In Newfoundland and Labrador, kidney patients receiving dialysis (blood purification) treatments at their local clinics are using Telehealth technology for weekly meetings with their nephrologists (specialists).
Jerry Appleby, a patient in Burin, 300 kilometres east of St. John's, said he used to see his nephrologist three times a year. "Now you can have a good talk with the doctor each week, ask questions about pills and talk about your blood tests right away," he said.
Craig Marshall, another Burin-area patient, agrees. "It's pretty useful that we can see them regularly and have the nurse right there in the discussion all during the dialysis session," he said.
Nurse Tom Hickman said the Burin unit, one of six local clinics around the province offering dialysis, has 17 patients who come in for treatment three times a week. "We move the mobile Telehealth unit from bed to bed while the patients are being treated and meet with the doctors right there," he said.
The Telehealth connection has made a difference in Hickman's workflow. For example, before the sessions began three years ago, he used to fax blood results to St. John's to be reviewed by the doctors, and he had to wait two weeks for the report. Now the results are discussed during the visits with the patient. "Copies of the doctor's patient notes, as well as any necessary prescriptions, are faxed to me at the end of the rounds," he said. "That's a big help for me and my patients."
Dr. Brendan Barrett, a nephrologist at Eastern Health in St. John's, said Telehealth makes him more productive. "Before, for remote clinics, we had to fly in, take a whole day to get there and maybe see one to five patients," he said. "Now I may visit one site via Telehealth up to four times a week, at different times, but all of the patients are getting a weekly consult. And there's no travel time involved."
More frequent doctor-patient contact is important, Dr. Barrett said, given that NL has the most dialysis patients per capita in Canada. He attributes this to an unhealthy traditional diet, sedentary lifestyle, genetics and irregular access to health care. There is also a high incidence of chronic disease, such as diabetes and hypertension, which can lead to kidney problems.
There are plans to expand the number of dialysis units in the province and to provide more pre-dialysis education, depending on staffing availability. "This vulnerable patient group tends, by and large, to be elderly and very ill," Dr. Barrett said. "Telehealth is allowing us to interact with them on a more regular basis and gather the first-hand knowledge we need to optimize their care."
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