A telegeriatric service in a small rural hospital: A case study and cost analysis

Introduction Small hospitals in rural areas usually have an insufficient caseload of frail old people to justify the regular presence of a geriatrician. This study examined the costs of providing a telegeriatric service by videoconference in a rural hospital, compared to the costs of a visiting geriatrician that travels to undertake in-person consultations. Methods A cost analysis was undertaken to compare the costs of the telegeriatric service model with the costs of a visiting geriatrician service model. A recently established telegeriatric service at Warwick Hospital was used as a case study. Results In the base case model (assuming four patients per round and a round-trip travel distance of 312 kilometres), an estimated AUD$131 per patient consultation can be saved in favour of the telegeriatric service model. Key drivers of costs are the number of patients per round and the travel distance and time in the visiting geriatrician model. At a workload of four patients per round, it is less expensive to conduct a telegeriatric service than a visiting geriatrician service when the round-trip travel time exceeds 76 minutes. Discussion Even under quite conservative assumptions, a telegeriatric service offers an economically feasible approach to the delivery of specialist geriatric assessment in rural and remote settings

Effects of a geriatric outreach program on the care of older adults in Northern British Columbia

The Northern Health Authority’s Geriatric Outreach Program provides consultations with geriatric specialists in-person and through videoconference. With Canada’s population aged 65+ expected to increase over the next several years, there is precedent to explore service delivery methods and how they influence care of older adults. Using a multi-method research design, formal-care providers’ perspectives of the Geriatric Outreach Program were explored, and the outcomes and costs of in-person and videoconferencing components were compared. Results revealed that the program supports care of older adults by providing access to geriatric care closer to patients’ homes and by providing comprehensive care plans back to the referring general practitioners. Costs of videoconferencing consultations were lower than in-person costs due to the added expense of specialist’s travel, and videoconferencing also resulted in more new diagnoses, medication changes, further testing, and requests for follow-up. However, further research is needed to fully understand these differences in outcomes

Promoting Clinical Engagement and Cross-sector Collaboration Through Changes in Workforce, Use of Technology, and Improved Business Systems

Published version made available here with permission from publisher.Background: Cross-sectoral collaboration across health care settings has the potential to deliver efficiencies as well as improve health care outcomes. There is a need for better understanding and awareness of models, mechanisms and strategies that enhance crosssectoral collaboration in Australia. Improved cross-sectoral collaboration is supported by a number of changes in workforce, use of technology and improved business systems. This review seeks to summarise these programs for those who may be seeking to engage in this area as a means of determining the range of options and possible proven benefits. Methodology: This study employs a mixed methods approach. A pragmatic literature review was undertaken to determine the relevant collaborative care models and review current programs Australia-wide that implement these models. Programs were selected from searching the grey and indexed medical literature as well as suggestions obtained from relevant stakeholders. Criteria for inclusion included having description in the peer reviewed and grey literature, ability to represent a unique model, extent of current use and description of outcomes of the intervention. Additional qualitative semi-structured interviews were conducted to elucidate more detailed information about technology, workforce and business systems. This information is summarised in the report and details about the individual programs are included as an appendix to this report. Results: Fifteen models were reviewed for this report. Qualitative semi-structured interview data were employed to supplement findings from the literature review. Key mechanisms of these models are described specifically focusing on the use of technology, workforce and business systems. Facilitators and barriers were identified and explored

When new technology is an answer for old problems: the use of videoconferencing in cognitive aging assessment

People living with cognitive impairment and dementia require regular screening of their symptomatology and needs. Brief cognitive screening is crucial for assessing these conditions. Such screening can give health professionals a snapshot of the patient’s cognitive abilities and help in their monitoring and adaptation. An appropriate administration of brief cognitive screening using telemedicine technology, such as videoconference, can improve access to care and treatment planning. Moreover, the burden that rural and underserved communities often suffer because of limited access to specialty mental health services is also of concern. Herein, in this review, we describe the existing and relevant research regarding the administration of neuropsychological instruments via videoconferencing, and suggest methodological improvements for further studies. To date, only a handful of scientific studies have been published documenting the feasibility and acceptability of videoconferencing among older people and health professionals. Varying in their assessment tools, the studies demonstrate the reliability of cognitive testing and clinical diagnosis of dementia via videoconferencing, as noted by the associations between results of several cognitive tests using it as compared to face-to-face interviews. Further research is required to replicate findings and bring new solutions for their adaptation to a wide range of individuals, health professionals, areas of practice and settings.info:eu-repo/semantics/publishedVersio

Telepsychiatry: The Evaluation and Treatment of Seniors in Rural Retirement Communities

Few studies examine the benefits from geriatric telepsychiatry in rural retirement communities. Objectives: 1. To demonstrate that using telepsychiatry a) standard approaches to psychiatric evaluation would yield diagnoses in Diagnostic and Statistical Manual of Mental Disorders (DSM-V); b. psychotherapies and pharmacotherapy could be effectively administered.  2. To examine the relationships among cognition, mood, agitation and functions at baseline and the response to treatment over time. Design: Prospective longitudinal study. Measures: Geriatric Depression scale (GDS), Mini Mental State Exam (MMSE), Barthel Index (BI), Pittsburgh Agitation Scale (PAS).  Setting: Video Teleconferencing.  Interventions: Psychotherapy, psychopharmacology. Participants: 428 Seniors over 55, met criteria for at least one DSM-V diagnosis. Results: Treatments were administered for a full range of psychiatric diagnoses and age-related medical conditions.  The most frequently prescribed pharmacological agents were: antidepressants (78%) antipsychotics (64%), memory enhancers (38%).   Participants (66%) received psychotherapy: individual (31%), couple (7%), family (13%). Variation in the MMSE scores were observed: 55% remained stable, 11% declined, 18% improved. GDS Scores improved from baseline to 26 weeks (p=0.02, d=0.99: 95% CI 0.39-1.56). PAS scores declined from baseline to 52 weeks  (McNemar’s S= 11.27, p=0.0008, d=1.17: 95% CI 0.63-1.68).   Function (BI) at week 26 was not statistically significantly different from baseline (t(26)=1.66, p=0.11, d=0.65: 95%CI -0.16-1.42). Participants maintained independence (64.5%) at 52 weeks  (McNemar’s S = 6.23, p=0.013, d=0.79: 95%CI 0.19-1.36) Conclusion: This study demonstrates the feasibility and benefit of providing a full complement of services via telepsychiatry to seniors and provides a rationale for more comprehensive reimbursement plans .

CASCADE baseline review of current partner technology enabled care service (TECS) initiatives and proposal for a collaborative evaluation strategy

This report covers D 3.3.1 and D3.3.2 of the CASCADE project providing a preliminary summary of existing telemedicine/telehealth technologies reported in the literature alongside an analysis of existing usage reported by partner sites PP2, 3, 5, 6 and 8. Partners were asked to provide information that addressed a series of questions summarised below. 1. What technology you are currently using and why? 2. When was the technology introduced and how is it being used with what kinds of populations of residents/patients/clients/staff including the reach (numbers)? 3. How much has this technology cost to be introduced (set up costs) and how much does it cost to run (running costs)? 4. What evidence has your organisation collected to date to show what beneficial impacts it is having and why? 5. What metrics does your organisation use to demonstrate the link between the technology and improvements in quality of life indicators for your client groups/staff groups (this may be Prezo/ Belrai/ InterRai data as well as staff wellbeing survey data) and feedback from relatives and families in satisfaction questionnaires? 6. What intentions, if any, do you have to expand or introduce new telemedicine/ e-health technologies? 7. What baseline financial figures do you have to support the introduction of the technology that you can share

Enhancing The Self-Efficacy Of Nurses In The Reduction Of Potentially Avoidable Nursing Home To Hospital Transfers

Nursing home hospitalizations are classified as potentially avoidable when they do not improve quality of life or change the course of illness. These hospitalizations are costly, disruptive and detrimental to the quality of nursing home care. Nurses maintain the interconnection amongst the key stakeholders involved in the decision to hospitalize and are integral to the efforts employed in reducing potentially avoidable transfers. The purpose of this project is to enhance the self-efficacy of long-term care nurses with respect to reducing potentially avoidable nursing home hospitalizations, utilizing an expert validated educational module. A review of the literature on potentially avoidable nursing home hospitalizations was completed. Bandura’s concept of self-efficacy was used to guide the development of the educational module. An on-line educational module was designed utilizing both audio and visual material. A panel of subject matter experts validated the curriculum. The palliative care self-efficacy scale was used to measure participant self-efficacy and advanced directives were measured to determine impact on nursing practice. Based on the results, it is deduced that this educational intervention enhanced the self-efficacy of the participating nurses and potentially increased the number of documented facility advanced directives. This educational module has the potential to enhance the self-efficacy of long-term care nurses with respect to reducing potentially avoidable hospitalizations. The next steps of this project include measuring potentially avoidable transfers pre and post intervention

Telehealth in primary health care settings within Australia and internationally

Access to appropriate health care services is often limited for people living in rural or remote areas, or for those with restricted mobility. One approach to minimising the inequality in access for those located at a distance from health care services is through telehealth service delivery. This review examined the evidence on telehealth models in Australia and elsewhere, with a specific focus on synchronous, real-time video consultations, where patients and health care providers were present simultaneously