The feasibility and cost-effectiveness of a novel telepaediatric service in Queensland

Smith, Anthony Carl (2004). The feasibility and cost-effectiveness of a novel telepaediatric service in Queensland PhD Thesis, School of Medicine, University of Queensland.

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Author Smith, Anthony Carl
Thesis Title The feasibility and cost-effectiveness of a novel telepaediatric service in Queensland
School, Centre or Institute School of Medicine
Institution University of Queensland
Publication date 2004
Thesis type PhD Thesis
Supervisor Professor Richard Wootton
Total pages 503
Language eng
Subjects 1114 Paediatrics and Reproductive Medicine
Formatted abstract Telehealth has the potential to improve access to health services for patients living in rural and remote communities. Despite the long distances in Queensland, telehealth has been significantly under-utilised. One possible reason is that it has generally been easier for the referrer to send patients to a specialist than to organise a telehealth consultation. This thesis describes a novel model of telehealth, in which a small scale call centre was accessible by a single telephone number. All calls made to the centre were received by a telepaediatric coordinator. The coordinator was responsible for facilitating the appropriate response.

The principal hypothesis was that by shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process could be made equally or more attractive than the conventional alternative. The model was tested and proven to be an effective method for the coordination of telehealth services. During the first three years of operation, about 1400 patient consultations were coordinated by the telepaediatric service. The continued usage of the service has been an encouraging sign of its acceptance amongst clinicians. Telepaediatric activity steadily increased to about 20 h of videoconferencing time per month for clinical consultations. On average 50 patient consultations were conducted per month. Paediatric subspecialties included burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry.

Activity data at selected regional sites pre and post telepaediatrics showed a marked reduction in the number of children travelling to Brisbane for an outpatient appointment and a substantial increase in the number of children accessing specialist services in their local hospital (via videoconference).
An economic analysis of telepaediatric activity showed savings made to the state health department. The total cost of providing 975 patient consultations through the telepaediatric service was $740,248. The estimated potential cost of providing an outpatient service to the same number of patients at the Royal Children’s Hospital (RCH) in Brisbane was $1,060,231. Based on the analysis of 975 patient consultations, telepaediatrics was a more cost-effective method for the delivery of outpatient services when the workload exceeded 597 patient consultations and resulted in a net saving of about $320,000 to the health service provider. A sensitivity analysis showed that the threshold point was most sensitive to changes related to videoconference equipment costs, staff salaries and patient travel costs; other factors (e.g. telecommunication costs) were less important. 

The family costs of attending outpatient appointments in person at the RCH and via videoconference at a regional hospital close to home were compared by interviewing 300 families. There were significant differences between the two groups. It cost families more to attend an appointment at the RCH than to attend a videoconference. 95% of families (n=100) in the RCH group reported at least one type of expense (median cost $18). In contrast, only 10% of families (n=200) who had a local videoconference reported any additional costs (median cost $0). Families who had their specialist appointment via local videoconference spent less time travelling to and from their appointment and less time off work.

The accuracy of clinical assessments for burns conducted via videoconference was investigated. Agreement between the two consultants when seeing patients face-to-face (FTF) was moderately high, with an overall concordance of 85%. When videoconferencing was used, the level of agreement was almost the same, 84%. This confirms that the quality of information collected during a videoconference appointment is similar to that information collected during a conventional FTF appointment for a follow-up burns consultation.

The routine use of telepaediatrics for the delivery of post-acute burns care meant that families in regional and remote parts of Queensland had more convenient access to specialist services which were normally only available in Brisbane. 293 patient consultations were conducted during the first three years.

A substantial proportion of outpatient care could be delivered using videoconferencing, email and the telephone. Telepaediatric burns services proved valuable in two key areas. The first area involved the delivery of routine specialist clinics via videoconference. The second area related to ad-hoc patient consultations for collaborative management during acute presentations.

Telepaediatrics was used to complement the conventional outreach programme for children with diabetes and endocrine conditions. In three years, 194 patient consultations and 13 education sessions were conducted via videoconference. Telepaediatric services in endocrinology and diabetes were established at three levels: (1) the coordination of routine specialist clinics via videoconference; (2) ad-hoc patient consultations for collaborative management during acute presentations and at times of urgent clinical need; and (3) the delivery of education to staff and patients throughout the state.

This study provides quantitative evidence to support the feasibility and cost-effectiveness of a novel telehealth service model in Queensland. Telepaediatrics has been successfully introduced as a routine service at the RCH, alongside conventional methods of health service delivery.
Keyword telehealth
telemedicine
online health
telepaediatrics
telepediatrics
paediatrics
pediatrics
outreach
health service delivery
cost-effectiveness
clinical effectiveness
rural and remote communities
outpatient services
Queensland
Australia
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