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The treatment of diabetic foot ulcers may not always be well organized and not all patients have access to expert evaluation. We investigated the use of telemedicine to enable a visiting nurse (in the patient's home) to coordinate the treatment with experts (at the hospital). The equipment consisted of a UMTS videophone and an Internet-based patient record. Field studies were carried out at the outpatient clinic and by following visiting nurses. A total of 15 participants were invited to five workshops and experiments held in our laboratories, at the hospital, and between hospital and patients' homes. Finally, in a pilot test, five patients were offered three teleconsultations at their homes in lieu of visits to the hospital. Preliminary results were promising: (1) both clinicians and patients found the equipment easy to use; (2) the doctor could prescribe treatment at a distance; (3) the visiting nurse had realtime contact with the hospital and treatment could begin immediately according to the doctor's orders; (4) the patient saved time in not having to travel to the hospital.
Re: Telemedicine treatment of diabetic foot ulcers
Treatment of diabetic foot ulcers in the home: video consultations as an alternative to outpatient hospital care.
Clemensen J, Larsen SB, Kirkevold M, Ejskjaer N Int J Telemed Appl. 2008;:132890
Quote:
The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.
Re: Telemedicine treatment of diabetic foot ulcers
netizens
What appears light years away now, myself and colleague Dr Chris Kirtley applied for sizable grant to support the use of telemedicine in Western Australia to track itinerant diabtiec clients as they moved across the big brown land. Using rural GP practices and the experts at a diabetic podiatry clinic in a city based hospital, the intention was to use the 'new computer cameras' (for that is how long ago it was) for monitoring diabetic ulcerations. Many rural indigenous clients go walkabout and some with horrendous ulcerations. Usually when they cross GP Division they are lost to the system and out intention was to use the new technology to link clinical experts.
We lost the grant for two reasons, unofficially we were told 'telemedicine' as a new developing technology had to be driven by the medical profession and applications from other disciplines were not seriously considered at that time; and officially we were informed the podiatry experts (at the city hospital) refused to share their knowledge with others.
More recently I worked with the Department of Health in WA in a home based care project (healthy@home), the staff were issued with a palm top computer as a means of telecommunication. The system had the potential to reply images and was for a very short time used to convey information to "experts" for on the spot help. Not sure whether the project was developed further but it did have great potential. At the FIP conference last year there was a podiatrist from Hong Kong who was also using telemedicine to good effect.
One of the interesting challenges about clinical education on placement is being able to maintain the educational continuity in the multi-centre placement (which may now be in different countries). Telemedicine does offer a viable means of communication which could link satellite placements. Driven by a common core curricululm ( we are probably closer to that than most people think) then through the web, clinicians, supervisors, experts and students can all be linked. Construction of this type of curriculum would come at a cost but it is technically possible to have one major podiatry education centre per country capable of directing and controlling clinical education. Once standard podiatric text are available on the web ( somethig that is likely to happen sooner rather than later) then individual CPD could easily be arranged to support and maintain a multitude of activities. (anywhere in the globe). Brave new world and its just around the corner.
Re: Telemedicine treatment of diabetic foot ulcers
Pilot trial of telemedicine as a decision aid for patients with chronic wounds.
Dobke MK, Bhavsar D, Gosman A, De Neve J, De Neve B. Telemed J E Health. 2008 Apr;14(3):245-9.
Quote:
The study goal was to evaluate the impact of the telemedicine consult on patients with chronic wounds. Thirty patients from long-term care skilled nursing facilities, referred to the ambulatory wound care program for wound assessment and preparation of management plans, were the subject of this prospective, randomized trial. To facilitate communication with a surgical wound care specialist, telemedicine feedback was provided prior to face-to-face consultation to 15 patients. The telemedicine consult included (1) wound assessment, (2) rationale for the suggested wound management with emphasis on wound risk projections, and (3) prevention and benefits of surgical intervention. This was communicated to the patient by the field wound care nurse. The telemedicine impact was measured by assessing the duration of the subsequent face-to-face consultation and patient satisfaction with further care decisions as well as by validation of a decisional conflict scale. The average duration of the face-to-face consultation was 50 +/- 12 minutes versus 35 +/- 6 (p < 0.01) minutes for patients subjected to the telemedicine feedback preceding the direct contact with the specialist. The telemedicine consult was found to be a useful aid in increasing the satisfaction rate from care decisions ultimately made during the direct consult (acceptance rate 93% vs. 47% in those subjected to treatment without the intermediate telemedicine consult, p < 0.01). The decisional conflict as a state of uncertainty about the course of action to take was reduced in patients subjected to telemedicine decision aid. The average Decisional Conflict Scale score was 14 +/- 1.73 in patients subjected to telemedicine feedback as opposed to 35 +/- 4.26 (p < 0.001) in no-telemedicine contact. The telemedicine consult preceding face-to-face evaluation improved patient satisfaction and understanding of their care as well as increased the perception of shared decision making regarding the wound care.
Telemedicine treatment of diabetic foot ulcers
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