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Hunter New England Area Health Service Pilot Telehealth High Risk Foot Clinic:

Connecting Tamworth and Newcastle

Prepared by Nicole MartinService Manager – Podiatry & Footcare Services

Greater Newcastle Cluster

The frightening facts …

“Every 30 seconds, somewhere in the world, a limb is lost as a consequence of diabetes” The Lancet November 2005

After a major amputation, 50% of patients will have their other limb amputated within 2 years. Goldner. Diabetes 1960; Armstrong, et al, J American Podiatry Med Assn, 1997

The relative 5-year mortality rate after limb amputation is at least 50%. When compared with cancer – it is second only to lung cancer (86%). (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%). Armstrong et al, International Wound Journal, 2007; American Cancer Society; Facts & Figures 2000

Background

Clients across Hunter New England Area Health Service (HNEAHS) with complex diabetes foot complications have traditionally had to travel to Newcastle to access multidisciplinary high risk foot services

The literature indicates that those clients with complex foot conditions who have access to a multi-disciplinary team, have improved foot health outcomes and overall reduced medical costs.

Ideally rural clients should be able to access multidisciplinary high risk foot services close to their home.

Background

Pilot Telehealth High Risk Foot Clinic

The aim of this project was to establish a pilot Telehealth High Risk Foot Clinic between the Newcastle and Tamworth sites, to improve the foot health of clients with diabetes and complex lower limb co-morbidities in the Tamworth area.

The six-month pilot ran from February – August 2010, with clinicians in Newcastle providing Telehealth multidisciplinary input for clients attending the Tamworth Podiatry Clinic.

Tamworth clients who matched the “High Risk Foot Clinic” eligibility criteria were offered either a Telehealth consultation in the Tamworth Podiatry clinic or a face-to-face appointment in Newcastle at the High Risk Foot Clinic.

Eight clients were involved with the pilot clinic; seven clients presented with foot wounds and one client presented with an acute Charcot Neuroarthropathy.

Pilot Telehealth High Risk Foot Clinic

How did the technology work??

Telehealth review by

Newcastle multi-disciplinary

high risk foot clinic

Telehealth

conference

between Tamworth

& Newcastle

clinicians

Appointment at

Tamworth Podiatry

Clinic

Pilot Telehealth High Risk Foot Clinic

Demographic Data

Sex Male 7 (87.5%)

Female 1 (12.5%)

Median Age Male 62 years (range 43 years – 73 years)

Female 64 years

Median Distance to clinics Tamworth 73.5 kilometers (range 1 km – 202.9 kms)

Newcastle 280.3 kilometers (range 210.6 kms – 347.9 kms)

Median Travel Time to clinics Tamworth 59 minutes (range 2 mins – 157 mins)

Newcastle 225 minutes (range 176 mins– 276 mins)

Pilot Telehealth High Risk Foot Clinic

Evaluation

Clinical outcomes

Feedback from clients / carers

Feedback from clinicians

Cost analysis

Pilot Telehealth High Risk Foot Clinic

Practical tips to help Patients feel comfortable in accessing specialist ambulatory care via telehealth ….

Skill development of local clinicians

Client care is centered:

– informed evidence based decisions for rural clients

– choice to access Telehealth in Tamworth or face-to-face in Newcastle

– client input into management plans

Detailed explanation of Telehealth facilities

Visits by Newcastle clinicians during initial pilot phase

Communication between clients and clinicians

Timely and integrated follow-up by clinicians

Pilot Telehealth High Risk Foot Clinic