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Background: Patient demand for oral and maxillofacial telehealth services increased during COVID-19. To explore the potential for their continued use post-COVID-19, an assessment was conducted by examining the association between the clinical and socio-demographic characteristics of consultants and the perceived facilitators and barriers influencing their future intent. Methods: Practicing oral and maxillofacial consultants were recruited through purposive and snowball sampling methods. Data were collected through surveys and key informant interviews. Chi-square tests were used to determine whether consultants' clinical and socio-demographic characteristics and perceptions were associated with a willingness to use telehealth in the future. Coded interview transcripts were analyzed thematically to identify the main themes influencing their willingness. Results: Among the 42 respondents, 82% expressed a willingness to continue using telehealth services with the majority having at least 2 to 3 years (p = 0.028) of experience utilizing these services. The four main themes impacting consultants willingness include the accessibility of oral and maxillofacial healthcare, challenges addressing patient needs, the uncertainty of diagnostic accuracy and effectiveness as a post-operation observation tool. Conclusion: Most oral and maxillofacial consultants favored the routine use of telehealth services beyond COVID-19. Concern for patients' needs was a key determinant of their continued use. Co-designing strategies to eliminate barriers and unmet needs for consultants and patients may improve oral and maxillofacial telehealth uptake. [ABSTRACT FROM AUTHOR]

Design: A multi‐methods, single‐centre pilot comprising a quasi‐experimental pre‐/post‐test design and an exploratory qualitative study. Setting: A rural Australian hospital and health service. Participants: Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. Intervention: The intervention comprised a 12‐week virtual care program delivered via teleconference by a specialist nurse, using a pre‐existing connected care platform. The program was tailored to the post‐operative recovery journey targeting post‐operative care, psychoeducation, problem‐solving and goal setting. Main Outcome Measures: Primary outcome: program acceptability. Secondary outcomes: quality of life; prostate cancer‐related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post‐intervention (T2); and 12 weeks post‐intervention (T3). Results: Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. Conclusions: This pilot has shown that a tailored nurse‐led virtual care program, incorporating post‐surgical follow‐up and integrated low‐intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite Government investment, disparity in access to clinical trials continue between metropolitan and regional & rural sectors (RRR) in Australia and around the world. To improve trial access closer to home for RRR communities and rare cancer patients even in metro settings, the Australasian Teletrial Model (ATM) was developed by Clinical Oncology Society of Australia and implemented in four states. Aim of this paper is to describe the steps and processes involved in the development and implementation of ATM guided by implementation science frameworks. Method: Two implementation science frameworks namely iPARIHS and Strategic Implementation Framework were chosen to guide the project. Details of steps and processes were extracted from COSA final report. Results: ATM met the criteria for worthy innovation. For the development and implementation of the ATM, stakeholders were at national, statewide and clinical levels. A co-design with end-users and inclusion of key stakeholders in steering committees and advisory groups made the implementation smoother. Clinician levers including advocacy were useful to overcome system barriers. During the project, more patients, and clinicians at RRR participated in trials, more primary sites collaborated with RRR sites and more RRR sites gained trial capabilities. Conclusion: Pilot project achieved its objectives including improved access to patients locally, creation of linkages between metro and RRR sites and enhanced capabilities of and access to RRR sites. Implementation science frameworks were useful for identifying the necessary steps and processes at the outset. Ownership by governments and creation of streamlined regulatory systems would enable broader adoption. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic increased the use of telehealth consultations by telephone and video around the world. While telehealth can improve access to primary health care, there are significant gaps in our understanding about how, when and to what extent telehealth should be used. This paper explores the perspectives of health care staff on the key elements relating to the effective use of telehealth for patients living in remote Australia. Methods: Between February 2020 and October 2021, interviews and discussion groups were conducted with 248 clinic staff from 20 different remote communities across northern Australia. Interview coding followed an inductive approach. Thematic analysis was used to group codes into common themes. Results: Reduced need to travel for telehealth consultations was perceived to benefit both health providers and patients. Telehealth functioned best when there was a pre-established relationship between the patient and the health care provider and with patients who had good knowledge of their personal health, spoke English and had access to and familiarity with digital technology. On the other hand, telehealth was thought to be resource intensive, increasing remote clinic staff workload as most patients needed clinic staff to facilitate the telehealth session and complete background administrative work to support the consultation and an interpreter for translation services. Clinic staff universally emphasised that telehealth is a useful supplementary tool, and not a stand-alone service model replacing face-to-face interactions. Conclusion: Telehealth has the potential to improve access to healthcare in remote areas if complemented with adequate face-to-face services. Careful workforce planning is required while introducing telehealth into clinics that already face high staff shortages. Digital infrastructure with reliable internet connections with sufficient speed and latency need to be available at affordable prices in remote communities to make full use of telehealth consultations. Training and employment of local Aboriginal staff as digital navigators could ensure a culturally safe clinical environment for telehealth consultations and promote the effective use of telehealth services among community members. [ABSTRACT FROM AUTHOR]

Objective: To assess the acceptability of a nurse‐led prostate cancer survivorship intervention adapted for virtual delivery and tailored to post‐surgical care, in a regional Australian hospital and health service. Methods: A qualitative exploratory study using the Theoretical Framework of Acceptability (TFA). Results: Twenty‐two participants took part in a semistructured interview comprising men who had completed the program (n = 16) and health professionals/service stakeholders involved in program delivery (n = 6). Acceptability of this virtual prostate cancer survivorship care program was very high across all constructs of the TFA, from the perspectives of both program recipients and those delivering the program. The quality of care received was seen as superior to what men had experienced previously (burden, opportunity costs). The time afforded by the regularly scheduled video‐consultations allowed men to come to terms with the recovery process in their own time (self‐efficacy), and provided an ongoing sense of support and access to care outside the consultation (ethicality). Clinically, the program improved care co‐ordination, expedited identification of survivorship care needs, and met service priorities of providing quality care close to home (burden, perceived effectiveness). Conclusions: Findings from this study suggest virtual post‐surgical care delivered via videoconferencing is highly acceptable to prostate cancer survivors in a regional setting. Future research exploring virtual program implementation at scale and long‐term patient and service outcomes is warranted. [ABSTRACT FROM AUTHOR]

Background and Aims: The COVID-19 pandemic significantly disrupted lower limb diabetes care. We aimed to map trends in diabetes-related lower limb amputation and hospitalisation rates through the COVID-19 pandemic., Methods: We performed a retrospective cohort study of all individuals who underwent a lower limb amputation for a diabetes-related foot complication from 2018 to 2021 at the Royal Melbourne Hospital, a quaternary hospital in Australia. Hospitalisation rates with a diabetes-related foot complication were collected for comparison. The start of the COVID-19 epoch was defined as 16 March 2020, when a state of emergency was declared in Melbourne., Results: During the study period, 360 lower limb amputations for diabetes-related foot complications were performed in 247 individuals. The median monthly number of amputations remained stable prior to and during the COVID-19 epoch; there was a median of 8.0 amputations per month (interquartile range (IQR) = 6.5-11) before COVID-19, compared to 6.5 amputations (IQR = 5.0-8.3) during the COVID-19 epoch (P = 0.23). Hospitalisation with a diabetes-related foot complication significantly increased from a median monthly rate of 11 individuals (IQR = 9.0-14) before COVID-19 to 19 individuals (IQR = 14-22) during the COVID-19 epoch (p < 0.001)., Conclusions: Despite increased hospitalisations for diabetes-related foot complications during COVID-19, there was not a corresponding increase in amputation rates. Face-to-face care of diabetes-related foot complications was prioritised at this centre and may have contributed to stable amputation rates during the pandemic., (© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Effective alcohol and other drugs (AODs) treatment has been proven to increase productivity and reduce costs to the community. Telehealth has previously been proven effective at delivering AOD treatment in the right settings. Yet, Australia's current Medicare funding restricts telephone consultations., Aim: We hypothesise that treatment modality influences attendance rates. Specifically, telephone consultations can remove barriers to accessing treatment and, therefore, can increase attendance., Methods: We conducted a retrospective audit on our addiction medicine specialist outpatient service from 1 July 2022 to 30 June 2023. A mixed-effects logistic regression model was used to analyse factors associated with attendance rates., Results: There were 576 participants in the study, and 3354 appointments were booked over the 12-month study period. Of these, 2695 were face-to-face, 541 were telephone and 118 were video. The unadjusted raw attendance rate was highest in the telephone group (87.24%), followed by face-to-face (73.02%) and video (44.92%). After adjusting for covariates, telephone consultation was associated with significantly increased odds of attending compared to face-to-face (odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.90-3.54, P < 0.001). Video consultation was associated with a 69% reduction in the odds of attending compared to face-to-face (OR = 0.31, 95% CI = 0.019-0.49, P < 0.001)., Conclusions: While physical attendance may be required for specific clinical care, telephone consultations are associated with increased attendance and can form an important adjunct to delivering addiction treatment. Given the substantial costs of substance use disorders, this could inform government policies and funding priorities to further improve access and treatment outcomes., (© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Over the past decade, the adoption of virtual wards has surged. Virtual wards aim to prevent unnecessary hospital admissions, expedite home discharge, and enhance patient satisfaction, which are particularly beneficial for the older adult population who faces risks associated with hospitalization. Consequently, substantial investments are being made in virtual rehabilitation wards (VRWs), despite evidence of varying levels of success in their implementation. However, the facilitators and barriers experienced by virtual ward staff for the rapid implementation of these innovative care models remain poorly understood., Objective: This paper presents insights from hospital staff working on an Australian VRW in response to the growing demand for programs aimed at preventing hospital admissions. We explore staff's perspectives on the facilitators and barriers of the VRW, shedding light on service setup and delivery., Methods: Qualitative interviews were conducted with 21 VRW staff using the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework. The analysis of data was performed using framework analysis and the 7 domains of the NASSS framework., Results: The results were mapped onto the 7 domains of the NASSS framework. (1) Condition: Managing certain conditions, especially those involving comorbidities and sociocultural factors, can be challenging. (2) Technology: The VRW demonstrated suitability for technologically engaged patients without cognitive impairment, offering advantages in clinical decision-making through remote monitoring and video calls. However, interoperability issues and equipment malfunctions caused staff frustration, highlighting the importance of promptly addressing technical challenges. (3) Value proposition: The VRW empowered patients to choose their care location, extending access to care for rural communities and enabling home-based treatment for older adults. (4) Adopters and (5) organizations: Despite these benefits, the cultural shift from in-person to remote treatment introduced uncertainties in workflows, professional responsibilities, resource allocation, and intake processes. (6) Wider system and (7) embedding: As the service continues to develop to address gaps in hospital capacity, it is imperative to prioritize ongoing adaptation. This includes refining the process of smoothly transferring patients back to the hospital, addressing technical aspects, ensuring seamless continuity of care, and thoughtfully considering how the burden of care may shift to patients and their families., Conclusions: In this qualitative study exploring health care staff's experience of an innovative VRW, we identified several drivers and challenges to implementation and acceptability. The findings have implications for future services considering implementing VRWs for older adults in terms of service setup and delivery. Future work will focus on assessing patient and carer experiences of the VRW., (© Leanne Greene, Miia Rahja, Kate Laver, Vun Vun Wong, Chris Leung, Maria Crotty. Originally published in JMIR Aging (https://aging.jmir.org).)

The objective of this study was to assess the viability and acceptability of an innovative Virtual Wound Care Command Centre where patients in the community, and their treating clinicians, have access to an expert wound specialist service that comprises a digital wound application (app) for wound analysis, decision-making, remote consultation, and monitoring. Fifty-one patients with chronic (42.6%) wounds were healed, with a median time to healing of 66 (95% CI: 56-88) days. All patients reported high satisfaction with their wound care, 86.4% of patients recommended the Virtual Wound Care Command Centre with 84.1% of patients reporting the app as easy to use. The data revealed that the Virtual Wound Care Command Centre was a viable and acceptable patient-centred expert wound consultation service for chronic wound patients in the community.

Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Comorbid psychological distress (i.e. insomnia and depression) is experienced by 20–40% of patients with cardiovascular disease. This has a considerable impact on their health and quality of life, leading to frequent re-hospitalisations, higher healthcare costs and a shorter life expectancy. Internet-based cognitive behavioural therapy shows great potential for treating psychological distress in cardiovascular disease. Effective and feasible treatments can, however, only benefit patients if they are fully implemented in clinical care. Aim: This scoping review aimed to explore the literature for internet-based cognitive behavioural therapy in cardiovascular disease and for strategies to implement the intervention. Methods: We searched electronic databases, journals and internet sources to find original studies about internet-based cognitive behavioural therapy in cardiovascular disease, adhering to scoping methodology guidelines. After identifying 267 titles, we screened 40 abstracts and chose 11 full-text articles for full-text screening. The results sections in four articles were searched for outcomes that related to the effectiveness and implementation of internet-based cognitive behavioural therapy by directed qualitative content analysis using an implementation framework. Results: Three of the four articles fulfilling the inclusion criteria concerned internet-based cognitive behavioural therapy for treating mild to moderate depressive symptoms in cardiovascular disease, and none focused on insomnia. The studies showed evidence for the effectiveness of internet-based cognitive behavioural therapy, and/or described patient factors influencing clinical effectiveness. Our qualitative content analysis showed that many implementation aspects and stakeholder perspectives remain unexplored. Conclusions: Internet-based cognitive behavioural therapy promises to alleviate patient suffering in cardiovascular disease. There is, however, little research about internet-based cognitive behavioural therapy for cardiovascular disease, and about how this evidence-based intervention is implemented. [ABSTRACT FROM AUTHOR]

Introduction Internationally, teledermoscopy has been found to have clinical and economic efficacy. This study aims to identify the attributes of a mobile teledermoscopy service that consumers prefer. This preliminary study was set within a broader randomised control trial (RCT) investigating the effectiveness of direct to consumer mobile teledermoscopy. Methods We undertook a discrete choice experiment (DCE). The DCE comprised 24 choice sets, divided into in two blocks of 12. For each choice set, respondents were asked to make discrete choices between two opt-out choices and two skin cancer screening service options described by seven attributes. A mixed logit model was used to estimate preferences for skin cancer screening services. Consumer preferences weights were used to calculate marginal willingness-to-pay (WTP) for skin cancer screening services. Results The DCE was completed by 113 consumer respondents. Consumers' preference for dermatologist involvement in their diagnosis, increased accuracy, and reduced excisions were all statistically significant in driving choice between service models. Consumers preferred having a professional involved in their skin cancer screening, rather than performing a self-examination. Consumers were only WTP $1.18 to change from a GP visit to mobile teledermoscopy (diagnosis using a phone camera). However, they were WTP $43 to have their results reviewed by a dermatologist rather than a GP, and $117 to increase the chance of detecting a melanoma if it was present from 65-75% to 95%. Conclusion Skin cancer screening services which are delivered by health professionals, rather than skin self-examination, are preferred by consumers. Consumers were willing to pay for their preferred skin cancer screening method, especially if a dermatologist was involved. [ABSTRACT FROM AUTHOR]

People staying in rural and remote areas of Australia face a higher prevalence of health conditions because of the reduced access to healthcare, including primary healthcare. This may be complicated by the lack of ability of public hospitals to schedule across telehealth resources. Some of the remote care facilities, too, face difficulties to locate and connect to other facilities that provide telemedicine services. Up to 15% of all general practice consultations are dermatology cases. One of the ways of providing increased specialty access for the underserved and patients with no access to dermatological care is through teledermatology. Over the past decade, there has been an increase in the popularity of the use of teledermatology in supporting patient care. Teledermatology allows the diagnosis of skin conditions by virtue of the visual nature of the field of dermatology, making it a good match for telemedicine. According to the journal Rural and Remote Health, the success and sustainability of telehealth services in rural and remote Australia are also influenced by key factors such as adaptability, economics, and vision. Teledermatology has the potential to bring a number of advantages, for instance, a reduction in the waiting and travel times for patients and their family members. However, there also exist challenges in delivering healthcare to the rural areas of Australia. [ABSTRACT FROM AUTHOR]

Scaling of projects from inception to establishment within the healthcare system is rarely formally reported. The Victorian Stroke Telemedicine (VST) programme provided a very useful opportunity to describe how rural hospitals in Victoria were able to access a network of Melbourne-based neurologists via telemedicine. The VST programme was initially piloted at one site in 2010 and has gradually expanded as a state-wide regional service operating with 16 hospitals in 2017. The aim of this paper is to summarise the factors that facilitated the state-wide transition of the VST programme. A naturalistic case-study was used and data were obtained from programme documents, e.g. minutes of governance committees, including the steering committee, the management committee and six working groups; operational and evaluation documentation, interviews and research field-notes taken by project staff. Thematic analysis was undertaken, with results presented in narrative form to provide a summary of the lived experience of developing and scaling the VST programme. The main success factors were attaining funding from various sources, identifying a clinical need and evidence-based solution, engaging stakeholders and facilitating co-design, including embedding the programme within policy, iterative evaluation including performing financial sustainability modelling, and conducting dissemination activities of the interim results, including promotion of early successes. [ABSTRACT FROM AUTHOR]

The clavicle is one of the most commonly fractured bones in the adult population. Management has traditionally been conservative, however more recent research has yielded higher non-union rates associated with non-operative management. This study aims to analyse the proportion of operative and non-operative treatment methods for clavicle fracture in a tertiary hospital facility and rural health sites accessed via telehealth, comparing patient outcome between these two methods of fracture management. Following ethical approval, a retrospective review was conducted of patients presenting with clavicle fractures to the Princess Alexandra Hospital Fracture Clinics and to Orthopaedic Fracture Clinics run via teleconference with rural health sites. Only 2% of patients received operative fracture management in the telehealth group, versus 33% in the tertiary hospital sample. Patient outcome was measured in the larger tertiary hospital sample, with clinical notes reflecting good patient outcome in 70% of operatively managed patients and 85% of patients with conservatively managed clavicle fractures. For the patients in the telehealth sample that returned for follow-up appointments, 93% reported a good outcome with one of these individuals undergoing operative treatment and the rest managed conservatively. [ABSTRACT FROM AUTHOR]

Background: Telehealth interventions have become increasingly important in health care provision, particularly during the COVID-19 pandemic. Video calls have emerged as a popular and effective method for delivering telehealth services; however, barriers limit the adoption among allied health professionals and nurses., Objective: This review aimed to identify and map the perceived barriers to the use of video call-based telehealth interventions among allied health professionals and nurses., Methods: A comprehensive literature search was conducted in the PubMed and CINAHL databases on June 22, 2022, and updated on January 3, 2023, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Only original studies published in English or German since June 2017 that reported barriers to the use of video call-based telehealth interventions were eligible for inclusion. The studies had to involve interviews, focus groups, or questionnaires with physical therapists, occupational therapists, speech and language therapists, audiologists, orthoptists, dieticians, midwives, or nurses. Each publication was coded for basic characteristics, including country, health profession, and target group. Inductive coding was used to identify the patterns, themes, and categories in the data. Individual codings were analyzed and summarized narratively, with similarities and differences in barriers identified across health professions and target groups., Results: A total of 56 publications were included in the review, with barriers identified and categorized into 8 main categories and 23 subcategories. The studies were conducted in various countries, predominantly the United States, Australia, the United Kingdom, Canada, Israel, and India. Questionnaires were the most commonly used evaluation method, with 10,245 health professionals involved. Interviews or focus groups were conducted with 288 health professionals. Most of the included publications focused on specific health care professions, with the highest number addressing barriers for physical therapists, speech and language therapists, and audiologists. The barriers were related to technology issues, practice issues, patient issues, environmental issues, attributions, interpersonal issues, policies and regulations, and administration issues. The most reported barriers included the lack of hands-on experience, unreliable network connection, the lack of technology access, diminished fidelity of observations and poor conditions for visual instructions, the lack of technology skills, and diminished client-practitioner interaction and communication., Conclusions: This review identified key barriers to video call-based telehealth use by allied health professionals and nurses, which can foster the development of stable infrastructure, education, training, guidelines, policies, and support systems to improve telehealth services. Further research is necessary to identify potential solutions to the identified barriers., (©Lena Rettinger, Sebastian Kuhn. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.08.2023.)

Introduction: In February 2018 the Remote Medical Practitioner (RMP)-led telehealth model for providing both primary care advice and aeromedical retrievals in Central Australia was replaced by the Medical Retrieval and Consultation Centre (MRaCC) and Remote Outreach Consultation Centre (ROCC). In this new model, specialists with advanced critical care skills provide telehealth consultations for emergencies 24/7 and afterhours primary care advice (MRaCC) while RMPs (general practitioners) provide primary care telehealth advice in business hours via the separate ROCC., Objective: To evaluate changes in clinicians' perceptions of efficiency and timeliness of the new (MRaCC) and (ROCC) model in Central Australia., Design: There were 103 and 72 respondents, respectively, to pre- and post-implementation surveys of remote clinicians and specialist staff., Findings: Both emergency and primary care aspects of telehealth support were perceived as being significantly more timely and efficient under the newly introduced MRaCC/ROCC model. Importantly, health professionals in remote community were more likely to feel that their access to clinical support during emergencies was consistent and immediately available., Discussion: Respondents consistently perceived the new MRaCC/ROCC model more favourably than the previous RMP-led model, suggesting that there are benefits to having separate referral streams for telehealth advice for primary health care and emergencies, and staffing the emergency stream with specialists with advanced critical care skills., Conclusion: Given the paucity of literature about optimal models for providing pre-hospital medical care to remote residents, the findings have substantial local, national and international relevance and implications, particularly in similar geographically large countries, with low population density., (© 2022 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Objective: This study explored use and perceived barriers to the use of post-operative video-link telehealth among a sample of Australian surgeons shortly before the COVID-19 pandemic., Methods: During 2019-2020, a survey was mailed to RACS or RANZCOG Fellows., Design: Cross-sectional survey., Setting and Participants: A total of 907 surgeons practising in Australia completed the survey., Main Outcome Measures: The study-specific survey assessed telehealth use in the last 3 months and the perceived barriers and enablers to the use of post-operative teleconsultations, across the domains: quality of care; convenience and efficiency; legal/regulatory issues; financial issues and technological issues., Results: Twenty-five percent of eligible surgeons returned the survey, with n = 763 pre-pandemic responses included in analyses. Approximately one-quarter (26%) of surgeons had used telehealth post-operatively with patients in the last 3 months. The most frequently endorsed barriers to use related to quality of care: 'I cannot undertake a patient examination' and 'I cannot provide the same level of care as during an in-person consultation'; and convenience and efficiency: 'Teleconsultations are more difficult to arrange'. Surgeons who had recently used telehealth were less likely to endorse most barriers. Younger age, awareness of Medicare telehealth reimbursement and working in neurosurgery, urology, paediatric surgery and plastic and reconstructive surgery (compared to general surgery) were associated with recent telehealth use by surgeons., Conclusions: Some surgeons' perceived barriers to telehealth pre-COVID may be overcome by COVID-19-related telehealth uptake and familiarisation. However, many barriers will need to be addressed to ensure that telehealth adoption is sustained beyond the pandemic., (© 2022 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.)

Small rural hospitals admit and manage older adults who, in city hospitals, would usually be offered geriatrician-supported comprehensive geriatric assessment and coordinated subacute care if required. Distance and diseconomies of scale prohibit access to the conventional in-person approach. A telegeriatric service model involving a geriatrician consulting remotely using wireless, mobile, high-definition videoconferencing; a trained host nurse at the rural site; structured geriatric assessment configured on a web-based clinical decision support system; routine weekly virtual rounds; and support from a local multidisciplinary team was established to overcome these barriers. This was a prospective observational study to examine the feasibility and sustainability of the model. Patient characteristics were recorded using the interRAI Acute Care assessment system. Usage patterns were derived from health service data sets and a service statistics database. Patients had characteristics that are consistent with characteristics of individuals typically referred for geriatric assessment. Overall, 53% of patients had cognitive impairment, 75% had limitations with activities of daily living, and the average Frailty Index was 0.44 ± 0.12. Stable patterns of consultation occurred within 6 months of start-up and continued uninterrupted for the remainder of the 24-month observation period. The estimated overall rate of initial consultation was 1.83 cases per occupied bed per year and 2.66 review cases per occupied bed per year. The findings indicate that the model was feasible and was sustained throughout and beyond the study period. This telegeriatric service model appears suitable for use in small rural hospitals. [ABSTRACT FROM AUTHOR]

Background Fast diagnosis and delivery of treatment to patients experiencing acute stroke can reduce subsequent disability. While telemedicine can improve rural community access to specialists and facilitate timely diagnosis and treatment decisions, it is not widely used for stroke in Australia. Aim Identifying the barriers and facilitators to clinician engagement with, and utilisation of, telemedicine consultations could expedite implementation in rural and remote locations. Methods Purposive sampling was used to identify and recruit medical and nursing staff varying in telemedicine experience across one hospital department. Twenty-four in-depth, face-to-face interviews were conducted examining aspects surrounding stroke telemedicine uptake. Inductive qualitative thematic analysis was undertaken, and two further researchers verified coding. Results The main barriers identified were contrasting opinions about the utility of thrombolysis for treating acute stroke, lack of confidence in the telemedicine system, perceived limited need for specialist advice and concerns about receiving advice from an unfamiliar doctor. Facilitators included assistance with diagnosis and treatment, the need for a user-friendly system and access to specialists for complex cases. Conclusions Acceptability of telemedicine for acute stroke was multifaceted and closely aligned with regional clinician beliefs about the value of thrombolysis for stroke, highlighting an important area for education. Addressing beliefs about treatment efficacy and other perceived barriers is important for establishing a stroke telemedicine programme. [ABSTRACT FROM AUTHOR]

Background: Electronic consultations (eConsults) allow general practitioners (GP) to seek the advice of a specialist via secure asynchronous digital communication., Aims: To report the outcomes of a proof of concept (POC) trial of eConsults for patients with diabetes and endocrine disorders., Methods: A prospective observational study conducted from November 2020 to May 2021. eConsults were provided by endocrinologists from the Princess Alexandra Hospital, Brisbane. The requests for advice were from GP in Brisbane South. An online questionnaire was completed by the GP and endocrinologist after each eConsult., Results: Forty eConsults were performed over 7 months. The majority were in relation to type 2 diabetes (30%) or thyroid conditions (30%). All eConsult responses were performed within the target of 72 h with 92.5% responses provided within 24 h. The average time taken for the endocrinologist to perform the eConsult was 14.2 ± 4.4 min. The GP rated the value of eConsults as excellent 97% of the time. The eConsult resulted in a new or additional course of action 68% (19/28) of the time and confirmed a course of action 32% (9/28) of the time. The eConsult avoided the need for referral of the patient for a face-to-face specialist review in 55% of the eConsults., Conclusion: An eConsult service was able to be delivered by endocrinologists from a tertiary hospital to GP in Brisbane South. With an appropriate funding model, the broader implementation and adoption of eConsults has the potential to address specialist waiting lists and facilitate models of integrated care., (© 2021 Royal Australasian College of Physicians.)

We aimed to explore consumer experiences of ambulatory telehealth services and whether consumer experiences differed according to whether they received their consultation using telephone or video technology. We conducted structured telephone interviews with patient consumers who had received a recent remote consultation by telephone or video call, at local ambulatory allied health or multidisciplinary services within a large public metropolitan public health network. Respondents were asked about their recent experience and future choices in relation to telehealth. Responses from consumers who received telephone and video consultations were compared. Consumers from community rehabilitation, community health, allied health outpatients, multidisciplinary specialist clinics and mental health services participated (n = 379), of whom 245 received a telephone consultation (65%) and 134 a video consultation (35%). Almost half of respondents (49%) expressed preference for future face-to-face care and 29% reported they would choose to use telehealth over face-to-face consultation for a similar appointment again. Many commented that they would be influenced by the type of consultation required and expressed a desire to have a choice. Approximately 80% of both groups reported they had achieved the desired outcome from their telehealth consultation. Consumers using video were more likely to experience technical issues. Telehealth met the needs of most consumers, and responses were similar for telephone and video consultations., (© 2021 John Wiley & Sons Ltd.)

The use of telehealth is becoming a prevalent feature in clinical practice worldwide, partly because of advances in medical and telecommunications technology. The coronavirus disease 2019 (COVID-19) pandemic has been a key driver in justifying the accelerated use of telehealth, leading to healthcare practitioners (HCPs) utilising virtual consultations more avidly. Although challenges remain, recent data have shown that remote consultations are feasible, safe and effective in South Africa (SA) and that HCPs should become proficient in conducting telehealth, virtual or remote consultations. These guidelines are based on the revised Health Professions Council of South Africa (HPCSA) General Ethical Guidelines for Good Practice in Telehealth (Booklet 10) and guidelines on remote or video consultations from the University of Oxford, the Royal Australian College of General Practitioners and the Royal College of Psychiatrists. These guidelines aim to equip HCPs with the basic knowledge and skills pertaining to medicolegal, communication and practical aspects of telehealth and how to practise telehealth safely and effectively in primary care settings in SA during the COVID-19 pandemic and beyond.

Australia is a vast country with one-third of the population living outside capital cities. Providing specialist rheumatologist services to regional, rural and remote Australians has generally required expensive and time-consuming travel for the patient and/or specialist. As a result, access to specialist care for remote Australians is poor. Rheumatoid arthritis is a common disease, but like many rheumatic diseases, it is complex to treat. Time-dependent joint damage and disability occur unless best evidence care is implemented. The relatively poor access to rheumatologist care allotted to nonmetropolitan Australians therefore represents a significant cause of potentially preventable disability in Australia. Telehealth has the potential to improve access to specialist rheumatologists for patients with rheumatoid arthritis and other rheumatic diseases, thereby decreasing the burden of disability caused by these diseases. Advances in videoconferencing technology, the national broadband rollout and recent Federal government financial incentives have led to a heightened interest in exploring the use of this technology in Australian rheumatology practice. This review summarises the current evidence base, outlines telehealth's strengths and weaknesses in managing rheumatic disease, and discusses the technological, medicolegal and financial aspects of this model of care. A mixed model offering both face-to-face and virtual consultations appears to be the best option, as it can overcome the barriers to accessing care posed by distance while also mitigating the risks of virtual consultation. [ABSTRACT FROM AUTHOR]

Background: A unique model of care was adopted in Australia following introduction of universal subsidised direct-acting antiviral (DAA) access in 2016 in order to encourage rapid scale-up of treatment. Community-based medical practitioners and integrated hepatitis nurses initiated DAA treatment with remote hepatitis specialist approval of the planned treatment without physical review., Aims: To evaluate outcomes of community-based treatment of hepatitis C virus (HCV) through this remote consultation process in the first 12 months of this model of care., Methods: A retrospective chart review of patients undergoing community-based HCV treatment from general practitioners and integrated hepatitis nurse consultants through the remote consultation model in three state jurisdictions in Australia from 1 March 2016 to 28 February 2017., Results: Sustained virological response at 12 weeks (SVR12) was confirmed in 383 (65.1%) of 588 subjects intended for treatment with a median follow-up time of 12 months (interquartile range 9-14 months). The SVR12 test was not performed in 159 (27.0%) of 588 and 307 (52.2%) of 588 did not have liver biochemistry rechecked following treatment. Subjects who completed follow up exhibited high SVR12 rates (383/392; 97.7%). Nurse-led treatment was associated with higher confirmation of SVR12 (73.7% vs 62.4%; P = 0.01) and liver biochemistry testing post treatment (57.5% vs 45.0%; P = 0.01)., Conclusions: Community-based management of HCV through remote specialist consultation may be an effective model of care. Failure to check SVR12, recheck liver biochemistry and appropriate surveillance in patients with cirrhosis may emerge as significant issues requiring further support, education and refinement of the model to maximise effectiveness of future elimination efforts., (© 2020 Royal Australasian College of Physicians.)

Introduction: The aim of this study was to compare the effectiveness of two geriatrician models of care, the telegeriatric service (TGS) and visiting geriatrician (VG), in regional and remote settings in terms of potential cost-savings to the health system and impact on health service use (HSU). Furthermore, to establish whether longer wait-times for clinic appointments led to increased HSU by study participants., Methods: Trends in patient emergency department presentations, hospitalisations and bed-days (HSU) were compared from 18 months before to 12 months after geriatrician appointment for the two services in the Western Australian Midwest region. The relationships between wait times, patient triage level and HSU were modelled. The costs of providing the services were offset against reductions in HSU after appointments., Results: The sample comprised consecutive patients using the TGS ( n  = 84) and VG service ( n  = 124). Patient characteristics were similar, although patients using the VG service had longer wait-times, were triaged as more urgent and demonstrated the highest levels of HSU. Both models were effective with similar rates of reduced HSU following appointments. Increased wait-times and higher patient triage urgency were associated with increased HSU., Discussion: Although TGS and VG showed similar reduced rates of HSU, TGS had the capacity to see a higher volume of patients, a broader geographical reach and improved waitlist management. Consequently, TGS was more effective at reducing avoidable hospitalisations and subsequent health deterioration due to shorter wait-times. Whilst face-to-face consultations are recognised as 'gold standard' a combination of the two models is most efficient.

This study compared the connectivity of video sessions to telephone sessions delivered to smokers in rural areas and whether remoteness and video app (video only) were associated with the connectivity of video or telephone sessions. Participants were recruited into a randomised trial where two arms offered smoking cessation counselling via: (a) real-time video communication software (201 participants) or (b) telephone (229 participants). Participants were offered up to six video or telephone sessions and the connectivity of each session was recorded. A total of 456 video sessions and 606 telephone sessions were completed. There was adequate connectivity of the video intervention in terms of no echoing noise (97.8%), no loss of internet connection during the session (88.6%), no difficulty hearing the participant (88.4%) and no difficulty seeing the participant (87.5%). In more than 94% of telephone sessions, there was no echoing noise, no difficulty hearing the participant and no loss of telephone line connection. Video sessions had significantly greater odds of experiencing connectivity difficulties than telephone sessions in relation to connecting to the participant at the start (odds ratio, OR = 5.13, 95% confidence interval, CI 1.88-14.00), loss of connection during the session (OR = 11.84, 95% CI 4.80-29.22) and hearing the participant (OR = 2.53, 95% CI 1.41-4.55). There were no significant associations between remoteness and video app and connectivity difficulties in the video or telephone sessions. Real-time video sessions are a feasible option for smoking cessation providers to provide support in rural areas.

Objectives: To explore the feasibility of using the video-conferencing program, Skype, on iPads with older adults living in long-term care (LTC) facilities. Method: Using a mixed-method design, six residents from one LTC facility in Queensland, Australia participated in a one-off interactive intervention session, followed by post-session semi-structured interviews. The intervention session involved a 15-minutes training session in using Skype, and 30-minutes interactive practise in making and receiving a call using Skype. Residents were interviewed after the intervention session to explore their experience and perceptions of using Skype on the iPad. Reflections about the intervention session were written as study notes by the research team. Qualitative data were analysed using an inductive, thematic analytic approach. Results: Four broad themes emerged: (1) Video-conferencing on iPads is inhibited by age-related cognitive decline and physical frailty; (2) Video-conferencing is an unfamiliar technology for many older residents, and practice and staff assistance are required; (3) Video-conferencing is regarded positively, and seen as a good way of communicating with family/friends; and (4) Use of video-conferencing highlights general concerns held about privacy and cyber security issues. Conclusion: Without adequate staff assistance, video-conferencing via iPads may be challenging for an older population in LTC. Alternatives such as telepresence robots may assist with these challenges.

Objective: To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services., Method: A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders., Results: The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable., Conclusion: Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle., (Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Telehealth, the delivery of health care services at a distance using information and communications technology, has been slow to be adopted and difficult to sustain. Researchers developing theories concerning the introduction of complex change into health care usually take a multifactorial approach; we intentionally sought a single point of intervention that would have maximum impact on implementation. We conducted a qualitative interview study of 36 Australian telehealth services, sampled for maximum variation, and used grounded theory methods to develop a model from which we chose the most important factor affecting the success of telehealth. We propose that clinician acceptance explains much of the variation in the uptake, expansion, and sustainability of Australian telehealth services, and that clinician acceptance could, in most circumstances, overcome low demand, technology problems, workforce pressure, and lack of resourcing. We conclude that our model offers practical advice to those seeking to implement change with limited resources.

Background: The global burden of disease attributable to chronic hepatitis C virus (HCV) is very large, yet the uptake of curative antiviral therapies remains very low, reflecting the marginalized patient population and the arduous nature of current treatments., Methods: The safety and effectiveness of a nurse-led model of care of inmates with chronic HCV was evaluated in 3 Australian correctional centers. The model featured protocol-driven assessment, triage, and management of antiviral therapy by specifically trained nurses, with specialist physician support utilizing telemedicine. Outcomes were evaluated qualitatively with key informant interviews, and quantitatively with patient numbers completing key clinical milestones and adverse events., Results: A total of 391 patients with chronic HCV infection were enrolled, of whom 141 (36%) completed the clinical and laboratory evaluations for eligibility for antiviral therapy over 24 months. Treatment was initiated in 108 patients (28%), including 85 (79%) triaged for specialist review conducted by telemedicine only. The demographic and clinical characteristics of the patients who entered the model and completed workup and those who initiated treatment featured a high prevalence of individuals of indigenous background, injection drug users, and those with psychiatric disorder. Serious adverse events occurred in 13 of 108 treated patients (12%) with discontinuation in 8 (7%). The sustained virologic response rate among those with complete follow-up data (n=68) was 69%, and by intention-to treat analysis was 44%., Conclusions: This nurse-led and specialist-supported assessment and treatment model for inmates with chronic HCV offers potential to substantively increase treatment uptake and reduce the burden of disease.

Background: The rise of the internet and related technologies has significant implications for the treatment of complex health problems, including the combination of depression and alcohol/other drug (AOD) misuse. To date, no research exists to test the real world uptake of internet and computer-delivered treatment programs in clinical practice. This study is important, as it is the first to examine the adoption of the SHADE treatment program, a DVD-based psychological treatment for depression and AOD use comorbidity, by clinicians working in a publicly-funded AOD clinical service. The study protocol that follows describes the methodology of this dissemination trial., Methods/design: 19 clinicians within an AOD service on the Central Coast of New South Wales, Australia, will be recruited to the trial. Consenting clinicians will participate in a baseline focus group discussion designed to explore their experiences and perceived barriers to adopting innovation in their clinical practice. Computer comfort and openness to innovation will also be assessed. Throughout the trial, current, new and wait-list clients will be referred to the research program via the clinical service, which will involve clients completing a baseline and 15-week follow-up clinical assessment with independent research assistants, comprising a range of mental health and AOD measures. Clinicians will also complete session checklists following each clinical session with a client, outlining the extent to which the SHADE computer program was used. Therapeutic alliance will be measured at intake and discharge from both the clinician and client perspectives., Discussion: This study will provide comprehensive data on the factors associated with the adoption of an innovative, computer-delivered evidence-based treatment program, SHADE, by clinicians working in an AOD service. The results will contribute to the development of a model of dissemination of SHADE, which could be applied to a range of technological innovations., Clinical Trials Registry: Australian Clinical Trial Registration Number: ACTRN12611000382976.

Background: Physical activity is important following breast cancer. Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas., Purpose: This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered, mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer., Methods: A randomized controlled trial comparing an 8-month intervention delivered by exercise physiologists (n = 73) to usual care (n = 70)., Results: Sixty-one percent recruitment rate and 96% retention at 12 months; 79% of women in the intervention group received at least 75% of calls; odds (OR, 95% CI) of meeting intervention targets favored the intervention group for resistance training (OR 3.2; 1.2, 8.9) and aerobic (OR 2.1; 0.8, 5.5) activity., Conclusions: Given the limited availability of physical activity programs for non-urban women with breast cancer, results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions.

Telegenetics is a new development in the service delivery of Genetic Services in Australia. This project was designed to establish if it was an acceptable alternative to a face-to-face consultation in the genetic assessment of intellectual disability, including morphological assessment, of the patient. Ten children from two outreach clinics in rural NSW who were referred by their pediatrician were assessed by a single geneticist via telehealth and then seen again face-to-face as a 'gold standard'. Satisfaction surveys were then sent to both the parents and the referring pediatricians. After the face-to-face appointment, the clinical geneticist reviewed the recordings of both the transmitted footage and the high definition footage that was sent separately. There were very few morphological findings missed by the telegenetic assessments. The discrepancies that were noted could decrease in frequency as staff become more familiar with the methods. The parents of the patients reported no problem with the cameras and telehealth. They would have preferred face-to-face appointment but would be happy to have the telehealth appointment if it meant being seen earlier. This pilot study suggests that clinical genetic diagnostic assessment could be performed by telemedicine.

More than three-quarters of Australia is classified as geographically remote. Remote areas are characterised by geographic isolation, cultural diversity, socioeconomic inequality, resource inequity, Indigenous health inequality, and a full range of extreme climatic conditions. Although several descriptive definitions have been developed for "remote health" and "remote practice", definitions of "remote medical practice" or "remote medicine" have not been previously published. In 2007, a working group of doctors and academics with experience in remote medicine was formed to develop the first advanced specialised remote medicine curriculum for remote doctors undertaking training with the Australian College of Rural and Remote Medicine. The first step was to define remote medical practice. Remote medical practice has eight key features: employment rather than private practice, isolation, use of telehealth, increased clinical acumen, extended practice, cross-cultural setting, multidisciplinary practice, and an emphasis on public health and personal security. From these eight features, we developed the first working definition of remote medical practice in the Australian context. Our definition will assist policymakers, medical colleges, standard setters, and educators to develop programs and resources for the future remote medical workforce.

The delivery of medical services through the use of modern technology is proving of significant benefit, particularly in remote communities where transportation of patients and medical practitioners is problematic. Technical systems supporting telemedicine-based consultations have been available for some years and more recently diagnostic services such as pathology and radiology have embraced this new technology. While teleradiology and telepathology allow medical services to be delivered across vast distances from highly populated areas to regions of low population density, the same technology can also deliver services across national and international boundaries. Where the patient and medical practitioner are located in different jurisdictions, issues arise regarding the regulation of medical service provision and this has an impact on the registration of medical practitioners, mutual recognition of training and specialisation and the administration of medical service provision. The increasing specialisation of medical practice and manpower shortages in key practice areas would suggest that there will be ongoing expansion of telemedicine services in the years to come. This will require greater standardisation of medical education, together with an improvement in arrangements for mutual recognition of medical practitioners across national boundaries.

Background: Amid rapid changes in surgical techniques and patient care, education and training for the new generation of health care providers is of utmost importance. An international telesurgical system, which we established between Japan and Korea through super-fast broadband Internet without any loss of quality, was shown to be a powerful tool for this purpose. We attempted to expand our advanced system throughout the Asia-Pacific region and studied its usefulness., Methods: Kyushu University Hospital (Fukuoka, Japan) was linked to 33 medical institutions and meeting venues in China, Taiwan, Thailand, Vietnam, Singapore, and Australia by academic optic fiber network. Digital video signals were directly converted into Internet protocol, and cipher security programs were used to protect patient privacy., Results: Of 49 international surgical teleconferences conducted, 16 were real-time demonstrations of surgery, and 33 involved recorded videos. For 37 events, two stations were connected pier-to-pier, and for the remaining 12, multiple stations were connected. The network remained stable, and the time delay between stations was restricted to 0.3-1.0 seconds. Responding to questionnaires, 70.6% of participants rated the image quality as "very good," and 22.5% rated it "good.", Conclusions: We succeeded in establishing a high-quality telesurgical system in a wide area of the Asia-Pacific region, and this is the first time high-speed Internet technology has been applied to surgery on such a large scale. Because it is not only of high quality but also economical and easy to set up, we believe this system will promote efficient remote surgical education and active academic exchange worldwide.

Objective: The aim of this paper is to describe some potential innovations in clinical mental health practice using modern communications technologies., Methods: We explored concepts arising from clinical practice and discuss the literature relating to such innovations., Conclusions: Iterative adaptations of technology to clinical mental health practice as well as more speculative interventions are possible within the framework of building evidence-based interventions and maintaining humane engagement.

Objective: To evaluate a telepsychiatry clinical service to Wagga Wagga in rural New South Wales, comprising a face-to-face interview with a psychiatrist followed by a telepsychiatry interview with a Sydney-based psychiatrist., Methods: Thirty-one patients were referred to a specialist mood disorder clinic in a rural setting for consultation and assessment. A retrospective evaluation was made to determine the acceptance of the teleconferenced psychiatry and face-to-face psychiatry, as well as the overall patient response., Results: Twenty participants completed all evaluation components. Their results indicated a satisfaction level of 95% with the consultation process as a whole, with 80% happy to use telepsychiatry again and 60% preferring telepsychiatry over travelling to a larger centre for face-to-face consultation. The face-to-face component was satisfactory for 85% of patients while the telepsychiatry component was satisfactory for 72%., Conclusions: Although face-to-face psychiatry was preferred by this sample, the telepsychiatry component was highly rated and preferred over travel to larger centres for face-to-face consultation, by residents of rural and remote locations. Certain issues are of more concern in telepsychiatry than face-to-face psychiatry, including confidentiality, rapport, explanation and education.

Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.

The residents of rural and regional Australia have less access to health care services than in capital cities. There is a reluctance of General Practitioners to practice in the country. New information technology and government initiatives are now addressing this problem. High bandwidth videoconferencing is now being routinely used to provide psychiatric consultations to areas without this service. But this (like many other implementations of telecommunication technologies to health) has resulted in loss of revenue to regional Australia while benefiting capital cities. Thus, the current implementation of telecommunication technology to health has resulted in loss of revenue of the regions while increasing the bias towards the cities. Further, the system is not economically viable and requires the Government to inject funds for the smooth operation of the system. This paper proposes the use of telecommunication technology for enabling the communities of regional Australia to access health facilities via physical and virtual clinics. The proposed technique is self supporting and is based in the country with the intent to prevent the drain of resources from regional Australia. The technique attempts to eradicate the problem at the root level by providing a business opportunity that is based in and to cater for the needs of the remote communities. The proposed system would provide health services by physical and virtual clinics and while serving the communities would be profit centres- and thus attracting doctors and other resources to the remote communities.