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Getting sick in the country no longer has to mean long trips to faraway specialists.

But while telemedicine is opening up health care to regional Australia, there are still some major teething problems.

A Skype session with a specialist in your GP's surgery, emailed scans and blood tests and phone consults, are just a sample of the range of telemedicine used today.

Federal funding helped kick start it, but there are no more government funds available, according to a report by Dr Yvette Blount at Macquarie University's Centre for the Health Economy.

"In 2012, the Federal Government allocated $20.6 million to a number of service providers to pilot a telehealth services across regional and rural Australia with access to the NBN," said Connected Care: Realising the Vision, the white paper on telehealth in rural Australia.

"The majority of the pilots are focused on the home-based care of older Australians with chronic conditions, on cancer management and on palliative care.

"A pilot study will examine the effectiveness of telehealth for eye services with remote Aboriginal and Torres Straight Islanders."

Media player: "Space" to play, "M" to mute, "left" and "right" to seek.

Audio: Rural and remote health practitioners are using telehealth, but often it is disconnected and specialists get too busy for regional patients. Dr Yvette Blount, Macquarie University (ABC Rural)

But they have not been a straightforward success, according to the new report by Dr Blount.

"What (regional doctors) told me, some specialists did just enough telehealth consults to get that funding, and then chose not to provide it any more," she said.

"The second issue the GPs told me about (was that) some specialists were happy to start with consults, but once they'd built up their practices with patients, they no longer had capacity to do that."

For doctors to deliver the right medicine remotely, it is important to have electronic health records, but that too has been set back, because of privacy concerns and patients being able to tinker with their own files.

"So the records are not going to be complete or accurate, so you're not going to make good decisions using the technology," said Dr Blount.

Queensland rural GP at Cloncurry in Queensland, Dr Sheilagh Cronin, said telehealth saved patients a lot of money and stress.

"I think it's become much more widely used, partly because Queensland Health has tried to make it a default situation," she said.

"So that when you're doing a referral for instance for travel, one of the questions on the form is 'Why aren't these people having telehealth?'

"It saves them money and time and expense for the patient.

"We're using it mainly for rheumatology, psychiatry and diabetes endocrinology."

Dr Cronin agreed that the lack of electronic medical history caused gaps in treatment.

"There's no doubt there's still barriers between private and public sector," she said.

"As a private practice we can't dial into the State's notes. it's moving at snail's pace.

"Our psychiatrist can do it, dial into our private practice notes, it's coded, but she can see the patient's notes."

About 110,000 specialist services like psychiatry and paediatrics were conducted via telehealth in just the past three years, and rural and regional New South Wales and Queensland have been enthusiastic supporters.

But another question raised by the paper Connected Care: Realising the Vision is "who keeps the notes?"

"The specialist generally orders tests before they see the patients, but in this case the GP has to, so all of a sudden the GP has more work they have to do, and so who has the duty of care?" said Dr Blount.

"How are those systems talking to each other, does the GPs information system talk to the specialist system and if they have to go to hospital where are the notes coming from?

If the patient needs physiotherapy, where are the notes held?

"Then we've got smart phone apps, that aren't just recording information about our blood sugar, our blood pressure, they're now diagnosing us."

"So how do clinicians make sense of that data to make a decision about the patient's care?"

A good example of how telehealth is helping regional children is the Royal Far West Children's Health scheme.

"The children come from rural and country areas, to see a number of specialists; for example to see physios, psychiatrist, a dentist," said Dr Blount.

"They've been able to use telehealth to follow up in a month rather than wait six months for the child to come back to the city.

"It's much more effective."

Dr Blount is wanting public comment from rural doctors, specialists and patients on the cost benefit of telehealth.

"Then we've got that hard evidence to be able to inform policy on how do we fund this, how much does the Government fund, the health insurance fund and the patience fund," she said.


Autor(en)/Author(s): Sarina Locke

Quelle/Source: ABC Online, 10.02.2015

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