Optimising specialist geriatric medicine services by telehealth

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.

Auditing the Audits: A Systematic Review on Different Procedures in Telemedicine

“…Of this sample of the studies considered, eleven were retrospective, three prospective, and eleven were unspecified (Tables 1 and 2). All articles included different clinical diseases and medical disciplines: dermatology [23][24][25][26], sexual health [27], psychiatry [28], neurology [29,30], geriatrics [31], ophthalmology [32][33][34][35], physiology [36], orthopaedics [37][38][39], respiratory failure [40], paediatric diabetic [41], injury/illness [42], mixed [43,44], radiology [45], and atrial fibrillation [46], N.S. [47].…”

“…Services treated by studies were different: 16 were telecounselling, four were telemonitoring [40,[44][45][46], and five were mixed [26,31,37,38,41]: telecounselling + telemonitoring.…”

“…The organizational aspects of telemedicine systems were evaluated in only two studies (8%). One of these two articles [40] took into account only the time of staff activity, while the other [31] specifically evaluated differences in the workflow of operators, training, changes in culture, attitude, and management. The latter was the only study in the sample to consider communicative aspects in the members of the healthcare team.…”

The perceived quality of video consultations in geriatric outpatient care by early adopters

“…On the other hand, the lack of a supportive infrastructure, as mentioned by Seiffert et al [ 18 ], was also the main barrier for implementation as mentioned by our participants, which is confirmed by the study of Haydon et al who describe recommendations regarding infrastructure for adoption of VC use in geriatric medicine. [ 19 ]. While COVID-19 served as a catalyst for the adoption of telemedicine in some geriatric clinical settings [ 20 ], this was less so among our geriatric outpatient setting.…”

Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population

“…It has been documented that a multidisciplinary team involving nurses may facilitate future treatment and rehabilitation in geriatric patients with cardiovascular disorders [ 86 ]. Dedicated centralized team leaders are best suited in implementing the guidelines for residential aged care facility residents requiring specialized geriatric care via telehealth and counselling [ 87 ]. It has also been observed that the enthusiastic involvement of pharmacists in deprescription has proved beneficial in the case of elderly patients in all types of resource settings [ 88 ].…”