Telehealth during the coronavirus disease 2019 pandemic: Rapid expansion of telehealth outpatient use during a pandemic is possible if the programme is previously established.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the health-care system both in Australia and internationally, and has rapidly transformed the delivery of health care in hospitals and the community. Implementation of social isolation and distancing measures to stop the spread of the disease and to reduce potential harm to patients has necessitated the use of alternate models of health-care delivery. Changes that would normally take months or years have occurred within days to weeks. METHODS: We conducted analysis of outpatient clinic data during the period of the pandemic and compared this to previous telehealth use. We also present the results of clinician and patient telehealth experience surveys. RESULTS: We describe a 2255% increase in the use of telehealth at a tertiary hospital within a period of six weeks, and a significant simultaneous reduction in the outpatient clinic failure-to-attend rate. The vast majority of patients and clinicians agreed that the standard of care provided by telehealth was the same as that provided by on-site appointments. DISCUSSION: Telehealth that previously had only limited utilisation has now become a main method for the delivery of outpatient care. Clinicians and patients agreed that consultations provided by telehealth were of the same standard as those provided on site. Health care in the post-pandemic period should embed the use of telehealth for outpatient care and consider the range of other clinical contexts where this can be utilised.

Telehealth quality check: Is it time for national standards?

BACKGROUND: Telehealth has seen rapid but unregulated growth in Australia during the COVID-19 pandemic, facilitated by the interim establishment of a universal Medicare Benefits Schedule item for telehealth consultations. Consumers and healthcare providers, including many general practitioners, have turned to telehealth with enthusiasm. OBJECTIVE: The aim of this article is to present evidence and analysis supporting the adoption of national telehealth standards in Australia. DISCUSSION: Despite efforts by professional organisations to develop telehealth standards, Australia lacks a national telehealth strategy and a unified set of shared standards for clinical governance and quality assurance that can be applied across the health system. To ensure consumer safety and support healthcare providers in telehealth, a national regulatory framework and telehealth standards should be established on the basis of the latest evidence on safety and quality in all forms of telehealth.

Telehealth model of care for routine follow up of renal transplant recipients in a tertiary centre: A case study.

Royal Melbourne Hospital (RMH) performs over 140 kidney transplant operations annually. Kidney transplant recipients require regular medical review, which results in loss of time and costs from travel, particularly for regional patients, and places high demand on the hospital outpatient service. The RMH renal transplant unit initiated a telehealth service in 2016 to provide cost effective, patient-centred clinical care for regional patients. To date, 263 clinical reviews have been conducted via telehealth, potentially saving 203,202 kilometres in travel distance; 2771 hours in car travel time; an estimated AUD $31,048 in petrol savings and 51 tonnes CO2 equivalents of greenhouse gas emissions. Lessons learnt have included the importance of using technology that allows patients to access telehealth from their place of choice. The option of a joint consultation with local healthcare providers has facilitated the development of extended care networks for our patients. Incorporation of telehealth into our outpatient system has been achieved with the existing nephrology workforce, making it a sustainable long-term review option. Our renal transplant telehealth outpatient clinic has been a successful change in the way we provide care to regional patients. Formal comparison of clinical outcomes and the patient experience of telehealth versus in person reviews are underway.

Using telehealth to improve access to hepatitis C treatment in the direct-acting antiviral therapy era.

Introduction: One-third of the Australian population lives outside major cities and this group has worse health outcomes. Telehealth is becoming an accepted way to improve patient access to specialist healthcare. Over 200,000 Australian's have hepatitis C virus (HCV) and new treatments are very effective and well tolerated. We aim to demonstrate that HCV treatment utilising telehealth support for care delivery has cure rates similar to onsite care in clinical trials. We also report length of consultation and calculate reductions in travel and carbon output. Methods: Patient demographic, clinical, and treatment outcome data were collected prospectively from hospital software and analysed retrospectively. This was an audit of all patients treated for HCV in one year from a single tertiary hospital that included telehealth in their care delivery. Results: Sustained virological response was achieved in 51/52 (98%) patients with completed treatment courses, and 51/58 (88%) of those who had a planned telehealth consultation as part of their management. A median of 634 km of patient travel was saved per telehealth consultation. Discussion: We found that a telehealth-supported outreach programme for patients in regional Australia with HCV produced similar outcomes to clinical trials. There was a considerable saving in time and cost for the patients and significant environmental benefit through the reduction in carbon footprint associated with travel to distant specialist health services. We conclude that telehealth facilitated outreach is a feasible and effective way to access HCV treatment and cure in regional Australia.

Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand.

People with asplenia/hyposplenism are at increased risk of fulminant sepsis, which carries a high mortality rate. A range of preventive measures is recommended although there is ongoing evidence that knowledge of and adherence to these strategies is poor. There have been significant changes in recommended vaccinations since the previously published recommendations in 2008. We provide current recommendations to help Australian and New Zealand clinicians in the prevention of sepsis in patients with asplenia and hyposplenia. The guideline includes Australian epidemiological data, preferred diagnostic techniques and recommendations for optimal antimicrobial prophylaxis and vaccination protocols.

A case of gonococcal necrotising fasciitis.

This case report details the progress of a patient with severe disseminated gonococcal infection with associated necrotising fasciitis. His admission was punctuated by multiple surgical debridements and a prolonged intensive care stay due to multiple organ failure. An extended course of azithromycin-based antimicrobial therapy achieved a cure and the patient was eventually discharged home after 8 weeks. To our knowledge this is the first such case of histologically and microbiologically confirmed gonococcal necrotising fasciitis.

Travel and pregnancy: an infectious diseases perspective.

Increasing numbers of women are choosing to travel during pregnancy. In the presence of an altered immune state, exposure to certain microbes can be particularly harmful. We have undertaken a review of the literature in order to provide strategies to minimize the infectious disease risks of pregnant travel. Included is a discussion of common immunizing agents and their safety in pregnancy.