Telemedicine for Specialist Geriatric Care in Small Rural Hospitals: Preliminary Data.
Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals.
Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia.|Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia.
Leonard C
LC
Gray
Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia.|School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Farhad
F
Fatehi
Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia.|Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia.
Melinda
M
Martin-Khan
Centre for Research in Geriatric Medicine, University of Queensland, Brisbane, Queensland, Australia.
Nancye M
NM
Peel
Centre for Online Health, University of Queensland, Brisbane, Queensland, Australia.|Queensland Children's Medical Research Institute, Brisbane, Queensland, Australia.
Anthony C
AC
Smith
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D015577:Geriatric Assessment; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D017216:Telemedicine
geriatrics; remote consultation; telegeriatrics; telemedicine; videoconferencing