Tele Health In Rural And Remote Australia

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Tele Health In Rural And Remote Australia

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Tele Health In Rural And Remote Australia

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Issues In Tele-Health In Rural And Remote Australia?


The life expectancy of the indigenous population of Australia is 10-11 years than the non-indigenous population of the country (Moffatt & Eley, 2010). This shows that indigenous population and people living in the remote and rural areas of Australia are facing the problems of lack of access to health care services. The health of people living in remote and rural sites is significantly poorer than their urban counterparts, because this population suffers from more chronic disease, and has low socio-economic status. Their physical and mental health is poor than the remaining urban population. Therefore, the provision of Telehealth has been initiated by Australia and many other countries, to improve the access of the rural and remote population to health care services.
There are many barriers that restrict their access of health care services. These barriers are distance, waiting time, transportation facilities, and high fees of the physicians, family disruptions, low income, discrimination, racism and other social disparities. Due to these reasons, rural and remote populations suffer from poor mental and physical health. Telehealth is an effective way to increase the access of the population to health care services with the use of technology in the rural and remote areas (John Wakerman, 2015). Telehealth enable to receive health care from the distance and allows receiving specialist services as well. Therefore, this paper will discuss the concept of telehealth and what exactly is facilitated through this approach. Paper will also briefly discuss the benefits of telehealth and how it can help in improving the health outcomes. However, paper will mainly focus on identifying the issues in telehealth that are making it a slow process that is fraught with failures.
According to the definition, “eHealth or Telehealth refers to the health care components delivered, enabled or supported through the use of information and communications technology” (Miyazaki, et al, 2012). Such technology includes the professional communication among the health care providers. Via online services patients can also access to specialist services, without physically accessing the service. Online tools and resources can be effectively used for it. Tele-health can be considered as a means of delivering effective health care service to the people with the help of telecommunication. According to the study of Bywood, Raven & Butler (2013), telehealth can be considered as the umbrella term for the telecommunication based or electronic expansion of the health care services. The services could include clinical as well as non-clinical services. The non-clinical services in the health care system include the Electronic Health Record (EHR) and telemedicine (telehealth clinical services). The health care system of Australia requires the reevaluation for the identification of the new ways of care, improving the health outcomes and for providing device based telehealth (Miyazaki, et al, 2012).
The access to the healthcare services is often very limited for the people living in the rural and remote areas. The access to the services becomes more difficult for the people, who have restricted functionality or mobility. Telehealth service can be an effective way of reducing the health inequalities in accessing the health care services. Some of the important equipments that are included in providing the telehealth care are the commercially-available videoconferencing equipment. Such equipments also include “the peripheral equipment, such as a digital stethoscope or a close-up camera” (Bywood, Raven & Butler, 2013). In very small number of cases Skype technology is also used. However, the effectiveness of this technology is under scrutiny and very limited studies have verified its effectiveness with weak designs.
The telehealth services were mainly based in the hospitals, which now also includes the other locations, such as aged care settings, community health care centers and health care centers for the Aboriginal people. Some of the most significant specialist services are offered through telehealth services are the services for the acute or chronic care that further includes “mental health/psychiatry, paediatrics, radiology, dermatology, pathology, endocrinology, oncology, neurology, dentistry, burns and wound care” (Bursell et al, 2013). Telehealth services are also significantly used for the diagnosis of the disease in the palliative care. The management and coordination of the telehealth for the indigenous people is done differently in Australia. In some of the jurisdictions of Australia, telehealth is centrally managed by NSW Telehealth Network. However, in some other states the telehealth service is privately managed by the general practitioners (GPs) and community care centers in Tasmania, through private hospital in South and Western Australia and through Rural Health Alliance in Victoria (Bradford, Caffery & Smith, 2016).
Through the evidences of the cost effectiveness of the telehealth services are very limited, but such services can be cost effective for the people suffering with chronic and life threatening conditions. It significantly plays an important role in providing services in aged care and indigenous population (Wade, Eliott, & Hiller, 2012). This service is very effective for the frail people, who may suffer from poor functionality and mobility. The important aspect of the telehealth services is that they are required to be tailored and altered according to the local conditions, and conditions of the healthcare system (Caffery et al, 2016). Identifying the specific needs of the population according to the geographical location is also important. Some of the significant benefits of the telehealth are that people living in the poor socio-economic conditions or those who are living in the rural and remote areas can have better access to health care service. The improved access will also improve the physical and psychological well being of the people. The waiting time will be reduced, travelling time will be saved, and the system will provide greater convenience for the patients and enhance their level of satisfaction (Moffatt & Eley, 2010).
Most of indigenous population of Australia lives in the remote and rural areas of the country, and the mortality rate is very high among the this population due to the high rate of the diseases like, diabetes, obesity, cardiovascular diseases, kidney diseases, cancer and mental disorders. The respiratory diseases also have the higher prevalence among this population that significantly affects the physical and mental well being of people (Shulver, Killington, & Crotty, 2016). Improving the accessibility of the primary health care services is important for reducing the health disparities and improving the health status of people. Telehealth can be significant step for achieving the goal of good health among the rural population. Telehealth is a significant effort for targeting Aboriginal communities. Specialists’ services are required for addressing various health issues that are experienced by the rural and remote population of the country.
The goal behind improving the access to the primary and specialist care is to improve the health of people and fulfilling the healthcare needs of Indigenous people. The primary and specialist care can address the population from various age groups. Aboriginal community-controlled health services (ACCHSs) are responsible for providing the primary and specialist healthcare services to the Australian Indigenous population (Caffery et al, 2016). However, due to the financial restrictions, providing specialist care and services in the rural and remote areas is difficult and costly. Therefore, the alternative care modal are required and one such model is Telehealth (Caffery et al, 2016).
Benefit of the Telehealth in Providing Primary Health Care
How to provide the primary health care in the rural and remote areas remains a significant challenge for the government of Australia and for the health care services as well. Bradford, Caffery & Smith, (2016) states that “One-third of Australia’s 23 million people live in rural or remote locations and these people live in towns, communities and isolated locations that have limited access to services and small population counts, which is less than 10,000”. People living the rural and remote areas of Australia are mainly the disadvantage groups because of their geographical location that makes it very difficult to access healthcare services. Therefore, these people experience poor health in comparison to the urban population of the country. According to the data obtained from the national census, the mortality rate of people, who are less that 65 years is double than their urban counterparts. Also, the life expectancy is four years lesser than those living in urban areas. All this can be associated with the poor health and poor access to the health care facilities. The equity of the health care service has been a significant goal of health sector of Australia (Gagnon et al, 2006). However, the access to healthcare services by the rural population is influenced by the distance, time and geography. The continuity of care and coordination are difficult to achieve and the disease burden on the rural and remote population is increasing. These problems also lead to the difficulty in monitoring the health and health outcomes of people.
The cost of healthcare is escalating; due to which the retention and recruitment of the heath care professionals in the rural and low economies is becoming difficult. The dilemma in providing the service to the people and people receiving the service is being faced by the health care authorities all over Australia. Delivering the healthcare service in the rural and remote areas is becoming challenging. Telehealth has become one of the effective solutions for the health care providers to deliver their quality services in the remote locations and to address the ongoing challenge. Health care at the distance can be effectively provided through telehealth. Telehealth can be effective measure to deliver the service, where the distance becomes the critical factor. By the using of the communication technology and information delivery system, health care professionals are able to deliver their services (Moffatt, & Eley, 2011). The exchange of information allows the effective diagnosis of the diseases, treatment and prevention of diseases and injuries, evaluation and research and also helps in providing health care education to the consumers. Telehealth allows taking the effective and continuous steps in the interest of people and improving their health outcomes. The Telehealth services can use the real time information for service delivery or they can also use stored and forwarded information.
Some of the other significant benefits of telehealth include supporting patients with better access to health care, reduced length of stay in the health care setting, reduced demand of the emergency services, improved service quality, improved clinical outcomes, reduced financial cost of access and transportation, timely diagnosis, improved care facility for the chronic disease, individualized care for the complex and chronic diseases, health education as well as peer support provision (Bursell et al, 2013).
Barriers to Telehealth or Issues in Telehealth
Despite of the obvious benefits of telehealth, the practical implementation and integration of the telehealth in the mainstream health care practice is very slow and has been facing many barriers (Jang-Jaccard et al, 2014). The scale and pace of development and adoption of telehealth has not been done in the same manner as it was anticipated. The evidences have also shown that many pilot programs have not migrated into the sustained services (Wade & Eliott, 2012).  The challenges and barriers associated with the telehealth services in Australia are well descrined through the perspective ethicolegal concerns, clinician preference for face-to-face consultations, funding models, change management practices, administration personnel and resources (Wade, Eliott & Hiller, 2012). Such observation related to telehealth are not just limited to Austrlia , the international up-take of the telehealth has not been consistent according to available evidences. It has not into pace with the rapid advancement in the health and communication technologies and not much opportunities have been noticed for the health care service delivery at a distance (Penz et al, 2007).
Infrastructure Issues
The rural and remote infrastructure has improved over the years in terms of improving the access of the people to primary and acute care services. Despite of the significant efforts, the gap has been found in the health care funding for the rural and remote infrastructure (John Wakerman, 2015). The rural and remote areas are primary and aged care deficit. At present, one of the major barriers to the teleheath is to find the doctors and health practitioners to connect with the patients or consumers. Although, evidences have shown that there are plenty of the telehealth projects in Australia, but these are mostly working in silos. No central instructions are yet offered. However, some of the organizations are working towards it (Caffery et al, 2016).
Infrastructure and Technological Barriers
The major barrier to up take telehealth is related to the infrastructure (Moffatt & Eley, 2011). The infrastructure problem is the major problem. Therefore the health care services in the remote and rural areas have to increase their accommodation facilities for providing effective care to patients. The infrastructure also includes the appropriate access to Internet. Telehealth is mainly based on the proper access to internet, but the rural and remote areas of Australia often suffer from the poor access to internet. The ability to access internet is also hampered by the lack of equipments that are mandatory for accessing internet. The lack of broadband connection makes it difficult to access internet and communicate with specialists. The required bandwidth for the video conferencing is not appropriately available. Some of the other fundamental problems associated with infrastructure are that computers are not available, computers do not have the cameras, or the computer lacks the software that are important for the camera. The tele conferences services are required to be eliminated for improving telehealth services (Moffatt & Eley, 2011).
The main aspect of the telehealth that was associated with providing service to the indigenous population was that to offer the culturally safe and competent care through video conferencing. The local Aboriginal health practitioner can help people in accessing the specialist care through video conferencing. But, the problem with video conferencing arises in choosing the video conferencing platform (Shulver, Killington, & Crotty, 2016). There are various kinds of the video conferencing platforms and not all the video conferencing platforms are interoperable, which means that there is no guarantee that the platform of the consumer will work with the platform used by the health care practitioner. The interoperationality issue of the technology, it is important that communities of the physicians and other health care professionals should be made. The community of the professionals will help in reducing the problem of platforms (Penz et al, 2007). Some of the early telehealth users were also dependent on using Skype. However, there are imminent issues with the Skype, such as the quality of the video and reliability are not up to the mark.
Lack of Medical Workforce
Supply versus demand is another barrier in effective implication of the telehealth services in Australia. The supply of the professional physicians in the rural and remote areas of the country is very less (Shulver, Killington, & Crotty, 2016). The medical human resource and the increasing demand of the medical workforce is the growing issue for the remote and rural communities of Australia. The health care system has been highly affected by the technological advancement in the professional practice. The uneven distribution of the medical professionals and medical workforce in the country is a big issue. There has been a shortage of the medical professionals and physicians in the remote and rural areas, which is mainly problematic for the smooth flow of the telehealth service (Steventon et al, 2012). The shortage of the physicians, again limits the access of the deprived people to healthcare services. Still there are many small cities and remote areas that are facing the problem of shortage of the medical human resources. There are approximately 335 specialists working in the urban areas, while there are only 148 specialists working in the remote areas (Shulver, Killington, & Crotty, 2016). This variation in the figures reflects the health inequality.
Perspective of the Stakeholders
The distance from the health care services also drives down the participation of rural and remote area population in health care. According to Steventon et al (2012), “Many telehealth services remain at the status of ‘innovation’, not extending beyond research pilots or niche markets to become part of routine healthcare delivery”. The implementation of the telehealth has identified that improvement in the various areas for addressing the technological issues, infrastructure issues, change management, organizational and jurisdictional boundaries, as well as funding. Most of the general practitioners have accepted the concept of telehealth for improving the services, still there are some barriers which is restricting the effective delivery (Moffatt & Eley, 2011). The most commonly identified barrier by the GP’s are resistance to change, hassle of coordinating with the specialists and taking appointments from them, concerns related to the clinical quality, needs of equipments and technophobia, availability of the specialists,  and lack of knowledge of the specialists in providing effective treatment (Armfield et al, 2014).
However, it is also important to understand the perspective and thoughts of the various stakeholders involved in the telehealth services. The most important stakeholders are the patients, physicians, healthcare professionals, policy makers, managers, and information technologists (Armfield et al, 2014). One of the most crucial aspects of the telehealth implementation is about understanding the direct perspective of the providers and their attitude and satisfaction towards implementing telehealth services (Sandberg et al, 2009). Some of the consumers and health care providers still believe in traditional approach. The evidences have shown that some people are reluctant to learn technology or do not possess the learning style required for telemedicine or telehealth. Some of the doctors and physicians also indicated that lack of confidence to use the technology and delivering competent services (Moffatt & Eley, 2011).
Funding and Time Issues
Another significant issue in the growth and expansion of the teleheath is funding. Funding has become a significant barrier in the take up of the telemedicine (Moffatt & Eley, 2011). The inadequate funding in telehealth is becoming a frequent issue in Australia, as well as in many other countries. The lack of funding for the GPs, specialists and other staff has been frequently experienced. These professionals are very important for the telehealth consultation, but lack of funding has resulted in lack of professionals. Some of the evidences and participants of the studies have also shown that lack of financial incentives for the professionals in remote sites is a big issue (Moffatt & Eley, 2011). The doctors want their service to be cost effective and want to receive better incentives. Lack of medicare, cost for doctors and cost for access are some of the issues that are not being effectively addressed for improving the expansion of telehealth. The telemedicine consultants and some of the telepsychiatric services are not receiving incentives from the Medicare. Telemedicine becomes more costly for the professionals, because it involves many tasks and lack of funding is also lowering the enthusiasm of the health care professionals (Tracy et al, 2008). The funding issues also restrict the proper flow of the telehealth services. The rural and remote health care infrastructure often lack proper resources for sustaining effective telehealth services (Sabesan et al, 2014). Telehealth provision states that patient should receive the health care close to their homes, but lack of resources and proper infrastructure those effective services can’t be delivered (Gagnon et al, 2007).
Another major barrier identified in this context is time. The time of consultation offered to the teledermatology is 30 minutes, while the traditional consultation has only 15 minutes. There are not extra incentives or extra pay for the doctors and specialists for providing their extra time. Another aspect of the time barrier is the time spent in learning the technical aspects of the consultation of telehealth and time for doing the things. Lack of skills for handling the equipment is a significant issue.
Equipment skills
 The rural and urban doctors have been found to have lack of skills for using the new equipments and also using the existing equipments. One of the common problems associated with the skills are inability to attach the image or jpeg files with the e-mails or inability to take the x-ray from the x-ray equipments and getting an image that has sufficient clarity. The doctors or physicians in the remote and rural areas have the lack of IT skills as well as lack of confidence to use technology. Training and ongoing support is very important in this regard.
Paper discussed the concept of telehealth in the Australian health care system. Telehealth is the use of the electronic information and tele-communication technologies to support the system of long distance clinical healthcare. Telehealth is mainly supported with the video technology. Therefore, it requires appropriate technological support and infrastructure. However, the evidences have shown that with anticipated benefits, there are high number of barriers and issues associated with telehealth technology. Paper explains the benefits of telehealth that can improve the quality of health care delivery in Australia. But, identified barriers are restricting the growth and expansion of telehealth. 
Paper identified that perspective and thoughts of the stakeholders must be integrated with the telehealth. So, that proper implication can be done in the remote and rural areas. The barriers identified in the paper are important to be addressed for elimination the issues of effective service delivery through telehealth. The barrier in up taking the technology based teleheath must be seen from the perspective of the service providers, as well as the service users for improving the clinical practice in remote and rural areas of Australia.
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