Professor Anthony Smith first began working with Queensland’s Cherbourg community in 2004, when he pioneered a mobile ear screening van to assess children at high risk of ear disease or preventable hearing loss.
Fifteen years later, the service continues to operate, although today it incorporates telehealth technologies for screening and assessment – technology that Professor Smith says has tremendous potential for Indigenous communities throughout the country.
A child attends the ENT screening van at Cherbourg.
The UQ Centre for Online Health (COH), led by Professor Smith, has developed a national and international reputation for enabling better access to specialist services in remote communities through the use of telehealth.
While its initiatives have reduced the need for costly and inconvenient travel for patients of all ages and dispositions, servicing Australia’s inland Indigenous population is one of the key motivators.
Right now, that relationship is fortifying thanks to advances in telehealth – using modern technologies to deliver virtual ‘face-to-face’ consultations from hundreds of kilometres away.
Professor Smith says it’s an exciting time in the field.
“Better understanding the enablers and barriers associated with telehealth implementation is at the heart of what we do,” Professor Smith says.
“Having frank conversations with elders, community members, health workers and local councils is a pleasure to be a part of, because we are collaborating on initiatives that are new, unique and transformative.
“These efforts take time – and it’s the time we spend with each community that makes our job worthwhile.”
Murals cover the walls of Cherbourg Hospital.
Professor Smith says this time spent with individual communities is essential to ensure that the services implemented are sustainable and will have a long-term impact.
“A critical element of all projects conducted by the COH is transparency and sustainability, because we genuinely want to see services extend beyond the life of specific research projects,” he says.
“There are many and undoubted challenges faced by rural and remote communities, but overcoming these through alternative models of care, is a task we all enjoy.”
Planning and establishing these new telehealth-enabled service models requires the expertise of the COH team, who take a practical approach to service development and telehealth evaluation.
Among the specialist services the COH has developed in partnership with Aboriginal and Torres Strait Islander communities are those to do with aged care, dementia, diabetes, and ear, nose and throat conditions.
Many of these services are used for screening and assessment, which assist local health services in planning treatment and potential referral to a specialist.
As well as the mobile ear screening van, which is is operated on a routine basis by local Aboriginal health worker Cecil Brown (fondly known as ‘Pickle’), the COH has worked with the Cherbourg, Cunnamulla and Charleville communities to train Aboriginal health workers on dementia assessment, dementia education and telehealth.
“The role of the health worker in each community is to raise awareness of dementia and help navigate the referral pathway in the event that a telehealth referral is made,” Professor Smith explains.
Tele-diabetes services have been delivered via videoconference to Cunnamulla and Charleville since 2015, supported by specialists at Princess Alexandra Hospital in Brisbane.
By road, the distance separating those western outposts from Queensland’s state capital is roughly 800 kilometres, or up to nine hours of continuous driving.
The COH has also worked with communities in the Torres Strait, where the costs, inconvenience and risks presented by inter-island travel adds another element to the usefulness of telehealth.
“Another benefit for communities is inclusiveness in specialist consultations and improved continuity of care."
The benefits of telehealth to patients’ quality of life are immediate and obvious, but if you scratch the surface, there are numerous spin-offs that may not be initially apparent.
For example, patients also benefit from significant financial and time savings due to drastically reduced travel, and they’re able to spend less time away from their home and family.
A by-product of less travel is fewer carbon emissions, therefore making telehealth a positive contributor to the long-term health of the planet.
“Another benefit for communities is inclusiveness in specialist consultations and improved continuity of care, which is not something to undervalue,” Professor Smith says.
“Through telehealth, local staff are being empowered by learning new skills, sharing these and feeling more valued by the community.
“Reducing the sense of isolation can also be a big boost for some health services, and has the possibility to incentivise recruitment and retention of staff in rural and remote areas."
Consultation, collaboration and engagement are key priorities for the COH.
In each instance of telehealth delivery, steps are taken to ensure services are delivered in a culturally appropriate way.
Regular site visits, constant communication and multidirectional exchanges of knowledge help support desired outcomes and long-term relationships.
Local health staff are able to contribute to consultations and learn from specialists during conferences – akin to a mentorship.
“I view this type of work environment as not only essential, but a privilege shared by the COH team,” Professor Smith says.
“While we are developing telehealth service models that meet the needs of the communities we are working with, these models have tremendous potential for other Indigenous communities throughout the country.
“Not only is our goal to ensure research is conducted in a transparent and culturally appropriate manner, our ambition is to share the findings in a useful and honest way.”
“Our aim is to ensure everybody living in Australia is able to access top-quality health services as close to home as possible.”
Measurable outcomes from the COH’s work are evident across its spectrum of programs.
Research describing the role of telehealth in Indigenous communities has been disseminated internationally through publication and presentations, with Professor Smith invited to deliver several keynote talks around the world.
Interest from health services in Western Australia and the Northern Territory is further evidence of the impact of the COH’s research.
Since 2009, the routine ear screening program has assessed approximately 1400 children in 35 schools throughout the South Burnett region of Queensland, with the proportion of eligible children screened in the Cherbourg community rising from 38 per cent to more than 85 per cent over time.
Diabetes-related activity by the COH has now saved more than 70 patients in rural and remote areas a return trip to Brisbane.
It has also helped improve attendance rates for some patients, who require ongoing monitoring and screening for further complications.
Progress in the field of dementia has led to the training of 12 health workers and practitioners who now lead the way in screening for dementia and coordinating telehealth services in Cherbourg, Cunnamulla and Charleville.
“Our aim is to ensure everybody living in Australia is able to access top-quality health services as close to home as possible,” Professor Smith says.
“Telehealth is integral to that ambition.”
Image credit: Getty Images/Marianne Purdie
Although the use of telehealth is commonly seen as a mechanism to support people separated by large distances, its use in metropolitan settings is also important to recognise.
Access to specialist appointments may be restricted because of other factors such as frailty, cost, lack of support or physical impairment.
Evidence has also shown that Indigenous people prefer to attend specialist appointments that involve Indigenous practitioners and/or are provided from community-controlled Indigenous health services.
In these settings, telehealth services can be delivered in trusted and familiar environments.
Professor Smith says that for the wider general population too, there are numerous reasons why telehealth is at the vanguard of reshaping health services for future generations.
“The rising costs of health care and increasing demands associated with an ageing population and chronic disease present many challenges, and opening our minds to the real potential of telehealth encourages us to rethink the efficiencies across the entire health sector,” he says.
“On any given day, you only have to look through an outpatient department to realise the number of people – and families – travelling for an in-person appointment, when telehealth could have been a viable option.
“I encourage everyone in the health profession to become familiar with telehealth and critically explore ways of providing services which promote efficiency, convenience and best practice.”
The story so far:
2004: Professor Anthony Smith visits Cherbourg for the first time alongside Queensland Health's ENT outreach team.
2009: The UQ Centre for Online Health (COH)’s mobile ear screening service is officially launched in Cherbourg.
2013: The COH establishes video conference facilities in Cherbourg, Cunnamulla and Charleville.
2015: The COH’s tele-diabetes service commences for people living in Cunnamulla and Charleville.
2017: The COH conducts site visits and starts engaging with communities and health services in the Torres Strait Islands.
2017: The COH’s dementia telehealth project, known as DREAMT, commences, providing Aboriginal and Torres Strait Islander peoples living in rural and remote areas with improved choice and access to dementia care services.
2019: The COH and its partners receive a commendation in the UQ Partners in Research Excellence Awards.
Professor Anthony Smith, Centre for Online Health
Last updated 12 September 2019.
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The Centre for Online Health is a foundation centre of the Centre for Health Services Research, within the Faculty of Medicine at the University of Queensland.