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Staying Strong TelehealthBetter Health Outcomes forOlder Indigenous Australians

March 2014

Indra Arunachalam – Strategic Projects Manager

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Staying Strong Project

Objective: Improve the health and wellbeing of

Aboriginal and Torres Strait Islanders by:

• supporting older Aboriginal and Torres Strait Islanders

access telehealth monitoring at their home or a hub

• developing and implementing cultural activities that

connect older Aboriginal and Torres Strait Islander

Australians with younger people to raise cultural

awareness and respect Indigenous history and heritage

March 2014 Slide 2

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Benefits of Telehealth

• Reduce emergency hospitalisations

• More accurate and timely diagnosis

• Increase awareness of own health conditions

• Increase independence and self-management

• Reduce need for GP home visits

• Peace of mind for older person and family

March 2014 Slide 3

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Telehealth Service Model

• Individualised monitoring plan with relevant vital health sign parameters, acceptable margins and frequency

• Monitor temperature, blood pressure, weight, pulse, oxygen levels, blood glucose levels and/or peak flow rate

• Measure at home or at telehealth services hub and transmitted to central location for triage management

• RN triages and responds to out-of-margin readings

• Provide vital health sign readings to participants/GPs to support diagnoses

March 2014 Slide 4

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Project Participants

Eligibility criteria:

• Identify as Aboriginal and Torres Strait Islander

• Aged over 50 years

• Live in project trial site

Current trial locations:

• Armidale, NSW

• Coffs Harbour, NSW

• Goodna, QLD

• Toowoomba, QLD

March 2014 Slide 5

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Project Evaluation

• Did it improve provision of health services?

• Did it empower people to better manage own health?

• What were the supporting and inhibiting factors in the uptake of telehealth among Aboriginal and Torres Strait Islanders?

• Did it reduce number of hospitalisation/length of time in hospital?

• Did the cultural activities improve the older person’s social connectedness?

• Did it enhance cultural awareness and respect for indigenous history and heritage?

• Did the project improve people’s quality of life (wellbeing index)?

March 2014 Slide 6

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Evaluation Methodology

• Baseline and Follow-up surveys– Personal Wellbeing Index

– Attitude to Technology

– Social Connectedness

• Yarning Circles with participants

• In-depth interviews with

– 8 project participants

– 4 key stakeholders

– Staying Strong registered nurses and project team

March 2014 Slide 7

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Participant Profile

• Currently 89 people receiving telehealth services

• Average age: 62 years

• Mostly female (70%)

• 33% single and 30% married

• 69% living with spouse and/or other family members

• 66% lived in a house; 34% in a flat or unit

• 38% had a primary (non-professional) carer

March 2014 Slide 8

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Conditions Affecting Participants

Diagnosis % of cases*

High blood pressure 67

Type 2 diabetes 48

High blood cholesterol

40

Asthma 28

Angina 17

Heart attack 12

Emphysema 11

Chronic bronchitis 7

March 2014 Slide 9

*Participants may have more than one condition so numbers do not add up to total number of participants

67% have 3 or more

health conditions

At least 30% have

been hospitalised once in

the last year

50% who have high

blood cholesterol also have high blood pressure

80% who have

angina also have high blood pressure

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Baseline Personal Wellbeing Index

March 2014 Slide 10

The normative range for Australians is 73.4 to 76.4 points

Spirituality/Religion

Future Security

Community Connectedness

Safety

Relationships

Achieving in Life

Health

Standard of Living

0 10 20 30 40 50 60 70 80 90 100

Staying Strong BCS Transition Care

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Baseline Attitude to Technology

March 2014 Slide 11

I was completely comfortable with the idea of using Telehealth in my home

I would find Telehealth easy to use

It would be easy for me to become skilful at using Telehealth

My interaction with Telehealth would be clear and understandable

Learning to operate Telehealth would be easy for me

Telehealth useful in my regular testing

Telehealth would save me time in having regular testing

Telehealth would make it easier to do regular testing

Telehealth would improve my access to regular testing of my health condition

- 10 20 30 40 50 60 70 80 90 100 Staying Strong BCS Transition Care

Staying Strong participants reported greater confidence with technology

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Baseline Social Connectedness

March 2014 Slide 12

To measure how NBN enabled older participants to connect with local school children in a way that improved their social connectedness, enhanced cultural awareness and increased respect for indigenous

history and heritage

In a crisis, I have the support I need from family and friends

I feel I belong in my community

I have people with whom I can do enjoyable things

I am happy with the friendships I have

0 20 40 60 80 100 120

Staying Strong Toowoomba Goodna Coffs Harbour Armidale

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Project Challenges

• Project timeframes

• National Broadband rollout

• Recruitment of telehealth nurses

• Stakeholder engagement

• Participant recruitment

March 2014 Slide 13

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Stakeholder Engagement- What Worked

• Early consultation

• Investment of time

• Responsive communications

• Partnership Agreements

• Working groups and involvement in project activities

• Awareness of local politics

March 2014 Slide 14

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Participant Recruitment- What Worked

• ‘Cups of tea’ and a yarn

• Culturally appropriate communications collateral

• Referral pathways involving Aboriginal and Torres Strait Islander organisations/people

• Support of local Elders/bush telegraph

• Awareness of local politics

March 2014 Slide 15

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Project Successes

• Expansion of integratedliving presence and partnership development at trial sites

• Organisational experience in the delivery of telehealth services

• Probable aversion of heart attack/reduction in hospitalisation

• Supplementary nursing support

March 2014 Slide 16

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Lessons Learnt

• Community engagement with Aboriginal and Torres Strait Islanders takes time

• Remote telehealth monitoring for Indigenous communities needs to be complemented with face-to-face contact

• GP involvement is important

• Asset Register for telehealth equipment and peripherals

• Strong internet connection is needed

March 2014 Slide 17

Funding bodies should take this into consideration

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Strategic Partnerships

March 2014 Slide 18

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Final Evaluation Report

• Completed by June 2014

• Acquitted by September 2014

• What are the enablers and barriers to older Aboriginal and Torres Strait Islanders using telehealth?

• Did telehealth deliver better health outcomes?

• Did it improve their quality of life?March 2014 Slide 19

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Contact Details

Indra Arunachalam

0437 900 237

indra@integratedliving.org.au

References:• Cartwright C, Wade R, Shaw K: The Impact of Telehealth and Telecare on

Clients of the Transition Care Program (TCP), May 2011

• Lee, Richard M, Robbins, Steven B: Measuring Belongingness: The Social Connectedness and the Social Assurance Scales. Journal of Counselling Psychology, Vol 42(2), Apr 1995, 232-241.

March 2014 Slide 20