“Staying Strong” Regional Telehealth Initiative
Home Care - Regional, 80 + beds
Health and wellbeing, Clinical care / medication management, Social participation
About the program
Research indicates that rural, regional and remote consumers of telehealth services benefit from improved:
- quality of clinical services
- continuity of care
- service coordination
- effective access to services via early assessment,
- reduced unplanned admissions and lower costs for travel-related costs
- (Moffatt and Eley, 2010).
In 2013, the “Staying Strong” regional Telehealth Initiative delivered via a nurse-led model of care, commenced with older Aboriginal and Torres Strait Islander peoples in regional locations in NSW and Queensland.
The identified outcomes were to improve the health and wellbeing of Aboriginal and Torres Strait Islander people by providing access to telehealth monitoring either in the home or at a local community hub. Along with this was the adoption of an intergenerational arm of cultural activities that maintained older Aboriginal and Torres Strait Islanders connection to younger generations to ensure cultural awareness, continuity of story and respect for Aboriginal history and heritage.
Through strong consultation and collaboration with Aboriginal Medical Services and Aboriginal Health Centres, the project team was able to demonstrate cross-cultural competence and respect leading to successful outcomes in participant recruitment, retention, relationships and shared learning.
Quantitative and qualitative data collated indicated overall participant satisfaction in the use of telehealth equipment to monitor vital health signs, a reduction in the costs of service provision, an increase in evidence-based clinical reporting to medical practitioners and overall improvement in the quality of care and health outcomes for older Aboriginal and Torres Strait Islander people.
What we did
The Staying Strong Telehealth pilot ran January 2013 - June 2014.
Participants were recruited via collaboration between the host organisation and local area Aboriginal Medical Services and Aboriginal Health Centres in Armidale, Coffs Harbour/Sawtell (NSW) and Toowoomba and Goodna (Qld).
A total of 136 older Indigenous people volunteered for the Staying Strong Telehealth pilot. Eligibility for inclusion consisted of identifying as an Aboriginal and/or Torres Strait Islander, be aged 50 years or older, have a chronic condition and reside in a National Broadband Network (NBN) rollout area.
The project team included members with specialised skills of engagement and experience in working with Aboriginal and Torres Strait Islander peoples to collaborate with local area health service providers.
Registered nurses skilled in telehealth administration were recruited to distribute telehealth units and provide training, monitoring and support of each participant. Clinical governance was provided by the host organisation.
Tunstall Healthcare supplied the telehealth computers, triaging software and specialist monitoring attachments such as blood pressure monitors, glucometers, oximeters, weigh scales, thermometers and/ or a lung function monitor.
Cartwright Consulting with full human research ethics approval granted by the Australian National Health and Medical Research Council, conducted the project evaluation of quantitative data sets such as:
- a Personal Wellbeing Index
- an Attitude to Technology questionnaire
- a Social Connectedness Scale
- and a Barthel Index.
Further de-identified data from a centralised database included clinical alerts, equipment alerts, daily recordings of participant vital sign readings and missed readings were also collated. The consultancy also evaluated qualitative data obtained including overall project satisfaction ratings, participant demographic profiles, and feedback from one-on-one interviews and from ‘yarning circles’.
Following recruitment and consent, participants were allocated into either a model of in-home monitoring or to the local area telehealth hub group according to their preference.
Each participant then received a health-monitoring plan developed by his or her individual general practitioner or by the host organisation’s telehealth registered nurse.
The plans were individually tailored, and determined which vital signs were to be monitored, the frequency of monitoring, and the acceptable range of each vital health sign. Inbuilt triaging software then automatically flagged any readings of concern for each individual participant.
Via broadband connectivity vital health sign readings from both in-home and hub equipment were automatically transmitted to a centralised database. Readings of concern were then remotely triaged and followed up by the telehealth registered nurse.
Innovation was encouraged leading to use research confirming the positive health and wellbeing effects for older people who are able to interact with the younger generation and participate in culturally specific activities (Cohen et al, 2006) to formulate the intergenerational project arm of the Staying Strong Regional Telehealth pilot.
This included the use of broadband technology to digitally record interviews with local Aboriginal Elders, conduct music workshops where school students learned songs from the Elders and to undertake cultural and historical research with family in order to ‘stay strong’ in both health and culture.
Why we did it
- Foster practical reconciliation
- Improve clinical outcomes
- Ensure regional peoples had equitiable access to quality healthcare options
The rationale for implementing the “Staying Strong” Regional Telehealth Initiative was to foster practical reconciliation action in regional communities using broadband and telehealth technology to “Close the Gap” on health outcomes experienced by elderly Aboriginal and Torres Strait Islander peoples with chronic health conditions.
The current life expectancy gap can be attributed to chronic disease, thus, the Staying Strong Regional Telehealth Initiative aimed to demonstrate that broadband accessibility coupled with ‘fit for purpose’ telehealth monitoring technology delivered via a supportive and innovative nurse-led model of care, increased access to timely care and built capacity for self-management of individual health conditions (Australian Government Department of the Prime Minister and Cabinet, 2015; Australian Institute of Health and Welfare, 2012).
Aboriginal and Torres Strait Islander people in regional areas are often challenged in meeting their health needs by lack of service availability, reduced transport accessibility and historical distrust of mainstream services (Cutliffe, 2004).
Regional locations in NSW and Queensland were identified in which to conduct the Staying Strong Telehealth pilot. Stakeholders including Aboriginal medical centres, Aboriginal Health Services, general practitioners, Telehealth registered nurses, the host organisation, the government funding body and the telehealth equipment supplier, collaborated to ensure engagement and recruitment of participants and the success of the Staying Strong initiative.
Who worked with us
A collaborative and strongly consultative approach was taken at the outset engaging communities, specialised individuals and organisations along with consumers.
As the Staying Strong Regional Telehealth Initiative aimed to support older Aboriginal and Torres Strait Islander Australians to “Stay Strong” in both health and culture, consultation and collaboration in developing the project and communicating with and engaging the consumers was facilitated by the host organisation and the following organisations;
- Aboriginal Cultural Centre and Keeping Place in Armidale, NSW
- Armajun Aboriginal Health Service in Inverell, NSW
- Carbal Medical Centre in Toowoomba, Qld
- Galambila Aboriginal Health Service, Coffs Harbour, NSW
- Goondir Aboriginal and Torres Strait Islander Corporation for Health Services in Dalby, Qld
- Jagun Aged Care in Coffs Harbour, NSW
- We Care Aboriginal and Torres Strait Islander Service for Aged and Disabled Association in Redbank Plains, Qld
Additional collaboration, particularly with regards to connecting the generations culturally, historically, musically and creatively was facilitated by us, various Aboriginal and Torres Strait Islander organisations and the New England Conservatorium of Music (NECOM) in Armidale, NSW.
The Staying Strong Regional Telehealth Initiative was also assisted by
- North Coast Medicare Local (NCML) in Coffs Harbour, NSW
- individual general practitioners of participants
- Tunstall Australasia from Brisbane, Qld in the supply of telehealth equipment
- Department of Health and Ageing (now Department of Health) under the NBN enabled Telehealth Pilots Program.
What we learned
The Staying Strong Regional Telehealth Initiative was the first of its kind to specifically trial telehealth with older Aboriginal and Torres Strait Islander peoples to improve access to health services and build capacity for self-management of people’s own health conditions.
The total sample of participants who volunteered for the Staying Strong Telehealth Initiative was 136, exceeding the 120 participants anticipated for the project. For purposes of evaluation, a sample of 70 was selected. The overall retention rate of participants was high, with only 6 of the 136 participants withdrawing from the pilot due to significant mental health issues. The average age of Aboriginal and Torres Strait Islander participants was 62 years, with 75% of the sample being women, 25% men.
The Australian Institute of Health and Welfare (AIHW, 2012) report that 40% of people with chronic diseases have three or more chronic conditions they are managing simultaneously. In keeping with this research, the Staying Strong participants exceeded these statistics with 90% of the sample having five or more chronic conditions and 10% of the sample with ten or more chronic conditions. 30% of the sample had at least one admission to hospital in the previous 12 months, and 67 participants of the 70 took medications daily. The most commonly reported conditions in the sample were, heart attack 4%, asthma 10%, chronic bronchitis 3%, Type II Diabetes Mellitus 15%, and other health conditions 23%.
The effective rollout of the Staying Strong pilot was highly dependent on the development and maintenance of collaborative relationships with local Aboriginal Medical Services and Health Centres. This relationship provided a strong referral base for participant recruitment and acceptance of the project by older Aboriginal people.
Another critical relationship factor to emerge was the Aboriginal community ‘grapevine’ and word of mouth recommendations from the participants to friends and relatives.
Relationships with the participants were underpinned by respect that the project team demonstrated for the older Aboriginal people. The phenomenon of ‘respect’ cannot be underestimated, and not only encompassed cross-cultural competence but also many nuances including;
- the capacity to find common ground
- the capacity to build relationships
- consistency in behaviour
- the capacity for humour
- a holistic view of Aboriginal and Torres Strait Islander people
- an empathic approach
- and a principled commitment to improving the health of the older Aboriginal people.
A sense of pride felt by the participants in having telehealth equipment in their home was another key motivator for the older Aboriginal and Torres Strait Islander people in the project.
Most of the participants were able to independently use the telehealth equipment after only three training/demonstration sessions, with all participants being proficient within two weeks.
This highlighted two significant considerations;
- participants found the technology easy to understand and use as it was matched with the learning styles of older Aboriginal and Torres Strait Islander users, which is focused on auditory, visual and kinesthetic modes rather than text based reading and writing methods,
- older people are willing, and can learn to utilise new technology given the support and conditions that to enable them to do so.
Participants also felt safe and secure with self-monitoring as they could see their own results and have the added reassurance that the RN was also monitoring their vital health indicators and prompting them to visit their General Practitioner or specialist when required, thus circumventing increased severity of symptoms and unplanned hospital admissions. The involvement of each individual’s GP also resulted in a holistic and multidisciplinary approach to the participant’s healthcare.
Barriers within the Staying Strong pilot included family and kinship responsibilities such as childcare responsibilities and ‘Sorry Business’ (funerals), which contributed to the busyness of people’s lives; visual and cognitive impairment, mental health issues, which resulted in the withdrawal of six participants, and technical issues at times with equipment such as poor Bluetooth connectivity.
We greatly valued the involvement in the National Broadband Network enabled Telehealth Pilots program and the ability to make a significant contribution to the body of research in the field of e-health and in Closing the Gap in health outcomes for Aboriginal and Torres Strait Islander peoples.
As a result of the success of this pilot, the host organisation is continuing with the use of telehealth by building a responsive and integrated nurse-led model to continue to assist older Aboriginal and non-Aboriginal consumers in regional, rural and remote locations.
More information on this program:
Vanessa Jones, firstname.lastname@example.org, or phone 0418 598 391