Aged and palliative care are two of the key focus areas for a $20.6 million pilot program announced by the federal government in April. The national broadband network enabled Telehealth Pilots Program will provide funding for innovative schemes over the next two years.
The government hopes that the ability to harness technology to support high quality palliative care in home or aged care settings could deliver massive economic benefits, while responding to patient preferences regarding their ability to die in their own homes.
A report prepared by Palliative Care Queensland for a Senate community affairs committee inquiry earlier this year found that it cost $900 per patient per day per palliative care bed compared with an average daily cost of $63 a day to deliver community-based palliative care.
A joint initiative led by the Minister for Health, Tanya Plibersek, and the Minister for Broadband, Communications and the Digital Economy, Stephen Conroy, the pilot telehealth projects are intended to demonstrate how broadband network services will benefit older or terminally ill Australians, and particularly those living in regional, rural, remote and outer metropolitan areas.
“The program also aims to provide coaching and healthy living support in the home to improve overall health outcomes for older Australians or those living with serious illness,” said Senator Conroy.
“For example, a person receiving palliative care in Armidale, NSW, could discuss symptom management with a palliative care nurse on Monday, equipment or physiotherapy needs with a physiotherapist on Thursday, and seek dietary advice the following week – all from care team members located in Newcastle.”
Dr Yvonne Luxford won’t take much convincing about the benefits of the approach. Luxford is the CEO of the Palliative Care Australia and says there are already a host of examples of care teams using technology to facilitate multidisciplinary meetings in rural and remote Australia. But she acknowledges that, to date, video-conferencing is probably not used as much as it could be in rural areas.
The advent of a Medicare claim number for video-conferencing consultations, however, plus incentives to encourage GPs to invest in video-conferencing equipment, may help remedy the situation. The rollout of higher speed, high-bandwidth communications channels courtesy of the broadband network also means that the quality of video-conferencing should improve significantly.
Besides supporting older or terminally ill patients, video-conferencing provides important professional support networks to palliative care specialists. “There might be just one nurse in palliative care [in a region] so it can be quite isolating.” Being able to connect to other specialists can be an important support for otherwise lone care providers,” Luxford said.
“I’m not sure there is so much use of actual patient monitoring though there have been a number of pilots in chronic disease. We could utilise the tools much better to enable patients and their carers to monitor their health.”
“That might include symptom management and pain management so that changing levels of pain can be monitored by a health professional. Some systems have a visual capability so that you can see the patient and the circumstances of where they are and where they are living. It’s important to know if the carers need a respite and it would be great if that could be linked into nursing homes and residential aged care.
“This is very much about empowering patients and their carers – there are a lot of medications given at home via a syringe driver and there is no reason that could not be enhanced by technology using some sort of secure Skype or a tablet – which would allow someone to talk about the reactions to the medication for example.”
Luxford believes that a technology-enabled palliative care program would also support a general desire on the part of most people to be able to die in their own homes rather than in hospital. “Last year we found that of those people who had thought about it 70 per cent would prefer to die at home.
“In Perth where there is the Silver Chain palliative care service, the [percentage] figures are in the high 60s. Nationally it’s really low, around 15 per cent as far as we know, more than half of all Australians die in a hospital,” she said.
Western Australia has become something of the poster child for technology supported palliative care services. Linda Hannig is the regional teleheath co-ordinator for the Kimberly, based in Kununurra. She explained that a communications system has been implemented which would allow up to 350 different sites to be connected as virtual meeting rooms.
Instead of attempting to get patients onto planes to visit palliative care specialists in Perth, people are able to have video-conference consultations at their local clinic if necessary. “To get to Perth for a half-hour appointment can take three days,” said Hannig. “Everyone has the right to be where they want to be when they are really ill.”
Although a palliative care physician had visited the Kimberley every second month for three days, this became unsustainable and was replaced in 2009 by four-hour palliative care video-conferences, which connected the palliative care specialist to hospitals, Aboriginal medical services, remote clinics and aged care referrals. In the first year, 100 palliative care patients were supported through the video-conferencing service.
While there were just nine video-conferencing units in the Kimberly in 2008 that has now risen to 34 and there are plans this year to run regional monthly palliative care clinics involving Aboriginal health services and all sites. Hannig said the rollout of the broadband network, expected in Broome in the next year and to much of the remainder of the region over the next three years would extend the reach of the care services.
Luxford said that a further important breakthrough would come from the arrival of electronic health records. “I’ve been told that the PCEHR [the personally controlled electronic health record which Australians can sign up for from July] will have space for an advance care directive. This is a legal document that states the kind of care you would like or not like.
“It’s about your goals of care – for example no to invasive feeding and no treatment to deliberately prolong life, that you do not want futile intervention,” said Luxford. Having that information instantly accessible as a computerised record to any treating doctor will be important in ensuring the most appropriate treatment plan is available, she said.
Having space for the record is one thing, encouraging people to use it another. As Luxford noted: “When we surveyed last year we found that 82 per cent of people hadn’t recorded what they wanted at the end of life.”
---
Quelle/Source: Aged Care INsite, Mai/June 2012
Bitte besuchen Sie/Please visit:
