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0000-0001-5333-2955
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University of Queensland
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Queen's University
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Publisher: SAGE Publications
Date: 08-11-2022
DOI: 10.1177/1357633X221123409
Abstract: In Australia, the COVID-19 pandemic has resulted in the exponential growth in the delivery of telehealth services. Medicare data indicates that the majority of telehealth consultations have used the telephone, despite the known benefits of using video. The aim of this study was to understand the perceived quality and effectiveness of in-person, telephone and videoconsultations for cancer care. Data was collected via online surveys with consumers ( n = 1162) and health professionals ( n = 59), followed by semi-structured interviews with telehealth experienced health professionals ( n = 22) and consumers ( n = 18). Data were analysed using descriptive statistics and significance was tested using the chi-square test. A framework analysis and thematic analysis were used for qualitative data. Results indicate telehealth is suitable for use across the cancer care pathway. However, consumers and health professionals perceived videoconsultations facilitated visual communication and improved patients’ quality of care. The telephone was appropriate for short transactional consultations such as repeat prescriptions. Consumers were rarely given the choice of consultation modality. The choice of modality depended on a range of factors such as the type of consultation and stage of cancer care. Hybrid models of care utilising in-person, video and telephone should be developed and requires further guidance to promote the adoption of telehealth in cancer care.
Publisher: Wiley
Date: 31-05-2019
Publisher: Wiley
Date: 31-05-2019
Publisher: SAGE Publications
Date: 10-2019
Abstract: There are finite resources available to spend on healthcare, with the increasing burden of disease and the increasing cost of providing healthcare it is imperative that methods for optimising health systems to improve sustainability are investigated. This study is part of a larger body of work investigating the potential for telehealth to improve the economic sustainability of the health system. The aim of this sub-analysis is to investigate the breakeven point for implementing a telehealth service that is the point after which the initial investment is recouped and the cost savings have become tangible. Literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature focusing on telehealth. Articles were included if they reported their findings from a health system perspective, demonstrated cost savings, and provided sufficient information to calculate the breakeven point. Less than half of the economic analysis studies examined reported cost savings for the health system as a result of telehealth. The breakeven point could be calculated for 12 articles, all of which were included in the analysis. These articles described evaluations for store-and-forward, remote monitoring and videoconference services. The breakeven points for these services ranged from near immediate (less than 1 year) to 9 years. Remote monitoring and store-and-forward services reached their breakeven points sooner than the videoconference services. The results demonstrated that telehealth is cost saving for the health system in a proportion of services. When costs are saved, the breakeven point can be immediate (less than 1 year) or may take more time to eventuate.
Publisher: Wiley
Date: 03-05-2020
DOI: 10.1111/AJD.13301
Publisher: Public Library of Science (PLoS)
Date: 07-10-2016
Publisher: Elsevier BV
Date: 12-2022
Publisher: Wiley
Date: 15-09-2023
DOI: 10.1111/AJCO.14002
Publisher: JMIR Publications Inc.
Date: 19-10-2020
DOI: 10.2196/17298
Abstract: Telehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services. This study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized. A scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence. The cost analyses reviewed provided evidence that telehealth reduced costs when health system–funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians. Health services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system.
Publisher: SAGE Publications
Date: 10-2019
Abstract: Access to telehealth services for children living in rural and remote areas of Australia is very limited. The delivery of allied health therapies to children in school via telehealth may help reduce inequality and improve academic outcomes over time. A service delivering speech and language therapy (SLT) and occupational therapy (OT) via videoconferencing to children at five rural schools was prospectively evaluated. Each child’s teacher rated their speech and language, participation in class and educational outcomes at the beginning and end of semester. Change in the summative teacher-rating index over the first and subsequent semesters in which a child received therapy was examined. Independent predictors of change were identified using multivariable linear regression. Over two years, 1029 sessions of SLT and 531 sessions of OT were delivered to 98 children (67% male, 38% in Prep at commencement) via telehealth. In their first semester of therapy, 57 children received SLT, 37 OT and four both therapies. The mean teacher-rating index significantly improved from the beginning (35.05 ± 10.68) to end (40.02 ± 11.75) of the first semester of therapy ( p 0.001). In multivariable linear regression, grade, school and baseline rating were significantly associated with the end-of-semester teacher-rating index. Delivering allied health therapy by videoconference may enable children to better engage with schooling. Differences in improvements by grade suggest improvements may be maximised by targeting therapy at certain year levels. This model may be useful in areas with limited access to allied health services.
Publisher: SAGE Publications
Date: 30-10-2016
Abstract: Using a case study approach, we conducted a retrospective review of 12 months of outpatient activity at the Princess Alexandra Hospital (PAH) in Brisbane, Australia. From our dataset we calculated two variables – the telehealth-eligible substitution rate and the overall telehealth substitution rate. Telehealth eligibility is specialty-specific and is based on clinical and geographical constraints. During the study period there were video consultations ( N = 1088) and traditional consultations ( N = 41,951). The telehealth-eligible and overall substitution rates were 17.5% and 2.5%, respectively. The overall telehealth substitution rate is substantially lower than the telehealth-eligible substitution rate. This is due to the majority of patients being from local catchment areas which are currently ineligible for video consultations at the PAH. The highest observed overall telehealth substitution rate was for the radiosurgery which had telehealth activity as a reportable key performance indicator since inception of the service, which may have contributed to the relatively high rate. In-home video consultations with patients who reside in metropolitan areas are needed to substantially increase the rate of telehealth substitution.
Publisher: BMJ
Date: 03-2021
DOI: 10.1136/BMJOPEN-2020-040232
Abstract: Chronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use. A systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology. From 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring. RPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM’s effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients. CRD42020142523.
Publisher: SAGE Publications
Date: 10-2019
Abstract: Clinical facilitation is an established strategy for introducing innovation into clinical practice. The Queensland Centre for Perinatal and Infant Mental Health has used clinical facilitation to establish a telehealth service to support perinatal and infant mental health in regional, rural and remote areas of the Australian state of Queensland. The aim of this study is to explore the role of clinical facilitation in implementing and sustaining the telehealth service. Semi-structured interviews were conducted with 14 remote-site users of the telehealth service. Interviews were analysed using thematic analysis. Two dominant themes emerged: unmet need and service visibility. The study confirms the usefulness of telehealth as a way to address unmet need for specialist mental health services in regional, rural and remote areas. The study also provides evidence that a telehealth service with intermittent demand requires a consistent clinical facilitator, to keep the service visible to remote-site clinicians and maintain awareness of the service as a referral option. Previous research has identified the importance of clinical facilitation in initial service implementation. This study demonstrates the necessity of clinical facilitation for ongoing service provision. Facilitation is likely to be more important where the telehealth service responds to intermittent or infrequent clinical need, compared with high-volume services where clinics are conducted routinely.
Publisher: SAGE Publications
Date: 08-11-2022
DOI: 10.1177/1357633X221119620
Abstract: Digital health interventions can be useful for the management of chronic disease. The aim of this study was to draw out universal themes to understand how people with chronic conditions experience digital health services, programmes, and interventions, and consequently, better inform future digital health delivery. An umbrella review was conducted to identify qualitative systematic reviews reporting digital health experiences in chronic disease. Themes for each included review were independently extracted and appraised by two review authors. Data analysis was conducted using the Constant Comparative method. Twenty-two systematic reviews containing 240 in idual studies were selected for inclusion. Mental health was the most common condition ( n = 5, 23%), followed by cancer ( n = 4, 18%) or a combination of chronic diseases ( n = 4, 18%). Common themes across the conditions were categorised under nine headings, including: (i) participation and engagement (strong usability and engagement vs reluctance to use digital health when these concepts are ignored), (ii) trust, confidence, and competence (users felt reassured, however technology illiteracy led to a perceived lack of control), (iii) perceived value, perceived effectiveness, transaction cost (gained from efficient aspects of digital health, but also lost through the burden of keeping up with data entry), (iv) perceived care quality (requiring tailoring and fostering motivation), (v) barriers and threats (related to technology risks and challenges), (vi) health outcomes (improved self-management capability), (vii) relationships (improved participant-health professional interaction, but interpersonal aspects such as face-to-face contact were lacking), (viii) unplanned benefit (where digital health often led to users feeling more empowered in their health journey), and (ix) ersity of experiences (reflecting ambivalence of experiences and discipline-specific experiences). People with chronic conditions perceive digital health provides feelings of reassurance and the ability to self-manage their condition. While there is ambivalence across the participant experiences reported within the major themes, this umbrella review has outlined a need for future interventions that are user-friendly, flexible, and tailored to in idual users. This will be best achieved through a co-design model, with the consumer actively involved in the planning and design of digital health products and services.
Publisher: Wiley
Date: 08-12-2022
DOI: 10.1111/AJCO.13899
Abstract: Cancer clinical trials have traditionally occurred in‐person. However, the COVID‐19 pandemic has forced adaptions of all aspects of cancer care (including clinical trials) so they can be delivered remotely. We aimed to quantify and qualify current use of telehealth and how it can be further improved and routinely integrated into cancer clinical trials in Australia. We used a mixed‐method study design, involving surveys of 14 multi‐site Collaborative Cancer Clinical Trial Groups members across Australia ( n = 98) and qualitative interviews with trial administrators and clinicians ( n = 21). The results of our study indicated a strong willingness to use telehealth for certain transactions of clinical trials because it was perceived as a way of increasing efficiency and reach of services. Hybrid models (including telehealth and in‐person methods), which considered transaction, cancer type, and patient preferences were most favorable. Additionally, telehealth allowed for greater equity to access and reduced trial burden but interestingly had little effect on increased ersity and recruitment. Factors influencing telehealth service implementation and uptake included communication among trial stakeholders, training, and learning from the experience of others in the clinical trials community. Many but not all aspects of clinical trial care are appropriate to be delivered via telehealth. A hybrid approach provides flexibility to trial delivery and may support greater equity of access to trials in the future. Our findings and actionable recommendations support the need for greater planning, training, and guidelines to enable telehealth to be better integrated into clinical trials. Opportunities exist to expand the use of remote patient monitoring to enable more objective data collection from trial participants in the future.
Publisher: JMIR Publications Inc.
Date: 04-12-2019
Abstract: elehealth represents an opportunity for Australia to harness the power of technology to redesign the way health care is delivered. The potential benefits of telehealth include increased accessibility to care, productivity gains for health providers and patients through reduced travel, potential for cost savings, and an opportunity to develop culturally appropriate services that are more sensitive to the needs of special populations. The uptake of telehealth has been hindered at times by clinician reluctance and policies that preclude metropolitan populations from accessing telehealth services. his study aims to investigate if telehealth reduces health system costs compared with traditional service models and to identify the scenarios in which cost savings can be realized. scoping review was undertaken to meet the study aims. Initially, literature searches were conducted using broad terms for telehealth and economics to identify economic evaluation literature in telehealth. The investigators then conducted an expert focus group to identify domains where telehealth could reduce health system costs, followed by targeted literature searches for corresponding evidence. he cost analyses reviewed provided evidence that telehealth reduced costs when health system–funded travel was prevented and when telehealth mitigated the need for expensive procedural or specialist follow-up by providing competent care in a more efficient way. The expert focus group identified 4 areas of potential savings from telehealth: productivity gains, reductions in secondary care, alternate funding models, and telementoring. Telehealth demonstrated great potential for productivity gains arising from health system redesign however, under the Australian activity-based funding, it is unlikely that these gains will result in cost savings. Secondary care use mitigation is an area of promise for telehealth however, many studies have not demonstrated overall cost savings due to the cost of administering and monitoring telehealth systems. Alternate funding models from telehealth systems have the potential to save the health system money in situations where the consumers pay out of pocket to receive services. Telementoring has had minimal economic evaluation however, in the long term it is likely to result in inadvertent cost savings through the upskilling of generalist and allied health clinicians. ealth services considering implementing telehealth should be motivated by benefits other than cost reduction. The available evidence has indicated that although telehealth provides overwhelmingly positive patient benefits and increases productivity for many services, current evidence suggests that it does not routinely reduce the cost of care delivery for the health system.
Publisher: SAGE Publications
Date: 29-06-2021
DOI: 10.1177/1357633X211023700
Abstract: Telehealth is recognised as a viable way of providing health care over distance, and an effective way to increase access for in iduals with transport difficulties or those living in rural and remote areas. While telehealth has many positives for patients, clinicians and the health system, it is important that changes in the delivery of health care (e.g. in-person to telehealth) do not result in inferior or unsafe care. In this review, we collate existing meta-analyses of mortality rates to provide a holistic view of the current evidence regarding telehealth safety. In November 2020, a search of Pretty Darn Quick Evidence portal was conducted in order to locate systematic reviews published between 2010 and 2019, examining and meta-analysing the effect of telehealth interventions on mortality compared to usual care. This review summarises evidence from 24 meta-analyses. Five overarching medical disciplines were represented (cardiovascular, neurology, pulmonary, obstetrics and intensive care). Overall, telehealth did not increase mortality rates. The evidence from this review can be used by decision makers, in conjunction with other disease-specific and health economic evidences, to support and guide telehealth implementation plans.
Publisher: SAGE Publications
Date: 26-09-2017
Abstract: Health services in the United States and Europe have reported that tele-orthopaedics saves significant patient travel time, reduces time off work, increases satisfaction with care and in some scenarios reduces the cost of care. Less is known about the role of tele-orthopaedics in Australia. The aim of this study was to explore Australian-based tele-orthopaedic services, and to identify the barriers and enablers associated with these services. We used a qualitative case study methodology where specific services were identified from multiple sources and invited to participate in a structured interview. Nine tele-orthopaedic services contributed to the study. Telehealth activity in each service ranged from one to 75 patients per week, and service maturity ranged from three months to 10 years. Services were used predominantly for fracture clinics and peri-operative consultations. The majority (78%) of services used videoconferencing. Two services used asynchronous methods to review radiographs without direct patient involvement. Tele-orthopaedics was found to be disruptive as it required the redesign of many care processes. However, all services found the redesign feasible. Staff resistance was a commonly cited barrier. Further, imaging repositories from multiple imaging providers complicated access to information. Key enablers included clinical ch ions, picture archiving and communication systems, and the perceived benefit to patients who would avoid the need for travel. Whilst it appears that tele-orthopaedics is not widely utilised in Australia, recognition of the barriers and enablers is important for the development of similar services.
Publisher: SAGE Publications
Date: 07-02-2022
DOI: 10.1177/1357633X221074499
Abstract: As COVID-19 restrictions reduce globally, services will determine what components of care will continue via telehealth. We aimed to determine the clinician, service, and system level factors that influence sustained use of telehealth and develop a framework to enhance sustained use where appropriate. This study was conducted across 16 allied health departments over four health service facilities (Brisbane, Australia). It used a multi-method observational study design, involving telehealth service activity data from hospital administrative databases and qualitative interviews with allied health staff (n = 80). Data were integrated and analysed using Greenhalgh's Non-adoption, Abandonment, Scale-up, Spread, and Sustainability framework. Increased telehealth use during the peak COVID period reverted to in-person activity as restrictions eased. Telehealth is unlikely to be sustained without a clear strategy including determination of roles and responsibilities across the organisation. Clinician resistance due to forced adoption remains a key issue. The main motivator for clinicians to use telehealth was improved consumer-centred care. Benefits beyond this are needed to sustain telehealth and improvements are required to make the telehealth experience seamless for providers and recipients. Data were synthesised into a comprehensive framework that can be used as a blueprint for system-wide improvements and service enhancement or redesign. Sustainability of telehealth activity beyond the peak COVID period is unlikely without implementation strategies to address consumer, clinician, service, and system factors. The framework can inform how these strategies can be enacted. Whilst developed for allied health disciplines, it is likely applicable to other disciplines.
Publisher: Elsevier BV
Date: 06-2022
DOI: 10.1016/J.JVAL.2021.12.001
Abstract: This study aimed to systematically review and summarize economic evaluations of noninvasive remote patient monitoring (RPM) for chronic diseases compared with usual care. A systematic literature search identified economic evaluations of RPM for chronic diseases, compared with usual care. Searches of PubMed, Embase, CINAHL, and EconLit using keyword synonyms for RPM and economics identified articles published from up until September 2021. Title, abstract, and full-text reviews were conducted. Data extraction of study characteristics and health economic findings was performed. Article reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards checklist. This review demonstrated that the cost-effectiveness of RPM was dependent on clinical context, capital investment, organizational processes, and willingness to pay in each specific setting. RPM was found to be highly cost-effective for hypertension and may be cost-effective for heart failure and chronic obstructive pulmonary disease. There were few studies that investigated RPM for diabetes or other chronic diseases. Studies were of high reporting quality, with an average Consolidated Health Economic Evaluation Reporting Standards score of 81%. Of the final 34 included studies, most were conducted from the healthcare system perspective. Eighteen studies used cost-utility analysis, 4 used cost-effectiveness analysis, 2 combined cost-utility analysis and a cost-effectiveness analysis, 1 used cost-consequence analysis, 1 used cost-benefit analysis, and 8 used cost-minimization analysis. RPM was highly cost-effective for hypertension and may achieve greater long-term cost savings from the prevention of high-cost health events. For chronic obstructive pulmonary disease and heart failure, cost-effectiveness findings differed according to disease severity and there was limited economic evidence for diabetes interventions.
Publisher: SAGE Publications
Date: 22-11-2017
Abstract: The objective of this review was to identify and describe telehealth models of care for ophthalmic services. We conducted a scoping review of the literature to identify how ophthalmic care can be delivered by telehealth. We searched the PubMed database to identify relevant articles which were screened based on pre-defined inclusion criteria. For included articles, data were extracted, categorised and analysed. Synthesis of findings was performed narratively. The scoping review included 78 articles describing 62 discrete tele-ophthalmic models of care. Tele-ophthalmic models of care can be used for consultative service, screening, triage and remote supervision. The majority of services were for general eye care and triage ( n = 17 26%) or emergency services ( n = 8 12%). The most common conditions for disease-specific models of care were diabetic retinopathy ( n = 14 21%), and glaucoma ( n = 8 12%). Most models of care involved local clinicians capturing images and transmitting them to an ophthalmologist for assessment. This scoping review demonstrated tele-ophthalmology to be feasible for consultation, screening, triage and remote supervision applications across a broad range of ophthalmic conditions. A large number of models of care have been identified and described in this review. Considerable collaboration between patient-end clinicians and substantial infrastructure is typically required for tele-ophthalmology.
Publisher: Emerald
Date: 15-07-2021
DOI: 10.1108/JHOM-04-2020-0159
Abstract: This study aims to determine elements of telehealth that have the potential to increase costs for the health system in the short to medium term. A search of PubMed, EMBASE and Scopus databases was performed in May 2018 using broad terms for telehealth and economics. Articles were included if they identified and explained reasons for an increase in cost for telehealth services. Studies were categorised by economic analysis type for data extraction and descriptive synthesis. Fourteen studies met inclusion criteria and were included in the review. These studies identified that increased health system costs were due to implementation costs (e.g. for equipment, software or staff training), increased use of other healthcare services (e.g. pharmaceutical services) and ongoing service costs (including staff salaries) resulting from telehealth being additive to traditional service (e.g. increased frequency of contact). Telehealth is often assumed to be a cost-effective method of delivering healthcare, even to the point where direct cost savings are expected by decision makers as a result of implementation. However, this investigation suggests it does not routinely reduce costs for the health system and can actually increase costs at both implementation and ongoing service delivery stages. Health services considering implementing telehealth should be motivated by benefits other than cost reduction such as improved accessibility, greater patient centricity and societal cost–benefit.
Publisher: SAGE Publications
Date: 02-11-2021
DOI: 10.1177/1357633X211041859
Abstract: Telehealth can effectively increase access to specialist care and reduce the need for travel. The Geri-Connect service was established in 2017 to support people living in residential aged care facilities in regional Victoria, Australia. Using the Model for the Assessment of Telemedicine, an evaluation of the Geri-Connect service identified service activity patterns and factors associated with uptake. Service activity from 2017 to 2020 and 10 semi-structured, key stakeholder interviews were captured and analysed. Between 2017 and 2020, video consultations were provided to 53 residential aged care facilities. Sustained growth (over 178%) and strong stakeholder acceptance highlight the effectiveness of this telegeriatric service. Four recommendations provide opportunities to further enhance service delivery including: implementation of an integrated health information system systematic evaluation of service impact on stakeholders and residents, auditing and subsequent provision of targeted training and regular auditing of software and hardware. Additionally, the need to augment fixed room hardware with mobile telehealth systems would increase access for residents with mobility problems. Dedicated personnel of the centralised team are best suited to implementing the recommendations. Whilst the provision of routine telehealth services into residential aged care facilities is challenging, the Geri-Connect service demonstrates that telehealth can be effectively provided to residential aged care facility residents needing specialist geriatric care.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH17135
Abstract: Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations. Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$). Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969 731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable. Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population. What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth. What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations. What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.
Publisher: BMJ
Date: 04-09-2015
DOI: 10.1136/INJURYPREV-2014-041216
Abstract: Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. A systematic search was undertaken on literature published between 1980 and 2010 relating to interventions around fatal and non-fatal drowning prevention in children and adolescents 0-19 years of age. Search methods and protocols developed and used by the WHO Global Burden of Disease Injury Expert Group were applied. Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2-4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these. Relatively few studies employ rigorous methods and high levels of evidence to assess the impact of interventions designed to reduce drowning. Studies are also limited by lack of consistency in measured outcomes and drowning terminology. Further work is required to establish efficacy of interventions for older children and adolescents. There is a need for rigorous, well-designed studies that use consistent terminology to demonstrate effective prevention solutions.
Publisher: Oxford University Press (OUP)
Date: 07-2021
DOI: 10.1093/EURJCN/ZVAB060.139
Abstract: Type of funding sources: Public hospital(s). Main funding source(s): Queensland Health Remote patient monitoring (RPM) is an underutilised telehealth intervention that can enhance self-management of cardiovascular and pulmonary disease and reduce acute care use. However, studies of effectiveness of RPM interventions vary widely. This study aimed to explain the variation in outcomes related to RPM interventions within cardiac and pulmonary populations. Specifically, we aimed to answer why some RPM interventions are more successful than others in reducing demand on acute care services. In brief, search terms for remote monitoring and acute care utilisation were used across three electronic databases: PubMed, EMBASE and CINAHL. The search, conducted in October 2020, included articles published in the last five years (2015-2020). Articles were included if they used RPM to monitor an in idual’s biometrics (e.g. heart rate, blood pressure) from a distance while they are not in hospital. Realist review methodology was used to enable exploration of how, why and for whom interventions do and do not work. Outcomes were evaluated to determine contextual factors and potential mechanisms that led to variation in cardiac and pulmonary intervention outcomes. After screening, 91 articles met the eligibility criteria and were included. We found that across a broad range of RPM interventions 31 factors emerged that are likely to impact the effectiveness of cardiac and pulmonary RPM innovations. These were synthesised into six theories of intervention success: 1) targeting populations at high risk 2) accurately detecting a decline in health 3) providing responsive and timely care 4) personalising care 5) enhancing self-management and, 6) ensuring collaborative and coordinated care. While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and with the key variables identified within this review incorporated, it is more likely that they will be effective at reducing acute hospital events.
Publisher: BMJ
Date: 08-2021
DOI: 10.1136/BMJOPEN-2021-051844
Abstract: Our recent systematic review determined that remote patient monitoring (RPM) interventions can reduce acute care use. However, effectiveness varied within and between populations. Clinicians, researchers, and policymakers require more than evidence of effect they need guidance on how best to design and implement RPM interventions. Therefore, this study aimed to explore these results further to (1) identify factors of RPM interventions that relate to increased and decreased acute care use and (2) develop recommendations for future RPM interventions. Realist review—a qualitative systematic review method which aims to identify and explain why intervention results vary in different situations. We analysed secondarily 91 studies included in our previous systematic review that reported on RPM interventions and the impact on acute care use. Online databases PubMed, EMBASE and CINAHL were searched in October 2020. Included studies were published in English during 2015–2020 and used RPM to monitor an in idual’s biometric data (eg, heart rate, blood pressure) from a distance. Contextual factors and potential mechanisms that led to variation in acute care use (hospitalisations, length of stay or emergency department presentations). Across a range of RPM interventions 31 factors emerged that impact the effectiveness of RPM innovations on acute care use. These were synthesised into six theories of intervention success: (1) targeting populations at high risk (2) accurately detecting a decline in health (3) providing responsive and timely care (4) personalising care (5) enhancing self-management, and (6) ensuring collaborative and coordinated care. While RPM interventions are complex, if they are designed with patients, providers and the implementation setting in mind and incorporate the key variables identified within this review, it is more likely that they will be effective at reducing acute hospital events. CRD42020142523.
Publisher: Mary Ann Liebert Inc
Date: 08-2020
Publisher: University of KwaZulu-Natal
Date: 06-12-2018
Abstract: Introduction: Access to speech-language pathology services for children in rural and remote communities is often limited. Telehealth is increasingly used to provide these services to schools, demonstrating high satisfaction with both service providers and recipients, but the requirements for successful program implementation are as yet unclear. We aimed to explore the implementation requirements for a telehealth speech-language pathology service for children from the perspective of a rural school. Methods: A qualitative approach, supplemented by program activity data, was used to understand the experiences and perceptions of the benefits, limitations, enablers and barriers of a telehealth speech-language pathology program delivered to a school servicing approximately 400 children in a small rural town in the state of Queensland, Australia. Thematic analysis was conducted of transcripts of in idual semi-structured interviews with nine school teaching staff and field notes of informal discussions regarding 85 speech-language pathology telehealth sessions (n = 9 children) during program establishment and implementation. Results: The speech-language pathology telehealth service was acceptable to teaching staff at the rural school, who cited improved access, the suitability of the technology for child engagement, and perceived effectiveness. Implementation issues were highlighted as critical to program success and scalability, particularly staff workload, technological issues, communication processes, and sustainability. Conclusion: School-based speech-language pathology services delivered via telehealth were perceived as a suitable way of increasing access for children by rural school staff. Future implementations of telehealth speech-language pathology programs should prospectively consider workload implications and develop strategies to communicate with and involve school staff.
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: Prevalence of hepatitis C virus (HCV) is substantially higher among prisoners than the general population. In Australia until recently, only a small proportion of prisoners with HCV received antiviral therapy. The direct-acting antivirals (DAAs) for HCV are highly effective, with a low burden of side effects. Since 2016, DAAs are available to all Australians with HCV. However, currently in Australia, they can only be prescribed by or in consultation with experienced prescribers. This study evaluated a telementoring service to upskill doctors and nurse practitioners working in correctional facilities. The telementoring service was implemented in five correctional facilities. Qualitative interviews were used to examine the perceived clinical effectiveness and organisational impacts of the service. Content analysis of the interviews was used to identify key themes. In the first ten months of the service, there were 16 telementoring sessions with 173 patients discussed. Sixteen staff participated in qualitative interviews. From these, three key themes were identified: access to antiviral therapy organisational impacts (cost, increased staff knowledge and confidence, staff time, and workload) and, adaptations of the care model and future opportunities. Telementoring is an effective method to facilitate eligible prescriber status to medical doctors and upskill other clinicians in correctional facilities to increase capacity to treat HCV.
Publisher: Wiley
Date: 30-03-2020
DOI: 10.1111/AJD.13249
No related grants have been discovered for Monica Taylor.