title: Overcoming the tyranny of distance: An audit of process and outcomes from a pilot telehealth spinal assessment clinic.
abstract: Introduction There is consistent evidence to indicate people living in rural and remote regions have limited access to healthcare and poorer health outcomes. One way to address this inequity is through innovative models of care such as telehealth. The aim of this pilot trial was to determine the feasibility, appropriateness and access to a telehealth clinic. In this pilot trial, the telehealth clinic outcomes are compared with the outreach clinic. Both models of care are commonly utilised means of providing healthcare to meet the needs of people living in rural and remote regions. Methods A prospective audit was conducted on a Spinal Assessment Clinic Telehealth pilot trial for patients with spinal disorders requiring non-urgent surgical consultation. Data were recorded from all consultations managed using videoconferencing technology between the Royal Adelaide Hospital and Port Augusta Community Health Service, South Australia between September 2013 and January 2014. Outcomes included analysis of process, service activity, clinical actions, safety and costs. Data were compared to a previous spinal assessment outreach clinic in the same area between August and December 2012. Results There were 25 consultations with 22 patients over the five-month telehealth pilot trial. Spinal disorders were predominantly of the lumbar region (88%); the majority of initial consultations (64%) were discharged to the general practitioner. There were three requests for further imaging, five for minor interventions and three for other specialist/surgical consultation. Patient follow-up post telehealth pilot trial revealed no adverse outcomes. The total cost of AUD$11,187 demonstrated a 23% reduction in favour of the spinal assessment telehealth pilot trial, with the greatest savings in travel costs. Discussion The telehealth model of care demonstrated the efficient management of patients with spinal disorders in rural regions requiring non-urgent surgical consultation at low costs with no adverse outcomes reported.
authors.affiliation: 1 Physiotherapy Department, Spinal Assessment Clinic, Spinal Unit Office, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Beard
authors.affiliation: 1 Physiotherapy Department, Spinal Assessment Clinic, Spinal Unit Office, Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Orlando
authors.affiliation: 2 School of Health Sciences, International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, Australia.
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics / Q000458:organization & administration*; D005102:Health Expenditures; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D061214:Patient Safety; D011446:Prospective Studies; D012017:Referral and Consultation; D019035:Rural Health Services / Q000191:economics / Q000458:organization & administration*; D013021:South Australia; D013122:Spinal Diseases / Q000175:diagnosis*; D017216:Telemedicine / Q000191:economics / Q000458:organization & administration*; D049269:Videoconferencing / Q000191:economics / Q000458:organization & administration*; D057832:Watchful Waiting
keywords: Telehealth; models of care; rural and remote; spinal assessment; spinal disorders