Rural response: telehealth in north Wales

Many of us use technology in our daily lives and don’t give it a second thought. We Skype and Facetime our friends and family and use video conferencing facilities to avoid travelling to work meetings. But we are very sceptical about using this technology when it comes to patients – especially with those who fall into the older and frail category.

The aim of CARTREF (CARe delivered with Telemedicine to support Rural Elderly and Frail patients) is to improve access to care for frail older patients in rural areas of Wales through using virtual consultations (VCs), or telemedicine. It is estimated that about 4,000 people aged 85 years and older fall into this category.

Our objectives were to respond to people’s long-term chronic health problems, including those needing end of life care, by bringing access to specialist care into easy reach for those living far from secondary care centres. The project brought together a number of pre-existing workstreams with connections to a recently-funded telehealth programme and aims to create a single pathway.

A team of clinicians, academics and service improvement specialists, who with their patient counterparts, had the expertise and enthusiasm to transform the service, led the Royal College of Physicians (RCP) Future Hospital development site programme. See http://bit.ly/2bmshQq Members include doctors Chris Subbe and Salah Elgenzhai, Eleri Roberts, Guto Gwyn, Marion Poulter and me.

Our initial focus was to set up telemedicine clinics at one community hospital, Bryn Beryl, for a selected group of individuals aged 85 years and older who required follow-up consultation by Care of the Elderly (CoTE) team based at Ysbyty Gwynedd Bangor 30 miles away. The patients are met and supported by an outpatient nurse during the consultation. There is scope for other healthcare professionals, such as physiotherapists, to be present – either at the base or community hospital – to offer advice. Three outcomes are being measured, the first being the travel distance and travel time saved for patients travelling to the community hospital instead of an acute one.

A total of 102 patients have been seen in the first four months, saving an average of 62 miles on travel and 38 minutes’ travelling time on a round trip. In addition, the patient satisfaction data collected through a questionnaire showed that most (84 per cent) of patients would recommend the consultations to their family and friends.

While most consultations have run smoothly, it is important to note that the patients were selected, consented and were given written and verbal information about the nature of telemedicine. When poor or inadequate bandwidth for the VC occurs, prompt technical support is essential. Further, the number of specialist appointments released as a consequence of the virtual CoTE consultations are being measured, as well as the consultation outcomes and the patients’ frailty scores.

As a result of the new pathway’s success, reflected in the high patient satisfaction rates, we hope to run 20 per cent of all outpatient visits using telemedicine in the future.

Olwen Williams is a consultant physician in sexual health and HIV and RCP Future Hospital lead at Betsi Cadwaladr University Health Board.

Author

Olwen Williams is a consultant physician in sexual health and HIV and RCP Future Hospital lead at Betsi Cadwaladr University Health Board.