Multidisciplinary clinical rehabilitation improving access to psychology services in australian rehabilitation hospitals: Could a telemedicine service be feasible?.

Abstract

Background: Early detection and management of neuropsychological impairments can improve outcome. However, few patients with stroke have access to psychology services. Aim(s): To illustrate the potential benefits of a telemedicine service to provide a rationale for improving access to neuropsychological services in 5 sub-acute rural hospitals located in Victoria (Australia). Method(s): A decision-analytic model was developed using best available data including the National Stroke Foundation Audit of Rehabilitation Services (2010 and 2012), Victorian Department of Health hospital separations data, reference hospital data for the cost of transfers, salaries and bed days. Descriptive statistics and multivariable median regression with adjustment for known confounders (i.e. age, gender and stroke severity) were undertaken to determine differences in length of stay used as input variables for the model. Three scenarios were compared to current practice access: A) increase local clinicians (private services); b) transport patients to urban services; and c) telemedicine. Result(s): Among 305 separations in 2012, 265 (87%) were predicted to have a neuropsychological impairment (cognitive or mood disorder) and 45% would require psychology services (n = 115). Based on 2010 audit data only 4% (n = 10) would be seen by psychology (current practice estimate). Patients who require psychology assessment have an 8-day longer length of stay (95% CI 5-11 extra days). Average costs per patient was the least for the Telemedicine scenario (AUD710 versus AUD4179 [more local clinicians], AUD2200 [transport] and AUD5200 [current practice]). Conclusion(s): Telemedicine neuropsychology services could reduce waiting times and reduce the burden of neuropsychological impairment in stroke survivors.