Browsing by Author "Scuffham, Paul A"
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- ItemA break-even analysis of delivering a memory clinic by videoconferencing.(2013-11-12) Comans, Tracy A; Martin-Khan, Melinda; Gray, Leonard C; Scuffham, Paul AWe analysed the costs of two kinds of dementia clinic In the conventional clinic held in a rural area the specialist travels to the clinic from the city In the videoconferencing clinic patients are also seen in a rural area but the specialist conducts the assessment by video from the city The fixed costs common to both modalities such as clinic infrastructure were ignored The total fixed cost of a monthly conventional clinic was 522 and the total fixed cost of a monthly videoconferencing clinic was 881 The additional variable cost of the specialist travelling to the conventional clinic was 2 62 per minute of the specialist s travelling time The break even point at which the cost of the two modalities is the same was just over two hours 138 min round trip A sensitivity analysis showed that the break even point was not particularly sensitive to changes in staff wages but slightly more sensitive to the non labour costs of videoconferencing Air travel is not an efficient alternative to travel by car Reducing the number of clinics to six per year results in a much higher cost of running the videoconferencing service compared to the conventional service Videoconferencing for the purpose of diagnosing dementia is both a reliable and cost effective method of health service provision when a specialist is required to drive for more than about two hours round trip to provide a memory disorder clinic service
- ItemA cost minimisation analysis of a telepaediatric otolaryngology service.(2008-03-27) Xu, Cathy Q; Smith, Anthony C; Scuffham, Paul A; Wootton, RichardPaediatric ENT services in regional areas can be provided through telemedicine tele ENT using videoconferencing or with a conventional outpatient department ENT service OPD ENT in which patients travel to see the specialist The objective of this study was to identify the least cost approach to providing ENT services for paediatric outpatients
- ItemAn economic analysis of email-based telemedicine: a cost minimisation study of two service models.(2008-06-06) Caffery, Liam; Smith, Anthony C; Scuffham, Paul AEmail based telemedicine has been reported to be an efficient method of delivering online health services to patients at a distance and is often described as a low cost form of telemedicine The service may be low cost if the healthcare organisation utilise their existing email infrastructure to provide their telemedicine service Many healthcare organisations use commercial off the shelf COTS email applications COTS email applications are designed for peer to peer communication hence in situations where multiple clinicians need to be involved COTS applications may be deficient in delivering telemedicine Larger services often rely on different staff disciplines to run their service and telemedicine tools for supervisors clinicians and administrative staff are not available in COTS applications Hence some organisations may choose to develop a purpose written email application to support telemedicine We have conducted a cost minimisation analysis of two different service models for establishing and operating an email service The first service model used a COTS email application and the second used a purpose written telemedicine application
- ItemThe effectiveness of telemedicine for paediatric retrieval consultations: rationale and study design for a pragmatic multicentre randomised controlled trial.(2014-11-10) Armfield, Nigel R; Coulthard, Mark G; Slater, Anthony; McEniery, Julie; Elcock, Mark; Ware, Robert S; Scuffham, Paul A; Bensink, Mark E; Smith, Anthony CBackgroundIn many health systems specialist services for critically ill children are typically regionalised or centralised Studies have shown that high risk paediatric patients have improved survival when managed in specialist centres and that volume of cases is a predictor of care quality In acute cases where distance and time impede access to specialist care clinical advice may be provided remotely by telephone Emergency retrieval services attended by medical and nursing staff may be used to transport patients to specialist centres Even with the best quality retrieval services stabilisation of the patient and transport logistics may delay evacuation to definitive care Several studies have examined the use of telemedicine for providing specialist consultations for critically ill children However no studies have yet formally examined the clinical effectiveness and economic implications of using telemedicine in the context of paediatric patient retrieval Methods DesignThe study is a pragmatic multicentre randomised controlled trial running over 24 months which will compare the use of telemedicine with the use of the telephone for paediatric retrieval consultations between four referring hospitals and a tertiary paediatric intensive care unit We aim to recruit 160 children for whom a specialist retrieval consultation is required The primary outcome measure is stabilisation time time spent on site at the referring hospital by the retrieval team adjusted for initial risk Secondary outcome measures are change in patient s physiological status repeated measure two time points scored using the Children s Emergency Warning Tool change in diagnosis repeated measure taken at three time points change in destination of retrieved patients at the tertiary hospital general ward or paediatric intensive care unit retrieval decision and length of stay in the Paediatric Intensive Care Unit for retrieved patients The trial has been approved by the Human Research Ethics Committees of Children s Health Services Queensland and The University of Queensland Australia DiscussionHealth services are adopting telemedicine however formal evidence to support its use in paediatric acute care is limited Generalisable evidence is required to inform clinical use and health system policy relating to the effectiveness and economic implications of the use in telemedicine in paediatric retrieval Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12612000156886