Dr Ben Wheeler is running remote diabetes clinics for rural Otago families, saving them the long trip to Dunedin.
TYPE ONE DIABETES is the second most common chronic condition in children, after asthma. In my region, from South Canterbury to Stewart Island, there are up to 200 children and young people with diabetes. Being a kid with diabetes is no fun. You have to be careful about what you eat, put up with finger prick blood tests and injections every day, and often wear a bulky insulin pump under your clothes. When I first started working here, children with diabetes in Otago had to make the trip to Dunedin every three months, sometimes more often, to see me for their clinic. For some families that meant a round trip of up to nine hours. It meant mum and dad having to take a day off work – sometimes two days, if they had to stay overnight. Often brothers and sisters would need to come too, with everyone missing school – all this for a half-hour consultation.
In 2014, I started running quarterly check-ups via video link from two other hospitals, Dunstan and Oamaru, which are far closer for some of the families. Now I sit in front of my screen in my office in Dunedin and the children, their parents, and a diabetes nurse specialist sit in front of a screen in a consultation room in Dunstan or Oamaru.
With diabetes care, much of the clinic is education and support, and we do a lot of looking at numbers – readings from their blood glucose meters and insulin pumps. We download the readings from the cloud and we look at them together and talk about the problems they are experiencing. It’s perfect for a telelink consultation, and if I need to examine the patient, to look at the injection site, for example, the nurse can do that.
I suppose you could do it by phone, but seeing each other adds an important dimension to a conversation and to building a relationship.
An unexpected consequence of these video conferences has been how it’s helped build relationships between the teams in the different hospitals. I had never met Sharon, the nurse specialist from Dunstan, but after doing the video conferences, we’ve built a good relationship. Now she contacts me at least once a week to talk about one of the patients; sometimes she asks me to “meet” a patient for an additional consultation. The patients and their families have gained a lot from that.
My dream is for telemedicine to allow more and more patients to get care delivered close to their home. There is always going to be a need for face-to-face consultations, but for follow up and maintenance of these complex conditions – for keeping people well – technology can save time and money for everyone - and cut down on the stress.
All the hospitals have video conferencing facilities - big screens and flash cameras, and we use them for meetings between healthcare professionals in different cities, and for remote lectures with medical students. But I think the future of telemedicine isn’t flash hardware, but using more powerful personal computers – having everything at your fingertips in your office – not high cost equipment and going to a special room. We have proven with our clinics that for a couple of hundred dollars of equipment at each end, and a good broadband service, you can do pretty much the same as you can do with a big VC suite. And it makes everything easier when I am in the comfort of my office.
The future? I can see the use of telelinks in other chronic specialties, and for follow up for patients who have been released from hospital. There’s definitely the potential for links from home. Over the next two years it’s going to become a vital tool for doctors – I can see my own use of telemedicine doubling from where we are today –- expanding to other regions like South Canterbury or Southland and into other conditions, like thyroid problems.
Dr Ben Wheeler is the paediatric diabetes specialist at Dunedin Hospital.