The use of online health techniques to assist with the delivery of specialist paediatric diabetes services in Queensland

We have tested an alternative method of delivering health services to regional areas of Queensland. By integrating telepaediatrics into an existing outreach programme for children with diabetes and endocrine conditions, we were able to reduce travel for specialist hospital staff while maintaining (and sometimes increasing) the contact patients had with the specialist team. In the first 28 months, we facilitated 160 patient consultations and 10 education sessions via videoconference through the telepaediatric service. By the end of the study, site visits were taking place annually and routine videoconference clinics were scheduled quarterly for the review of new patients and follow-up. Telepaediatric services in endocrinology and diabetes were established at three levels: the coordination of routine specialist clinics via videoconference; ad hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need; and the delivery of education to staff and patients throughout the state. The net result was improved access to specialist services from rural and remote areas of Queensland.

Attitudes toward psychiatry among students entering medical school

Objective: To survey the attitudes of Australian medical students to determine their views about the relative attractiveness of psychiatry as a career compared with other specialities, and against findings from a North American study. Method: We surveyed 655 first-year medical students attending six Australian Universities. Results: Responses indicated that Australian medical students view psychiatry as distinctly less 'attractive' than other career options, as reported in the North American sample. In comparison with other disciplines, psychiatry was regarded as more interesting and intellectually challenging, but also as lacking a scientific foundation, not being enjoyable and failing to draw on training experiences. Conclusion: Our findings suggest that psychiatry has an image problem that is widespread, reflecting Community perceptions and the specialist interests of medical students on recruitment. If psychiatry is to improve its 'attractiveness' as a career option, identified image problems need to be corrected and medical student selection processes re-considered.

Teledermatology can produce high-quality care at low cost

Teledermatology can provide both accurate and reliable specialist care at a distance. This article reviews current data on the quality of care that teledermatology provides, as well as the societal cost benefits involved in the implementation of the technique. Teledermatology is most suited to patients unable to access specialist. services for geographical or social reasons. Patients are generally satisfied with the overall care that teledermatology provides. Real-time teledermatology is more expensive than conventional care for health services. However, significant savings can be expected from the patient's perspective due to reduced travel. Appropriate patient selection, improved technology and adequate clinical workloads may improve both the quality and cost effectiveness of this service.

The cost of allied health assessments delivered by videoconference to a residential facility for elderly people

We calculated the cost of providing allied health assessments to high-dependency residents of a rural facility for elderly people. The costs of conducting assessments via videoconferencing were compared with the costs of conducting assessments face to face. The observed costs in a three-month pilot trial were used to estimate the annual costs. Given an annual workload of 1000 occasions of service, each videoconference assessment would cost $84.93, compared with $90.25 for face-to-face assessments. Allied health assessments delivered by videoconferencing became cheaper at workloads of approximately 850 occasions of service annually. Additional increases in the workload further improved the financial viability of this approach to service delivery.

Organizational aspects of e-referrals

Three different, well established systems for e-referral were examined. They ranged from a system in a single country handling a large number of cases (60,000 per year) to a global system covering many countries which handled fewer cases (150 per year). Nonetheless, there appeared to be a number of common features. Whether the purpose is e-transfer or e-consultation, the underlying model of the e-referral process is: the referrer initiates an e-request; the organization managing the process receives it, the organization allocates it for reply; the responder replies to the initiator. Various things can go wrong and the organization managing the e-referral process needs to be able to track requests through the system; this requires various performance metrics. E-referral can be conducted using email, or as messages passed either directly between computer systems or via a Web-link to a server. The experience of the three systems studied shows that significant changes in work practice are needed to launch an e-referral service successfully. The use of e-referral between primary and secondary care improves access to services and can be shown to be cost-effective.

A national survey of telehealth activity in Australian hospitals

We conducted a national survey of Australian hospitals to assess their use of telehealth. Information was sought from the 814 hospitals with 10 or more beds, excluding the small number that provided only day surgery and seven for which we could not identify a contact person. A total of 564 replies were received (a 69% response rate). Nationally, nearly half (49%) reported that they were engaged in some telehealth activity. However, there was a significant difference across jurisdictions. Hospitals in the public sector were significantly more likely to report the use of telehealth than those in the private sector (62% vs 14%). Hospital remoteness was measured according to the Accessibility/Remoteness Index of Australia (ARIA). The highest levels of use were reported by hospitals in 'very remote' and 'remote' areas (90% and 88%, respectively), with moderate levels of use in 'moderately accessible' and 'accessible' areas (67% and 52%, respectively) and the lowest level of use in 'highly accessible' areas (35%). This trend was significant.

A review of the first year's experience with an automatic message-routing system for low-cost telemedicine

The Swinfen Charitable Trust has used email for some years as a low-cost telemedicine medium to provide consultant support for doctors in developing countries. A scalable, automatic message-routing system was constructed which automates many of the tasks involved in message handling. During the first 12 months of its use, 1510 messages were processed automatically. There were 128 referrals from 18 hospitals in nine countries. Of these 128 queries, 89 (70%) were replied to within 72 h; the median delay was 1.1 day. The 39 unanswered queries were sent to backup specialists for reply and 36 of them (92%) were replied to within 72 h. In the remaining three cases, a second-line (backup) specialist was required. The referrals were handled by 54 volunteer specialists from a panel of over 70. Two system operators, located 10 time zones apart, managed the system. The median time from receipt of a new referral to its allocation to a specialist was 0.2 days (interquartile range, IQR, 0.1-0.8). The median interval between receipt of a new referral and first reply was 2.6 days (IQR 0.8-5.9). Automatic message handling solves many of the problems of manual email telemedicine systems and represents a potentially scalable way of doing low-cost telemedicine in the developing world.