Telehealth in the Home

Telehealth in the Home: Palliative and Aged Care in SA project 

The Telehealth in the Home: Palliative and Aged Care in SA project was a collaborative project between Flinders University and the Southern Adelaide Local Health Network (SALHN) of South Australia Health to evaluate the impact of telehealth option in the provision of palliative care, rehabilitation and aged care services in the southern region of Adelaide, South Australia, between February 2013 and June 2014. The project was funded by the then Department of Health and Ageing, and the Department of Broadband, Communication and Digital Economy.

The aims and objectives of the pilot were to examine the potential for telehealth in the home for palliative care, aged care and rehabilitation services, with expected outcomes for patients, carers and clients; health care professionals; and Health and aged care systems.

A total of 162 participants received services in their homes by the 30 June 2014 via NBN (26 participants), 3G (89 participants), SA Health Digital Telehealth Network (45 participants), or ADSL2 (2 participants) broadband access technologies. These participants included:

• 43 Community Palliative Care patients (plus three residents who received a palliative care service in a residential care facility via DTN)
• 72 Community Rehabilitative Care patients
• 43 Aged Care patients in SA Health RACF (19 rehabilitation patients, 24 aged care patients, where 3 of the aged care patients also received palliative care services)
• 2 aged care patients in a SA Health RACF and 2 aged care patients in a private ACH nursing home (who are not included in the clinical analysis in the report.

The project showed that palliative care, rehabilitation and aged care services delivered by telehealth can:

• provide this care in innovative ways that were acceptable to patients, their carers, and clinicians;
• support consumers in collaborating with and communicating with their carers and health services;
• identify health issues earlier and provide an increased intensity of care;
• increase the accessibility of services ;
• reduce travel for clinicians and patients;
• reduce clinical service costs;
• successfully deploy simple commodity grade technology;
• and provide technology support services to patients and clinicians.

CareSearch was involved in supporting the palliative care trial by brokering the technological applications for the trial and supporting data collection and analysis.

Palliative care patients at home received structured online video contact with the palliative care team using a tablet device (iPad), a remotely monitored health utilisation diary and self-assessment applications to record their health status and ‘quality of life’, and an exercise tracking device and scales to monitor their physical activity and weight. Carers are critical to palliative care support, so they were also encouraged to provide self-assessment on-line, or to contribute to assessment of the patient. Automatic alerts were generated when distressing symptoms, a fall in function to a predetermined level, or any unplanned health care utilisation were reported via the self monitoring applications.

Data from 43 participants demonstrates that telehealth enabled access to clinical care that is highly valued by both patients and carers, particularly for those patients whose disease burden prevents them from travelling. The routine of daily completion of self-assessment applications enabled more accurate reporting on changes in symptoms, and triggered a significant number of alerts that would otherwise have gone undetected, leading to meaningful, and more timely clinical intervention. Activity based monitoring was of less clinical value than anticipated. Use of the telehealth system or iPad apps by carers in bereavement was also less than anticipated.

Palliative Care clinical staff generally had positive views of the usefulness of telehealth. Travel and patient contact time requiring senior clinicians was reduced by approx. 65%during the telehealth trial. Clinical efficiencies and new models of care were developed during the project. There is ongoing and iterative development of new clinical algorithms and practice which integrate telehealth into palliative care services.