Infectious disease consults offered via telemedicine

A meaningful tool for clinical specialist support

A telemedicine-based infectious disease consultation service established in July 2014 by Sioux Lookout’s Meno Ya Win Health Centre and the Division of Infectious Diseases at The Ottawa Hospital has been “a meaningful tool for clinical specialist support” in the Sioux Lookout region, according to a recently published study in the Journal of Telemedicine and Telecare.

In the first year of the service, there were 76 initial consultations and 115 follow-up appointments and case conferences for patients diagnosed with a variety of infectious diseases, including pediatric cases of acute rheumatic fever, active adult tuberculosis and infected diabetic foot ulcers.

All but one of the patients seen were from First Nation communities.

Prior to the program, infectious disease expertise was only available through informal curbside consultations with specialists at tertiary care centres, but there were no formal assessments or follow-ups performed except for a minority of complex patients, the study notes.

In addition to providing specialist care to a First Nation patients in need, telemedicine can also save health-care dollars.

Twenty-eight of the telemedicine appointments were perfomed for patients in their home communities, which have telemedicine videoconferencing capability via the Ontario Telemedicine Network and Keewaytinook Okimakinak eHealth Telemedicine Services, a community-based and owned network providing telehealth infrastructure to First Nations in the Sioux Lookout region.

Of the 32 remote northern communities in the region, 25 can only be reached by air. The cost of flying patients to Sioux Lookout via scheduled air services is $3,000, notes the study, while an emergency air ambulance transfer costs $15,000.

The study also notes that most remote communities lack the infrastructure and resources to support the administration of intravenous antibiotics, requiring patients to stay in Sioux Lookout for the duration of their treatment.

“Once there is adequate support for home intravenous programs in the communities, lengths of stay could be further reduced and more follow-ups could occur in the community,” state the authors, Jai Mashru, Dr. Michael Kerlew, Dr. Raphael Saginur and Dr. Yoko Schreiber.

Avoiding expensive travel to Sioux Lookout, Thunder Bay and Winnipeg has the potential for “massive” cost savings, they say.

It also minimizes disruption of work and family life.

The article points out that the Sioux Lookout region suffers from a high incidence of tuberculosis, hepatitis C, blastomycosis, acute rheumatic fever and community acquired MRSA compared to the rest of Canada, and attributes it to “lack of access to clean, running water and overcrowded and inadequate housing.”

Specialists noted some limitations to using telemedicine technology, including poor image resolution, lack of three-dimensionality, and “the inability to conduct a hands-on physical exam, especially in the assessment of pedal pulses and assessment of sensation in patients with diabetic foot ulcers… especially in the absence of a health care provider.

“As the technology improves,” they conjecture, the ability to ausculate and to observe the three-dimensionality of lesions and perhaps even palpate lesions may increase.”

Access to specialists via telemedicine “in a region that suffers a large burden of infectious disease and geographic challenges is a well-received clinical advancement for care… with potential for major socioeconomic benefits,” the study concludes.

Filed in: Research

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