Having patient consultations conducted by geriatricians using telemedicine technology is an acceptable alternative to in-person consultations when hospitals are unable to employ a geriatrician to work on site, according to the authors of a study published in the Medical Journal of Australia.
Prof Leonard Gray, Professor of Geriatric Medicine at the University of Queensland, and his co-authors conducted an observational study in the geriatric ward of Toowoomba Base Hospital, where ward-based consultations with an off-site geriatrician are delivered by video conference.
"Weekly rounds are conducted by video conference. A web-based clinical support system enables the remote geriatrician to have accurate clinical information, particularly with reference to geriatric syndromes and functional and psychosocial problems," Prof Gray said.
"Interaction is achieved through a wireless, mobile video conferencing apparatus, which enables two-way vision and conversation between the geriatrician and the patient, accompanying nurse and junior house doctor. The camera is controlled remotely by the geriatrician and permits panning and a zoom capability sufficient to read 12-point text.
Of 15 patients who were interviewed, most found both the technical aspects and the medical consultation to be acceptable.
The video conferencing model limits the ability to perform hands-on clinical examination, although there is evidence that cognitive assessment and neurological examination can be performed reliably by video conferencing.
The potential loss of accuracy in these areas of assessment in geriatric practice requires further research. Nevertheless, in many communities, a telemedicine service will be the only viable means of having access to the expertise of a geriatrician.
The authors envisage the model being extended to other inpatient clinical situations, including geriatric consultation in non-geriatric wards in small rural hospitals where a geriatric ward configuration is not justified.
The Medical Journal of Australia
is a publication of the Australian Medical Association.