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      A retrospective review of telehealth services for children referred to a paediatric nephrologist

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          Abstract

          Background

          Telemedicine has emerged as an alternative mode of health care delivery over the last decade. To date, there is very limited published information in the field of telehealth and paediatric nephrology. The aim of this study was to review our experience with paediatric telenephrology in Queensland, Australia.

          Methods

          A retrospective audit of paediatric nephrology telehealth consultations to determine the nature of the telehealth activity, reasons for referral to telehealth, and to compare costs and potential savings of the telehealth service.

          Results

          During a ten-year period (2004 – 2013), 318 paediatric telenephrology consultations occurred for 168 patients (95 male) with the median age of 8 years (range 3 weeks to 24 years). Congenital anomalies of the kidney and urinary tract (30 %), followed by nephrotic syndrome (16 %), kidney transplant (12 %), and urinary tract infection (9 %) were the most common diagnoses. The estimated cost savings associated with telehealth were $31,837 in 2013 (average saving of $505 per consultation).

          Conclusions

          Our study suggests that paediatric telenephrology is a viable and economic method for patient assessment and follow up. The benefits include improved access to paediatric nephrology services for patients and their families, educational opportunity for the regional medical teams, and a substantial cost saving for the health care system.

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          Most cited references16

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          Cost savings from a telemedicine model of care in northern Queensland, Australia.

          To conduct a cost analysis of a telemedicine model for cancer care (teleoncology) in northern Queensland, Australia, compared with the usual model of care from the perspective of the Townsville and other participating hospital and health services. Retrospective cost-savings analysis; and a one-way sensitivity analysis performed to test the robustness of findings in net savings. Records of all patients managed by means of teleoncology at the Townsville Cancer Centre (TCC) and its six rural satellite centres in northern Queensland, Australia between 1 March 2007 and 30 November 2011. Costs for set-up and staffing to manage the service, and savings from avoidance of travel expenses for specialist oncologists, patients and their escorts, and for aeromedical retrievals. There were 605 teleoncology consultations with 147 patients over 56 months, at a total cost of $442 276. The cost for project establishment was $36 000, equipment/maintenance was $143 271, and staff was $261 520. The estimated travel expense avoided was $762 394; this figure included the costs of travel for patients and escorts of $658 760, aeromedical retrievals of $52 400 and travel for specialists of $47 634, as well as an estimate of accommodation costs for a proportion of patients of $3600. This resulted in a net saving of $320 118. Costs would have to increase by 72% to negate the savings. The teleoncology model of care at the TCC resulted in net savings, mainly due to avoidance of travel costs. Such savings could be redirected to enhancing rural resources and service capabilities. This teleoncology model is applicable to geographically distant areas requiring lengthy travel.
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            Uptake of telehealth services funded by Medicare in Australia.

            Objective The aim of this study is to identify the extent to which the Medicare item numbers and incentives, introduced in July 2011, have been effective in stimulating telehealth activity in Australia. Methods A retrospective descriptive study utilising data on the uptake of telehealth item numbers and associated in-person services, from July 2011 to April 2014, were obtained from Medicare Australia. The main outcome measures were number of telehealth services over time, plus uptake proportionate to in-person services, by jurisdiction, by speciality, and by patient gender. Results Specialist consultations delivered by video communication and rebated by Medicare rose to 6000 per month, which is 0.24% of the total number of specialist consultations. The highest proportional uptake was in geriatrics and psychiatry. In 52% per cent of video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. There were substantial jurisdictional differences. A significantly lower percentage of female patients were rebated for item 99, which is primarily used by surgeons. Conclusions Medicare rebates and incentives, which are generous by world standards, have resulted in specialist video consultations being provided to underserved areas, although gaps still remain that need new models of care to be developed. What is known about the topic? Video consultations have been rebated by Medicare since July 2011 as a means of increasing access to specialist care in rural areas, aged care facilities and Aboriginal health services. What does this paper add? The uptake of this telehealth initiative has grown over time, but still remains low. For half the video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. Geriatrics and psychiatry are the specialties with the highest proportional uptake. What are the implications for practitioners? New models of care with a greater focus on consultation-liaison with primary care providers need to be developed to realise the potential of this initiative and to fill continuing gaps in services.
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              Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis.

              We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3-24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) (P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was euro198 and that of a hospital visit was euro177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B (P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.
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                Author and article information

                Contributors
                +61-7-3068 5857 , peter.trnka@health.qld.gov.au
                megan.white@uq.edu.au
                wdrenton@gmail.com
                steven.mctaggart@health.qld.gov.au
                jburke@gil.com.au
                asmith@uq.edu.au
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                1 August 2015
                1 August 2015
                2015
                : 16
                : 125
                Affiliations
                [ ]Queensland Child and Adolescent Renal Service, Queensland, Australia
                [ ]Department of Paediatrics and Child Health, The University of Queensland, Brisbane, Australia
                [ ]Centre for Online Health, The University of Queensland, Brisbane, Australia
                [ ]Queensland Children’s Medical Research Institute, Brisbane, Australia
                [ ]Queensland Child and Adolescent Renal Service, Lady Cilento Children’s Hospital, 501 Stanley Street, South Brisbane, Queensland 4101 Australia
                Article
                127
                10.1186/s12882-015-0127-0
                4522118
                09b9f950-1005-4796-85f3-ee28340d90bb
                © Trnka et al. 2015

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 13 January 2015
                : 28 July 2015
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Nephrology
                telemedicine,telehealth,paediatric nephrology,kidney disease,cost savings
                Nephrology
                telemedicine, telehealth, paediatric nephrology, kidney disease, cost savings

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