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Technology puts physio behind bars

After successfully using telehealth to provide Spinal Assessment Clinics (SAC) to remote patients in three states, physiotherapist Matthew Beard had an idea to offer digital health consultations to patients in another isolated location: the state’s prisons.

Experience working within the prison health system meant he knew this population had limited and costly access to surgical outpatient services. His team of physiotherapists at Royal Adelaide Hospital’s SAC was already managing referrals from prison health services to assess spinal disorders. To do this, prisoners had to be transferred to Royal Adelaide Hospital, a costly and time-consuming exercise to execute, Matthew says.

With the SA Health Digital Telehealth Network already in place at prison sites, albeit under-utilised, Matthew was convinced SAC could use the technology to deliver an efficient and coordinated service to the SA prison health service. However, he was equally fearful that if he followed the traditional process of stakeholder engagement and committee review the ‘good idea’ might not see the light of day.

‘Not all people believe that prisoners should receive ready access to health services, but I believe all people deserve the right to access healthcare in a timely manner and now the technology is readily available to do this quickly and without great expense,’ Matthew says. ‘The idea would also have other positive benefits, as the prisoner would not need to leave the facility to seek a specialist and could benefit the emotional wellbeing of both staff and prisoners.’

So, Matthew took a more unorthodox approach to introducing the initiative from his existing operational budget and involve only his team and a few key senior health officials, who approved the project.

He wasn’t bucking the system, he says, but rather avoiding potential red tape that could delay or derail implementation of this innovation. And, having successfully run spinal telehealth clinics for patients in South Australia, the Northern Territory and New South Wales, the concept was already ‘tried and tested’.

‘I know that may not be the way of the public service anymore but having worked for a long time in the sector, I knew that if we wanted to get this Technology puts physio behind bars off the ground we just had to do this quietly and get the key movers at the other end to say it was a good idea and to give it a try,’ he says.

‘I also knew we had a model that was tested on patients in country areas in three states: it was very well accepted, it was safe, it was efficient and it saved an enormous amount of money in escorts and travel. The GPs who provided the referrals liked it as well as we provided a contemporaneous report following the consult, so changes in patient management could be quickly initiated.’

With this fast and lean approach in motion, the prison spinal telehealth clinic was established within months, operating from September 2016. The team liaises with prison health staff to provide assessment of the patient’s concerns, analysis of imaging, and provisional diagnosis and treatment recommendations of the spinal condition without them having to leave the facility.

It’s become a public health success in saving time, people power, court resources and money in transferring prisoners from jails to Adelaide to seek treatment, and has been publically acknowledged for improving communication with SA Prison Health Service.

Last year, SA Health named the spinal service as a finalist in its annual awards, crediting it with ‘having significantly improved the delivery of health services to the South Australian community’ in the Enhancing Hospital Care section.

‘We were already getting a number of referrals from prison health into the spinal service, which is a surgical service where I have some physiotherapists working in advanced practice roles. Having worked in prison health in the past, I was conscious that to get a prisoner from a metropolitan or country prison requires an enormous logistic challenge, and it is hugely expensive.

‘When they are moved out of regional jails they may often lose the privileges they may have acquired over time regarding their room or work detail, so they may not be readily willing to get care for musculoskeletal conditions so early on. And, once they get to Adelaide to wait for a medical appointment, if there happened SA.indd 70 14/02/2018 11:42 am March 2018 71 to be a number of court cases with prisoners waiting on that day, they take priority, which may mean they have travelled half way across the state, spent two days in Adelaide and then their appointment is cancelled at the last minute because there are other priorities.

‘For all those reasons, concerning this population, I felt that if we could project the service to the site, we could avoid all the transport, we could avoid prisoners potentially losing privileges … plus, we would save the tax payer a huge amount of money. It seemed like a win, and it seemed like a win that didn’t need to go to every stakeholder to decide it was a good idea.’

The Spinal Assessment Clinic may not have won a SA Health Award, but being named as a finalist highlights the work and efforts of physiotherapists in advancing the use of telehealth within the public sector, Matthew Beard says. ‘That’s something the profession can be proud of,’ Matthew says. ‘We advocate for a more accessible and equitable health system, and to provide this we need physiotherapists to innovate, to think laterally, and maximise existing budgets. ‘For SA Health to acknowledge this initiative, and the physiotherapists who made it work, not only helps raise our professional profile but it also demonstrates we can utilise technology to efficiently deliver outpatient services.’

The spinal service is now in operation at all state-based correctional facilities.

Marina Williams

 

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