To evaluate the feasibility and acceptability of providing telehealth consultations in rheumatology.
A prospective review of new consults from a rural area assessed by a rheumatologist in an urban area using telehealth. Patient demographics were recorded along with a self-administered questionnaire reporting assessment of the acceptability of the process. Referring physician and consultant provided open ended feedback as to relative strengths and weaknesses of telehealth versus traditional consult. A simple cost and time benefit analysis was undertaken.
The spectrum of patients with rheumatic disease assessed was similar to a traditional consultation clinic. Patients found the overall process to be acceptable and effective. Apart from accessibility to specialist consultation, the greatest benefit was improved communication among patient, referring physician, and consultant. The process was determined to be efficient in both time and cost savings.
Telehealth rheumatology consultations are feasible, acceptable, and cost/time effective and are therefore advocated for those geographic areas where traditional consultations are not readily available.
It is good to read that nurses in Ontario, Canada, have set up a campaign under the banner 'More nurses, better care!' (News March 5), urging the public to join the fight for more nurses in the province.
This commentary is about Canada's ability to afford a comprehensive pan-Canadian approach to elder care. In redefining the universal public system, a broad and more comprehensive definition of universal public care is needed for those whose physical or mental abilities are impaired. The Scandinavian model affirms that this is both effective and affordable. Comparisons of Canada with other nations in the Organisation for Economic Co-operation and Development on taxation and spending levels reveal that there is room for Canada to increase taxation to fund a Scandinavian model while still having competitive tax and spending rates.
Health funding is central to public health planning and clinical practice, hence this comparison of GDP health expenditure and five year post-diagnostic cancer survival rates of England and Wales with the USA and eight European countries. The three lowest proportional GDP health expenditures over the period 1980-1990 were Denmark, England and Wales, and Spain. The USA had the highest proportional GDP expenditure, followed by France, Germany, and The Netherlands. Overall the USA had the best cancer survival rates in the 14 sites reviewed, followed by Switzerland, The Netherlands, and Germany. The least successful were Spain, England and Wales, and Italy. In respect to the high incidence cancers, colorectal, lung, and female breast cancers, England and Wales survival rates were the poorest of all ten countries, followed by Denmark and Spain. Higher GDP health expenditure and longer survival rates for each gender were significantly correlated indicating a possible association between fiscal input and clinical outcomes, which poses problems for the development of effective public health.
The problems in traditional residential long-term care settings described in the lead paper are the tip of the iceberg in relation to changes in the landscape of healthcare and social policy in Canada over the past two decades. The primary purpose of this commentary is to identify some of the less visible changes and how these are affecting our perceptions, values and policy directions in "long-term care," however it is defined. The secondary purpose is to caution readers of the dangers of trying to resolve all social policy issues through medicare. This temptation is an artifact of our history and fragmented constitutional powers. It is also due to a well-intended but highly problematic shift in the nature and purpose of public health insurance (and government) in Canada during the 1990s. Without a greater understanding of these and other underlying issues, a pan-Canadian program dedicated to residential long-term care under the upcoming Health Accord risks adding to existing problems. There is also a desperate need for better understanding of the intergenerational needs of Canadian families in relation to healthcare and eldercare.