1. 1 Hunter New England Area Health Service Pilot Telehealth High Risk Foot Clinic: C onnecting Tamworth and Newcastle Prepared by Nicole Martin Service Manager – Podiatry & Footcare Services Greater Newcastle Cluster

2. T he frightening facts …  “Every 30 seconds, somewhere in the world, a limb is lost as a consequence of diabetes” The Lancet November 2005  After a major amputation, 50% of patients will have their other limb amputated within 2 years. Goldner. Diabetes 1960; Armstrong, et al, J American Podiatry Med Assn, 1997  The relative 5-year mortality rate after limb amputation is at least 50%. When compared with cancer – it is second only to lung cancer (86%). (Colorectal cancer 39%, Breast cancer 23%, Hodgkin’s disease 18%, Prostate cancer 8%). Armstrong et al, International Wound Journal, 2007; American Cancer Society; Facts & Figures 2000

3. B ackground  Clients across Hunter New England Area Health Service (HNEAHS) with complex diabetes foot complications have traditionally had to travel to Newcastle to access multidisciplinary high risk foot services  The literature indicates that those clients with complex foot conditions who have access to a multi-disciplinary team, have improved foot health outcomes and overall reduced medical costs.  Ideally rural clients should be able to access multidisciplinary high risk foot services close to their home.

4. B ackground

5. P ilot Telehealth High Risk Foot Clinic  The aim of this project was to establish a pilot Telehealth High Risk Foot Clinic between the Newcastle and Tamworth sites, to improve the foot health of clients with diabetes and complex lower limb co-morbidities in the Tamworth area.  The six-month pilot ran from February – August 2010, with clinicians in Newcastle providing Telehealth multidisciplinary input for clients attending the Tamworth Podiatry Clinic.  Tamworth clients who matched the “High Risk Foot Clinic” eligibility criteria were offered either a Telehealth consultation in the Tamworth Podiatry clinic or a face-to-face appointment in Newcastle at the High Risk Foot Clinic.  Eight clients were involved with the pilot clinic; seven clients presented with foot wounds and one client presented with an acute Charcot Neuroarthropathy.

6. P ilot Telehealth High Risk Foot Clinic How did the technology work?? Telehealth review by Newcastle multi- disciplinary high risk foot clinic Telehealth conference between Tamworth & Newcastle clinicians Appointment at Tamworth Podiatry Clinic

7. P ilot Telehealth High Risk Foot Clinic Demographic Data

8. P ilot Telehealth High Risk Foot Clinic Evaluation  Clinical outcomes  Feedback from clients / carers  Feedback from clinicians  Cost analysis

9. P ilot Telehealth High Risk Foot Clinic Practical tips to help Patients feel comfortable in accessing specialist ambulatory care via telehealth ….  Skill development of local clinicians  Client care is centered: –informed evidence based decisions for rural clients –choice to access Telehealth in Tamworth or face-to-face in Newcastle –client input into management plans  Detailed explanation of Telehealth facilities  Visits by Newcastle clinicians during initial pilot phase  Communication between clients and clinicians  Timely and integrated follow-up by clinicians

10. P ilot Telehealth High Risk Foot Clinic