Tuesday, 21 April 2020

Telehealth; the New Normal?

Lauren Miller, amazing what a deadline can do!
Telehealth can be awesome but has inherent limitations. Like so much of what I do, it requires practice and it also requires a buy in from both therapist and patient. I spent a bit of time helping Lauren Miller out with a review paper on telehealth and hand therapy she punched out for the AHTA. I've pasted the introduction below. The paper demonstrated that there is established proof that telehealth can be a viable and effective treatment modality. I would agree with this, albeit we need to recognise that it does have limitations. I'll let you read Lozza's work first, then I'll add my 5 cents. 

Evidence of clinical effectiveness of telehealth consultations by Hand Therapists: for the consideration of Private Healthcare Australia, Lauren Miller, PhD1,2, Hamish Anderson3,4, Andrea Bialocerkowski, PhD 5,6

Hand Therapy and Coronavirus (COVID-19)

Hand Therapy is the science and art of rehabilitation of the upper limb from the shoulder to the hand. It involves the assessment, using standardised tests, of the injured limb from which a specific treatment program is designed (Australian Hand Therapy Association, 2020). A variety of specialised treatment techniques are used to achieve client goals. Hand Therapy is practiced by occupational therapists and physiotherapists, and traditionally occurs in the face-to-face delivery mode.

However, in the wake of the coronavirus (COVID-19) pandemic, measures aimed at controlling the spread of the virus within our community have been introduced. These include social distancing of at least 1.5 metres between individuals, advice for people to stay at home (particularly those aged over 70, or over 65 with pre-existing conditions, or Indigenous people aged over 50 with pre-existing conditions) and self-isolation for those who have recently returned from overseas, tested positive, or been in contact with someone who has (Australian Government, 2020).

These important measures present significant challenges to the traditional face-to-face model of care. Telehealth consultation provides an alternative and in many cases adjunct option that enables continued access to Hand Therapy services and prevents unnecessary delays in receiving care while minimising risk of coronavirus (COVID-19) disease transmission. Telehealth consultation may become even more crucial in the event of more restrictive lockdowns, such as those being enforced in other countries.

Fortunately, the Australian Hand Therapy community is well placed to introduce safe and effective telehealth consultations. The use of telehealth has been repeatedly shown to be efficient, cost-effective, and able to deliver the results that Australian Hand Therapy consumers demand, and deserve. It is the strident view of the Australian Hand Therapy Association that to enable privately insured patients to access appropriate and effective health care during the restrictions of this pandemic, hand therapists need to be able to bill private health insurers for teleconsultations.

Ordinary meme, but pickings were slim
The issues I have faced are mostly addressed in the article. They include poor display quality that means I can't tell if a wound is infected or just angry, reluctance on behalf of patients to actually pay for my time, and the inability to repair a splint over the internet. The evidence does exist to justify telehealth as a modality. My immediate problems are twofold. 

Number one is that with no one playing sport or doing risky things, with no elective surgery, and with no one visiting a GP for anything other than a fearful sniffle, I don't have patients knocking on my door at the moment. I do want to utilise telehealth but I don't currently have a patient population to use it on. Bigger practices, those associated with trauma surgeons, and those who pre-pandemic had established exercise classes may be different. Good luck to you all. Also what can't be effectively addressed is a perceived inability on my part to translate what the patient needs to do without being able to physically put my hands on them. I'll learn that if I get the chance to persist, perhaps in the  post COVID-19 world. Ultimately, the valuable lesson for us all is that it is an option, and is likely one that should be be added to most therapy tool kits from here on. So well done Lozza, and thank you.

Look after those fingers,


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