Distance diagnosis proving adequate for those at the ‘top end’ of Australia

Tele-ophthalmology has improved the delivery of eye care to an underserved and remote population, a physician reports.

NUREMBERG — Medical care in the rural areas of northern Australia is limited because remote population centers are scattered over great distances.

Few medical specialists are on hand, and a generalist may be available only once every 1 or 2 weeks. Tele-ophthalmology helped to shorten some of those distances and increase contact between ophthalmologists and aboriginal Australians, according to a presentation here.

Following the success of the effort in ophthalmology, practitioners in other medical disciplines are increasingly integrating telemedicine, said Nitin Verma, MD, of Casuarina, Australia.

“The combination of physical presence and telemedicine allows us to provide a cost-effective service in the ‘top end’ of Australia,” said Dr. Verma, who described his recent experience with distance medicine here at the Deutsche Ophthalmochirurgen meeting.

100% screenings

Diabetes mellitus (DM) is on the rise in Australia, especially among the aboriginal population. It is estimated that close to a half million Australian citizens are undiagnosed diabetics, and many of them have not had a recent eye exam. But now, thanks to tele-ophthalmology, screening exam rates are better in aboriginal areas than in urban areas of Australia, Dr. Verma said.

“We have reached, in many of the aboriginal communities, 100% coverage. Nowhere else in Australia do they have such a figure they can boast of,” Dr. Verma said.

Before the use of tele medicine, the ophthalmologists responsible for delivering care to the remote areas of Australia, usually by way of mobile clinics, found that a third of their time was spent on DM screenings. Computers freed them from the screening process and allowed them more time to treat their needy patients instead.

“Because there is more time for the specialist to spend on curative treatment, the waiting lists for care have decreased dramatically,” he said.

At screening stations or regional health centers in the aboriginal territories, specially trained nurses or aboriginal health care assistants take fundus or anterior segment photos and send them along with patient data via e-mail. Information provided in this manner is sufficient in most cases to make a diagnosis and prescribe treatment.

“The picture, along with the clinical data, is sent to me at the end of the week. I have a look and decide on the treatment for each patient,” he said.

Digital diagnosis

Using the combination of information from the physical exam and telemedicine, Dr. Verma and staff have been able to call in patients for suture lysis, recommend cataract surgery and suggest laser treatments — all without the physical presence of the doctor for diagnosis.

Some of the direct benefits seen since starting telemedicine 5 years ago are earlier presentation of disease and improved patient compliance.

“It provides continuity of care, allowing follow-up and recall of patients with chronic diseases,” Dr. Verma said.

Even the patients like it.

“They like the instant visual feedback. It helps in patient education. The laser rates have gone up, as has compliance. When possible, we carry out laser treatments in the community with a portable diode laser,” he said.

Enthusiasm needed

“Telemedicine isn’t rocket science,” Dr. Verma said. “But it only works when there is enthusiasm; enthusiasm on the part of the person transmitting the image and the person reading the image.”

The enthusiasm generated in the tele-ophthalmology venture has spread to other medical disciplines in the top-end area, which are now increasing their reliance on telemedicine. This has resulted in more patients being treated in community health centers.

“Other specialties have also joined this program, and this has increased the communication with and the trust between the doctor and the patient,” he said.

In addition to its clinical usefulness, telemedicine has turned out to be cost-effective, saving from $100 to $200 over the cost of a hospital or medical center exam.

“A consultation in the bush costs us about $277. One in the main hospital costs $477. The regional center is somewhere in between. So the financial advantages are quite obvious,” he said. For diabetic screening, telemedicine has proven to be cost-effective as well.

A study comparing patients treated through telemedicine to patients treated using conventional medicine confirmed that, in addition to lower treatment costs, there were no adverse events as a result of telemedicine.

“All of this is in line with the World Health Initiative, Vision 2020,” Dr. Verma added.

“We have now networked along with the other hospitals to expand the telemedicine network that has been created. The applications of telemedicine are endless,” he said.

For Your Information:

Nitin Verma, MD, can be reached at the Royal Darwin Hospital, P.O. Box 41326, Casuarina, NT 0811 Australia; +(61) 417-873-213; fax: +(61) 8-89-227-822.