Allied Health and Human Performance, The University of South Australia, North Terrace, Adelaide, SA 5000, Australia
Department of Podiatry, Central Adelaide Local Health Network, Adelaide, SA, Australia; and Watto Purrunna Aboriginal Health Service, Port Adelaide, SA, Australia
Rural Remote Health. 2024 Feb;24(1):7970. doi: 10.22605/RRH7970. Epub 2024 Feb 28.
Diabetes-related foot disease (DFD) is one of the most prevalent causes of global hospitalisation and morbidity, and it accounts for up to 75% of lower-extremity amputations globally. The 5-year mortality rate following any amputation ranges from 53% to 100%. Early identification of wounds and multidisciplinary management can reduce amputation rates by 39-56%. Rural and remote communities and Indigenous populations are disproportionately affected by DFD. This is reflected in amputation rates, which are much higher for Indigenous than for non-Indigenous Australians and for those in very remote areas than for those in major cities or inner regional areas. The large geographical spread of the population in Australia is a substantial barrier for those providing or accessing health services, particularly multidisciplinary and specialist services, which undoubtedly contributes to poorer DFD outcomes in rural and remote communities.
A real-time, video-based telehealth service for DFD management was established at the Royal Adelaide Hospital Vascular Services clinic to improve access to specialist services for rural and remote Aboriginal and Torres Strait Islander communities. An exploratory qualitative study that utilised one-on-one, semi-structured interviews was conducted with 11 participants who identified as Aboriginal and who had participated in the telehealth foot service. Interviews were transcribed, de-identified and analysed using thematic analysis, using an inductive approach.
Four interrelated themes emerged. 'Practical benefits of staying home' describes the reduced burden of travel and advantages of having local healthcare providers and support people at consultations. 'Access to specialists and facilities' highlights how some participants felt that there was a lack of appropriate facilities in their area and appreciated the improved access telehealth provided. 'Feeling reassured that a specialist has seen their feet' reflects the positive impact on wellbeing that participants experienced when their feet were seen by specialist health staff. 'Facilitates communication' describes how participants felt included in consultations and how seeing a person on screen assisted conversation.
The advantages of real-time, video-based telehealth go beyond reduced travel burden and improved access to specialist care. This model of care may facilitate relationship-building, patient wellbeing, and feelings of trust and safety for Aboriginal and Torres Strait Islander DFD patients.
糖尿病相关足部疾病（DFD）是全球住院和发病的最常见原因之一，占全球下肢截肢的比例高达 75%。任何截肢后的 5 年死亡率在 53%至 100%之间。早期发现伤口并进行多学科管理可以将截肢率降低 39-56%。农村和偏远社区以及土著居民受到 DFD 的影响不成比例。这反映在截肢率上，土著居民的截肢率远高于非土著澳大利亚人，而非常偏远地区的截肢率高于主要城市或内部地区。澳大利亚人口分布广泛，这对提供或获得医疗服务，特别是多学科和专科服务的人来说是一个巨大的障碍，这无疑导致了农村和偏远社区 DFD 结果更差。
为了改善农村和偏远地区的土著和托雷斯海峡岛民社区获得专科服务的机会，在阿德莱德皇家医院血管服务诊所建立了一个基于实时视频的 DFD 管理远程医疗服务。对 11 名参与远程足部服务并自称为土著的参与者进行了一项探索性的定性研究，采用一对一、半结构化访谈。访谈转录、去识别并使用主题分析进行分析，采用归纳法。
出现了四个相互关联的主题。“留在家里的实际好处”描述了减少旅行负担的好处，以及拥有当地医疗保健提供者和在咨询时支持人员的优势。“获得专家和设施”强调了一些参与者认为他们所在地区缺乏适当设施，并赞赏远程医疗提供的更好的获得机会。“感到专家看过他们的脚，感到安心”反映了参与者在专科卫生人员看过他们的脚时所经历的对幸福感的积极影响。“促进沟通”描述了参与者如何感到被纳入咨询中，以及在屏幕上看到一个人如何协助对话。
实时视频远程医疗的优势不仅在于减少旅行负担和改善获得专科护理的机会。这种护理模式可能有助于建立关系、提高患者的幸福感以及为土著和托雷斯海峡岛民 DFD 患者建立信任和安全感。
