecare. 2016 Dec;22(8):459-464. doi: 10.1177/1357633X16673794.
For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014-June 2015 (pre-expansion) was compared with July 2015- June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders.
对于昆士兰州偏远地区和农村地区的居民来说，慢性病毒性肝炎的治疗是一项重大的未满足的健康需求，因为他们很难在除了主要大都市医院之外的三级医院之外获得专科医生的治疗。为了增加昆士兰州偏远地区慢性病毒性肝炎的治疗，一个基于团队的远程医疗模式得到了扩展。该模式扩展了在专家远程医疗咨询之前先进行初始护理咨询。我们对肝病远程医疗服务的引入和扩展进行了回顾性审计。将 2014 年 7 月至 2015 年 6 月（扩展前）的活动与 2015 年 7 月至 2016 年 6 月（扩展后）的活动进行了比较。我们对主要工作人员进行了访谈，以确定促成该服务成功的因素，并确定该服务模式面临的持续挑战。与扩展前相比，临床咨询量增加了四倍多（扩展前有 131 次远程医疗咨询，扩展后有 572 次；p<0.001）。未到诊率下降（扩展前为 13.0%，扩展后为 6.5%；p=0.030），表明患者对该服务的参与度提高了。工作人员表示，在专家咨询之前，护士进行的初步评估以及为患者提供个性化的治疗包是增加患者流量和参与度的关键因素。这种扩展的团队方法似乎有效地为昆士兰州中部偏远地区的服务不足地区提供了专门的治疗。它可以作为进一步扩大昆士兰州偏远地区慢性病远程医疗管理的模型。
