title: The delivery of specialist spinal cord injury services in Queensland and the potential for telehealth.
abstract: BACKGROUND
  The Queensland Spinal Cord Injuries Service (QSCIS) is a statewide service in Brisbane at the Princess Alexandra Hospital (PAH). The QSCIS assists individuals with a spinal cord injury (SCI) through three services: the Spinal Injuries Unit (SIU), Transitional Rehabilitation Program (TRP) and the Spinal Outreach Team (SPOT). The aim of this study was to undertake a review of ambulatory services provided by the QSCIS (SIU and SPOT) to help identify where telehealth may potentially be useful.
  
  
  METHODS
  Profiling of patients with SCI in Queensland was achieved using database records containing referral data. Services provided by SIU Outpatient Clinics and the SPOT during a 6-year period (January 2008 - December 2013), were analysed. Using postcodes, we estimated distances between place of residence and Brisbane. We compared the general population of SCI patients with patients managed through SIU Outpatient Clinics and the SPOT.
  
  
  RESULTS
  During the 6-year period, 2073 patients were referred to the QSCIS (and living) at the time of the analysis. 74% of all patients were male. The median age was 51y (IQR 39y-61y). About two-thirds of all patients lived within 200 km of Brisbane. 24% of all patients registered with the QSCIS lived further than 200 km away from Brisbane. 7513 appointments were provided in the SIU outpatient clinic. 43,827 occasions of service were reported by the SPOT, including telephone consultations (66%) and home visits (26%). 72 outreach clinics were held in selected regional sites for up to 100 patients per year. 13 videoconference appointments reported. 90% of all patients who attended the SIU outpatient clinic lived within 200 km of Brisbane. About two-thirds of patients who received a service from the SPOT lived within 200 km of Brisbane.
  
  
  CONCLUSIONS
  Since one third of all patients registered with the QSCIS live at least 200 km away from Brisbane; it appears that these patients may not be accessing the same services as Brisbane based patients. Telehealth models of care, which promote better engagement with local health service providers (such as general practitioners, nurse practitioners and allied health professionals) could improve equity of access and reduce the need for extensive travel.
authors.affiliation: Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands. eileenvandepol@gmail.com.
authors.forename: Eileen
authors.initials: E
authors.lastname: van de Pol
authors.affiliation: PAH Telehealth Centre, Metro South Health, Princess Alexandra Hospital, Queensland, Australia. Karen.Lucas@health.qld.gov.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Lucas
authors.affiliation: Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia. Timothy.Geraghty@health.qld.gov.au.
authors.forename: Timothy
authors.initials: T
authors.lastname: Geraghty
authors.affiliation: Spinal Outreach Team, QLD Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia. Kiley.Pershouse@health.qld.gov.au.
authors.forename: Kiley
authors.initials: K
authors.lastname: Pershouse
authors.affiliation: Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia. SandraK.Harding@health.qld.gov.au.
authors.forename: Sandra
authors.initials: S
authors.lastname: Harding
authors.affiliation: Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Queensland, Australia. Sridhar.Atresh@health.qld.gov.au.
authors.forename: Sridhar
authors.initials: S
authors.lastname: Atresh
authors.affiliation: Health and Society, Department of Social Sciences, Wageningen University, Wageningen, The Netherlands. annemarie.wagemakers@wur.nl.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Wagemakers
authors.affiliation: Centre for Online Health, The University of Queensland, Queensland, Australia. asmith@uq.edu.au.|Princess Alexandra Hospital, Postal: PAH Telehealth Centre, Ground Floor, Main Building, Princess Alexandra Hospital, Woolloongabba, 4102, Australia. asmith@uq.edu.au.
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Smith
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D016208:Databases, Factual; D005260:Female; D006297:Health Services Accessibility; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D011793:Queensland; D012017:Referral and Consultation; D013038:Specialization; D013119:Spinal Cord Injuries; D017216:Telemedicine; D014195:Travel; D049269:Videoconferencing
references.citation: Arch Phys Med Rehabil. 2012 Mar;93(3):413-9
references.pmid: 22277242
references.citation: J Telemed Telecare. 2010;16(4):207-10
references.pmid: 20511577
references.citation: Arch Phys Med Rehabil. 2008 Dec;89(12):2332-41
references.pmid: 19061746
references.citation: Public Health Rep. 2001;116 Suppl 1:94-102
references.pmid: 11889278
references.citation: J Telemed Telecare. 2009;15(4):196-202
references.pmid: 19471032
references.citation: J Telemed Telecare. 2003;9 Suppl 2:S58-61
references.pmid: 14728763
references.citation: Spinal Cord. 2013 Sep;51(9):715-20
references.pmid: 23752260
references.citation: Spinal Cord. 2003 Apr;41(4):220-30
references.pmid: 12669086
references.citation: Telemed J E Health. 2006 Apr;12(2):160-2
references.pmid: 16620171
references.citation: J Telemed Telecare. 2010;16(3):152-7
references.pmid: 20386036
references.citation: Neuroepidemiology. 2010;34(3):184-92; discussion 192
references.pmid: 20130419
references.citation: Med J Aust. 2005 Oct 3;183(7):366-8
references.pmid: 16201955
references.citation: Int J Telemed Appl. 2012;2012:861860
references.pmid: 22934107
references.citation: Med J Aust. 2009 Jan 5;190(1):15-9
references.pmid: 19120002
references.citation: Clin Rehabil. 2013 Dec;27(12):1072-83
references.pmid: 23823709