C81 Telehealth provides meaningful contributions to patient care in ALS

27-11-2019

MNDA SYMPOSIUM PERTH DEC19 PRESENTATIONS

Session 7B Improving Care Practice

Australia

Background: The utilisation of online health communications is expanding rapidly, allowing more patients to access healthcare remotely. Specialist multidisciplinary care has been found to improve survival and quality of life in ALS, but regular access is difficult for many patients. Telehealth appears a necessary and advantageous medium to improve access. In clinical practise, the extent to which Telehealth is effectively utilised and by whom is under-evaluated in ALS.
Objectives: We sought to review the Telehealth services offered at our specialist statewide ALS clinic in Melbourne, Australia, and examine the clinical outcomes related to the provision of Telehealth services.

Methods: Our cohort study comprised a retrospective, systematic medical file audit of all ALS patients who utilised Telehealth from November 2018 to April 2019. Demographic information was collated, alongside residing locale, and disease specific variables including disease onset and duration. Medical file entries pertaining to each session were examined and summarised. Themes emerging from these summaries were subsequently coded, allowing the research team to identify the key outcomes of each session.

Results: ALS patients were engaged in a total of 84 Telehealth sessions over the 6-month period, accounting for 45% of all sessions offered by our broader progressive neurology service. ALS patients living in regional areas accounted for 32% of sessions, while metropolitan patients accounted for the remaining 68%. Those living in metropolitan Melbourne were further advanced in their disease (average duration of 5 years) compared to their regional counterparts (average duration of 3 years). In total 9,538km of travel was avoided, with an estimated cost saving of $6,222AUD. Of patients accessing medical care, 63% accessed neurology, 49% saw neuropsychiatry and 18% liaised with palliative care specialists. Physiotherapy was the most frequently accessed allied health service, present in 45% of sessions, followed by occupational therapy, speech pathology and dietetics. Telehealth was rarely accessed for emotional/behaviour support with only 2% of patients utilising the service for clinical psychology and no documented interactions for other psychosocial services. Medical entries detailed a range of clinical outcomes, including medical review, physical function and PEG/NIV recommendations, swallowing and communication strategies, nutritional changes, research education and end of life planning.

Discussion and conclusions: ALS patients appear to be successfully accessing Telehealth services. Moreover, clinical outcomes associated with Telehealth sessions were similar to those expected from traditional face-to-face services. Critically, psychological supports were rarely provided to patients via Telehealth, which may be an avenue for increased service provision. Our findings indicate that ALS patients living long distances away from services or with increasing disease related disability were most likely to utilise Telehealth. These findings highlight the importance of integrated Telehealth services within ALS clinics, in providing equitable access to multidisciplinary specialist care.

Source: Abstract Book symposium Perth