DISTANT CARE DRAWS ST VINCENT’S ADDICTION PATIENTS CLOSER

Dr Craig Rodgers knew he was on a winner when the St Vincent’s Hospital Sydney Addiction Specialist found himself providing clinical advice remotely to a farm worker driving a combine harvester in the NSW Murrumbidgee region.

Murrumbidgee Local Health District spans 125,243sq km across southern NSW, from the Snowy Mountains in the east to the plains of Hillston in the northwest and all the way along the Victorian border.

“During the harvest they are working 16 hours a day, with no chance to come to a clinic for an appointment,” says Dr Rodgers, a Senior Staff Specialist in Addiction Medicine at St Vincent’s Hospital. “Our amazing admin’ support officer was able to ring this guy, talk him through the software he’d need on his phone, and help him dial in through that.

“So there he is on his combine harvester, his case worker is in Deniliquin, and I’m in Sydney. It was one of the most unusual consults I’ve ever done, but it was such a good outcome.”

Dr Rodgers is part of a St Vincent’s Hospital telehealth team that has won ongoing government backing and client praise by bringing a vital city-based drug and alcohol program to the bush.

The program, developed in collaboration with the Murrumbidgee LHD, was a recent finalist in the 2021 HESTA Compassion in Action Social Justice Awards. Run by Catholic Health Australia, the award recognises individuals or teams who have shown creativity, commitment, and accomplishment in effecting positive social change.

Dr Rodgers says the program has seen a system of a sole visiting specialist approximately each three months augmented by a Sydney-based team who provide two, four-hour addiction medicine specialist clinics each week.
It has dramatically cut patient waiting times from up to three months to just a few days, reduced some of the stigma faced by those with drug and alcohol issues, and generally eased client access to the service.
It also provides support and training to local drug and alcohol clinicians in country areas, helping to build their communities’ capacity to care for people with substance abuse disorders.
Dr Rodgers says client access is the key to providing specialist substance disorder treatments, which in rural and remote areas has traditionally been limited.
“There has generally been a shortage of addiction medicine specialists and other medical practitioners, including GPs authorised to prescribe opioid treatment, in these areas,” he says. “This often led to delays, with poor patient outcomes.
“Prior to the pilot scheme Murrumbidgee LHD used a fly-in, fly-out system to increase specialist access, but this was costly and did not provide adequate coverage or continuity of care.
“FIFO works for some specialities, where treatment can wait a little while, but with drug and alcohol treatment it’s good to access it as soon as possible – especially as what clients are using can be life-threatening.”
Under the program clients are referred, usually by their GP, to their local drug and alcohol service, where their case is managed by a local clinician, social worker or nurse, who is on site to act as care coordinator.
Clients then attend a local clinic to access their telehealth appointments, with the local clinician helping with access where needed.
“Onsite support is key in this model,” Dr Rodgers says. “Many patients may not have the skills or technology needed to participate. They may not have money for a fancy iPhone or laptop or wifi.
“And the telehealth clinics are better attended. Normally people are encouraged to turn up for themselves, but in these rural areas local telehealth case coordinators really encourage people to come in.”
Dr Rodgers says access to hospital or a chemist for drug and alcohol treatment can be quite stigmatising, especially in small towns.
By avoiding usual treatment channels and long waiting times telehealth helps clients avoid some of the problems.
“Drug users all over the country are stigmatised, but in a small country town more so. In a town of say 1000 everybody tends to know who is roaming the street and who may be affected by drugs.”
The program also gives the St Vincent’s Hospital team an opportunity to share skills at a regional level. There are weekly sessions where the local service participants can dial in via Teleconferencing facilities and receive training, and local clinicians are on hand during consultations.“It’s an opportunity to give an on-the-run education to those local clinicians around how opioid, alcohol or methamphetamine treatment works, plus allow time for case discussion with workers,” Dr Rodger says. “It’s extra collegial support they would not normally have.”
The service has won over its clients, with a survey finding 100% of participants agreeing telehealth is a convenient way to receive their care, and that they would be more than happy to have a future telehealth consult.
From about 77 clients in the pilot scheme, Dr Rodgers says it has expanded into other areas – the NSW Far West, Western and Southern Local Health Districts – and had 95 clients by October.
The team is now sharing its model with the Hunter New England LHD, which plans to use it as a basis in their remote towns and cities.