One of the Aged Care Royal Commission recommendations regarding the rights of older people receiving aged care is the right for equitable access to care services. For people living in Residential Aged Care Facilities (RACFs) video consultations can improve access to healthcare, including but not limited to facilitating consultations with their GP or specialist without needing to travel. Healthdirect Video Call offers a range of advantages for patients who reside in RACFs, as well as their doctors: •    Continuity of care and multidisciplinary care •    Less mobile patients or those who have difficulty traveling can attend appointments from the comfort of their residence •    Nursing staff in RACFs support residents during their consultation with their GP via Video Call •    Free training and support is available for both RACF staff and clinicians to give them the information and confidence they need to participate in effective video consultations.

Case Study: Western NSW Primary Health Network

Western NSW Primary Health Network (WNSW PHN) has helped set up video-based GP consultations for residents in Aged Care Facilities (RACFs) in their network, using healthdirect Video Call. 

Their program, Telehealth for Residential Aged Care (TRAC), was initiated in 2017 as a partnership with the NSW Rural Doctors Network. The program worked successfully in Broken Hill and Dubbo and was expanded into other locations in 2018. 

Video consultations are particularly useful for RACF residents who have mobility issues and for those who need to see a GP relatively urgently. The healthdirect Video Call technology was selected for its combination of high levels of security and privacy and very simple user interface.

“While many people think aged care residents wouldn’t want to have a Video Call consultation, we’ve found most of them are keen to do it as they like to save their GP time,” says Michele Pitt, Portfolio Lead – Chronic Disease, Aged Care and Palliative Care at WNSW PHN.

Michele Pitt and Michelle (Shelley) Squire, Aged Care Project Officer at WNSW PHN, have worked to make Video Call consultations a key element of the business as usual workflow for doctors seeing patients in RACFs. They attribute their success to developing a comprehensive training program, nurturing telehealth champions and regularly communicating with all participants.

The results have been very impressive. In FY 2019/20 there were 590 Video Call consultations with RACF residents. In July 2019, when all three Broken Hill RACFs were in lockdown due to a flu outbreak and two GPs were unavailable, one GP managed 80 Video Call consultations by himself ensuring continuity of care for the residents. 

The model used by WNSW PHN

RACFs in Blayney, Broken Hill, Canowindra, Dubbo, Parkes and Wentworth all use Video Call regularly for health consultations with residents. 

The model of care stipulates that both the aged care resident and registered or enrolled nurse at the RACF must be present during the Video Call consultation to enable a clinical handover to the GP or allied health professional.

On the technical side, due to the limited WiFi connections at some rural and remote locations and to ensure the success of the program, WNSW PHN provided the necessary equipment on both sides of the consultation. 

Each general practice and RACF receives an iPad with a 4G network data plans, along with video telehealth training for GPs and RACF staff. 

Training for RACFs and GPs

WNSW PHN developed a comprehensive Video Call toolkit covering everything from obtaining consent, how to turn on and charge an iPad, how to clean an iPad between uses and how to use Video Call for a consultation. They train all RACF staff and GPs before they start to use Video Call.

RACF staff also undertake training in the ISBAR (introduction, situation, background, assessment, recommendation) protocol for clinical handover. More than three-quarters of all RACF staff in the WNSW PHN area have completed ISBAR training.

A leader in the area of video telehealth

WNSW PHN is seen as a leader in the area of video telehealth in the Aged Care sector and has been contacted by other PHNs for information and advice regarding their toolkit. The toolkit was shared with all PHNs in mid-2020 with some, including Hunter New England and Central Coast PHN, adapting it for use in their own regions.

Due to the successful TRAC program in place when the COVID-19 pandemic was declared in March 2020, and with the new MBS items that accompanied the pandemic, WNSW PHN was perfectly placed to respond to new demand. 

The WNSW PHN telehealth team onboarded and trained new clinics quickly and efficiently during that time and from June to October 2021 there were 499 video calls in the TRAC program with RACF residents. Video Call has been a crucial enabler of continuity of care to patients during the pandemic, particularly for those in rural and remote areas. 

Champions are the key

Michele Pitt says identifying a champion in each RACF and general practice is the key to successful adoption of video-based consultations. 

“In Broken Hill, one GP embraced Video Call and their practice has now done the majority of the Video Call consultations here,” Michele said. “We’ve noted that practices without a strong clinical lead have not been as responsive.”

Regular communication maintains momentum

In addition to staff training and internal advocacy of video telehealth, Shelley Squire says it’s important to maintain regular lines of communication with all services in the program. 

During the COVID-19 pandemic this has strengthened relationships and RACFs are very responsive to PHN communications.

“Staff turnover in RACFs means we need to keep up very regular communication so that we maintain a good connection with the telehealth advocates and can quickly train new staff when needed,” says Shelley.

Collecting feedback and the benefits of Video Call consultations

After each Video Call consultation, the Video Call platform allows GP and RACF staff to complete a post-consult log which auto-generates at the completion of the consultation. The form asks questions about the quality of the call, technical issues and the outcome of the consultation. 

“FY19/20, almost three-quarters of aged care residents who had a video consultation said that Video Call was better than a face-to-face consultation,” Shelley said. “Less than one per cent reported that Video Call consultations are less than adequate”. 

“We’ve also found that the number of residents transported to an emergency department, and the number of bed days for a resulting hospital stay, are both less after a Video Call consultation.”

Acknowledgements

Thank you to Western NSW Primary Health Network for sharing its experience and tips for success with the healthdirect Video Call team. The NSW Rural Doctors Network and the Australian Department of Health fund the TRAC program.