The reported benefits of telehealth for rural Australians
Jennifer J. Moffatt A B and Diann S. Eley AA The University of Queensland, School of Medicine, Rural Clinical School, Locked Bag 9009, Toowoomba DC, QLD 4350, Australia. Email: d.eley@uq.edu.au
B Corresponding author. Email: j.moffatt@uq.edu.au
Australian Health Review 34(3) 276-281 https://doi.org/10.1071/AH09794
Submitted: 14 June 2009 Accepted: 4 November 2009 Published: 25 August 2010
Abstract
Objective. A literature review was conducted to identify the reported benefits attributed to telehealth for people living and professionals working in rural and remote areas of Australia.
Data sources. Scopus and relevant journals and websites were searched using the terms: telemedicine, telehealth, telepsychiatry, teledermatology, teleradiology, Australia, and each state and territory. Publications since 1998 were included.
Study selection. The initial search resulted in 176 articles, which was reduced to 143 when research reporting on Australian rural, regional or remote populations was selected.
Data synthesis. A narrative review was conducted using an existing ‘benefits’ framework. Patients are reported to have benefited from: lower costs and reduced inconvenience while accessing specialist health services; improved access to services and improved quality of clinical services. Health professionals are reported to have benefited from: access to continuing education and professional development; provision of enhanced local services; experiential learning, networking and collaboration.
Discussion. Rural Australians have reportedly benefited from telehealth. The reported improved access and quality of clinical care available to rural Australians through telemedicine and telehealth may contribute to decreasing the urban–rural health disparities. The reported professional development opportunities and support from specialists through the use of telehealth may contribute to improved rural medical workforce recruitment and retention.
What is known about the topic? An extensive international literature has reported on the efficacy of telehealth, and to a lesser extent the clinical outcomes and cost-effectiveness of telemedicine. Systematic reviews conclude that the quality of the studies preclude definitive conclusions being drawn about clinical and cost-effectiveness, although there is some evidence of effective clinical outcomes and the potential for cost-benefits. Little attention has been paid to the benefits reported for people who live in rural and remote Australia, despite this being a rationale for the use of telehealth in rural and remote locations.
What does this paper add? Patients in rural and remote locations in Australia are reported to benefit from telehealth by increased access to health services and up-skilled health professionals. Health professionals are reported to benefit from telehealth by up-skilling from increased contact with specialists and increased access to professional development. The review findings suggest that one strategy, the increased use of telehealth, has the potential to reduce the inequitable access to health services and the poorer health status that many rural Australians experience, and contribute to addressing the on-going problem of the recruitment and retention of the rural health workforce.
What are the implications for practitioners? The use of telehealth appears to be a path to up-skilling for rural and remote practitioners.
Acknowledgement
The authors thank Dr A. C. Smith of the Centre for Online Health for his editorial advice on an earlier version of the paper.
[1] Roine R, Ohinmaa A, Hailey D. Assessing telemedicine: a systematic review of the literature. CMJA 2001; 165(6): 765–71.
[2] Hersh WR, Hickam DH, Severance SM, Dana TL, Pyle Krages K, Helfand M. Diagnosis, access and outcomes: update of a systematic review of telemedicine services. J Telemed Telecare 2006; 12(Suppl. 2): 3–31.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[3] Whitten PS, Mair FS, Haycox A, May CR, Williams TL, Hellmich S. Systematic review of cost effectiveness studies of telemedicine interventions. BMJ 2002; 324(7351): 1434–7.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[4] Hailey D, Ohinmaa A, Roine R. Study quality and evidence of benefit in recent assessments of telemedicine. J Telemed Telecare 2004; 10(6): 318–24.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[5] Norton SA, Burdick AE, Phillips CM, Berman B. Teledermatology and underserved populations. Arch Dermatol 1997; 133(2): 197–200.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[6] Chandrashekhar AK. Telemedicine in Gulf War. Aviat Space Environ Med 1992; 63(2): 135–7.
| PubMed |
[7] Mair F, Fraser S, Ferguson J, Webster K. Telemedicine via satellite to support offshore oil platforms. J Telemed Telecare 2008; 14(3): 129–31.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[8] Yellowlees P, McCoy WT. Telemedicine. A health care system to help Australians. Med J Aust 1993; 159(7): 437–8.
| PubMed |
[9] Humphreys JS. Key considerations in delivering appropriate and accessible health care for rural and remote populations: discussant overview. Aust J Rural Health 2009; 17(1): 34–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[10] Margolis SA, Ypinazar VA. Tele-pharmacy in remote medical practice: the Royal Flying Doctor Service Medical Chest Program. Rural Remote Health 2008; 8(2): 937.
| PubMed |
[11]
[12] Brear M. Evaluating telemedicine: lessons and challenges. HIM J 2006; 35(2): 23–31.
| PubMed |
[13] Smith AC, Gray LC. Telemedicine across the ages. Med J Aust 2009; 190(1): 15–9.
| PubMed |
[14]
[15] Smith AC, Youngberry K, Christie F, Isles A, McCrossin R, Williams M, et al. The family costs of attending hospital outpatient appointments via videoconference and in person. J Telemed Telecare 2003; 9(Suppl. 2): 58–61.
| Crossref | GoogleScholarGoogle Scholar |
[16] Buist A, Coman G, Silvas A, Burrows G. An evaluation of the telepsychiatry programme in Victoria, Australia. J Telemed Telecare 2000; 6(4): 216–21.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[17] Cowain T. Cognitive–behavioural therapy via videoconferencing to a rural area. Aust N Z J Psychiatry 2001; 35(1): 62–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[18] D’Souza R. Telemedicine for intensive support of psychiatric inpatients admitted to local hospitals. J Telemed Telecare 2000; 6(Suppl. 1): 26–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[19] Cregan P, Stapleton S, Wilson L, et al. The ViCCU Project – achieving virtual presence using ultra broadband internet in a critical clinical application – initial results. Stud Health Technol Inform 2005; 111 94–8.
| PubMed |
[20] Doessel DP, Travers H, Hunter E. The use of touch-screen technology for health-related information in indigenous communities: some economic issues. Prometheus 2007; 25(4): 373–92.
| Crossref | GoogleScholarGoogle Scholar |
[21] Trott P. The Queensland northern regional health authority telemental health project. J Telemed Telecare 1996; 2(Suppl. 1): 98–104.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[22] Gelber H, Alexander M. An evaluation of an Australian videoconferencing project for child and adolescent telepsychiatry. J Telemed Telecare 1999; 5(Suppl. 1): 21–3.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[23] Starling RN, O’Connell C, Couzos C. NACCHO GP network – enhancing communication in Aboriginal health. S. Aust Fam Physician 2005; 34(10): 849–50.
| PubMed |
[24] Blignault I. Multipoint videoconferencing in health: a review of three years’ experience in Queensland, Australia. Telemed J 2000; 6(2): 269–74.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[25] Dillon E, Loermans J, Davis D, Xu C. Evaluation of the Western Australian Department of Health telehealth project. J Telemed Telecare 2005; 11(Suppl. 2): 19–21.
| Crossref | GoogleScholarGoogle Scholar |
[26] Lessing K, Blignault I. Mental health telemedicine programmes in Australia. J Telemed Telecare 2001; 7(6): 317–323.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[27] Greenwood J, Williams R. Continuing professional development for Australian rural psychiatrists by videoconference. Australas Psychiatry 2008; 16(4): 273–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[28] Hayward T, Mitchell JG. Renal case conference using teleradiology and videoconferencing between Adelaide and Alice Springs. J Telemed Telecare 1999; 5(3): 205–7.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[29] McColl I. Dermatology education on the web. J Telemed Telecare 2003; 9(Suppl. 2): 33–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[30] Yellowlees P, Kennedy C. Telemedicine applications in an integrated mental health service based at a teaching hospital. J Telemed Telecare 1996; 2 205–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[31] Kennedy C, Blignault I, Hornsby D, Yellowlees P. Videoconferencing in the Queensland health service. J Telemed Telecare 2001; 7(5): 266–71.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[32] Smith AC, Scuffham P, Wootton R. The costs and potential savings of a novel telepaediatric service in Queensland. BMC Health Serv Res 2007; 7 35.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[33] Trott P, Blignault I. Cost evaluation of a telepsychiatry service in northern Queensland. J Telemed Telecare 1998; 4(Suppl. 1): 66–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[34] Eedy DJ, Wootton R. Teledermatology: a review. Br J Dermatol 2001; 144(4): 696–707.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[35]
[36] Swanson B. Information technology and under-served communities. J Telemed Telecare 1999; 5(Suppl. 2): 3–10.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[37] Barry CJ, Constable IJ, McAllister IL, Kanagasingam Y. Diabetic screening in Western Australia: a photographer’s perspective. J Vis Commun Med 2006; 29(2): 66–75.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[38] Dillon E, Loermans J. Telehealth in Western Australia: the challenge of evaluation. J Telemed Telecare 2003; 9(Suppl. 2): 15–9.
| Crossref | GoogleScholarGoogle Scholar |
[39] Mitchell BR, Mitchell JG, Disney AP. User adoption issue in renal telemedicine. J Telemed Telecare 1996; 2(2): 81–6.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[40] Mathews KA, Elcock MS, Furyk JS. The use of telemedicine to aid in assessing patients prior to aeromedical retrieval to a tertiary referral centre. J Telemed Telecare 2008; 14(6): 309–14.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[41] Hall G, Hennessy M, Barton J, Coroneo M. Teleophthalmology-assisted corneal foreign body removal in a rural hospital. Telemed J E Health 2005; 11(1): 79–83.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[42] Ellis I. The clinical champion role in the development of a successful telehealth wound care project for remote Australia. J Telemed Telecare 2005; 11(Suppl. 2): 26–8.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[43] Faulkner K, McClelland L. Using videoconferencing to deliver a health education program to women health consumers in rural and remote Queensland: an early attempt and future plans. Aust J Rural Health 2002; 10(1): 65–72.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[44] Phillips JL, Davidson PM, Newton PJ, Digiacomo M. Supporting patients and their caregivers after-hours at the end of life: the role of telephone support. J Pain Symptom Manage 2008; 36(1): 11–21.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[45] St George I, Cullen M, Gardiner L, Karabatsos G. Universal telenursing triage in Australia and New Zealand – a new primary health service. Aust Fam Physician 2008; 37(6): 476–9.
| PubMed |
[46] D’Souza R. A pilot study of an educational service for rural mental health practitioners in South Australia using telemedicine. J Telemed Telecare 2000; 6(Suppl. 1): 187–9.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[47] Harris V, Smith AC, Armfield NR. Education for regional health professionals using mobile videoconferencing. J Telemed Telecare 2007; 13(Suppl. 3): 44–7.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[48] Chan FY, Soong B, Taylor A, Bornick P, Allen M, Cincotta R, et al. Fetal endoscopic telesurgery using an internet protocol connection: clinical and technical challenges. J Telemed Telecare 2003; 9(Suppl. 2): 12–4.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[49] Morris DG. Using telemedicine to facilitate training in cardiotocography (CTG) interpretation. J Telemed Telecare 2000; 6(Suppl. 1): 53–5.
| Crossref | GoogleScholarGoogle Scholar | PubMed |