Paramedics are conversant when working with people who live in rural communities, they know the challenges associated with the provision of care to these populations, they are also skilful when working with a variety of information technologies. This insight will help them develop service provision even further.
There are millions of people all over the UK who are living with a variety of long-term conditions or disability. Living with long-term health conditions can have a massive impact on the lives of those people, their families, those who offer care to them as well as the amount of money spent on services provided. Delivering care to those communities who live in more rural areas of the country adds to the complexity of managing long-term conditions. Taking health care to the consumer (the patient) through telehealth and telecare using telemedical tools can help to overcome this challenge; introducing telehealth means helping people in new ways. It can offer regular monitoring of the person's condition, appropriate and personalised responses, along with enhanced support.
Those living in smaller populations have less-direct access to vital healthcare resources and this can be detrimental to their health and wellbeing. Accessible healthcare includes offering telemedical tools that provide important clinical care at a distance.
As the number of telemedical tools grows this can lead to increasing the quality of care and decreasing delivery times. Examples of telemedical tools can include web meetings and online video tools, providing expert care everywhere. These types of web meetings can occur securely; they may take place at the patient's home, negating a wait whereby the patient has to wait days to see a health professional who may have to travel to an area, or patients having to take time off work travelling to see the health care professional; care can be provided almost immediately with less inconvenience.
Whilst web meetings are ideal for the fundamentals of primary care, they may not be appropriate for care of the older person, long-term care and other types of clinical needs. In these cases various types of devices are available that put hospital-quality patient monitoring devices into patients' homes. These devices send data to monitoring centres, which screen patients who are in different geographical areas. It is essential, however, that these devices are appropriate and well maintained. The data (including imaging and results of other specimens) can be securely accessed by health care providers from a distance.
Those people who have behavioural health and mental health problems, and who also live in rural areas can have their care needs made more accessible using telehealth; accessing mental health care in rural communities may be even harder to access. Online chat, Skype-like video conversations and secure online messaging should be considered in order to help those who need access to skilled practitioners.
When the patient is at the heart of all that we do we must ensure that care is tailored to meet individual needs. Telemedicine in its various forms can help to achieve this, the patient and the health service can benefit from enhanced use of technology. Using technology has the ability to provide the consumer with the power, putting them in the driving seat.
It is becoming increasingly clear that the current way of providing health care is unlikely to be sustainable as a result of ageing populations, growing demand for responses to care episodes that are often complex, patient expectations and challenging financial pressures. There is a need therefore to determine other more sustainable ways of ensuring that the health care needs of the population across the UK are addressed; things will need to be done differently in the future as a result of these pressures. The solution to this problem has to be within the system and the systems being used.
In day-to-day life more and more people are using technology, industries are investing in technology as solutions or alternatives, e.g. online banking, buying holidays and shopping online. However, in delivering health and care services this use of technology does not appear to have been as well received as it could have. The health service must invest in technology but, the investment needs to be of the right type and above all it needs to be informed by patients, paramedics and other clinicians.
It is still seen as the norm for patients to have to travel to hospital or have to physically go to see their GP, and for those people with conditions such as chronic obstructive pulmonary disease this can cause much physical and psychological distress and anxiety. It seems that the public are ready for more technology and this could also be in relation to their health and social care. This model, the biomedical model of care, was constructed around hospitals during the 20th century and at that point this was an appropriate model. At that time a paternalistic approach to illness was used, it is no longer applicable to think that “the doctor knows best”.
More access to technology is required (for patients and paramedics) to complement the care provided and in so doing truly offering a service around the patient. The use of technology to complement care is wide and varied and is already being used or there is a desire to use it. 75% of those who visited NHS Direct would have gone to their GP and/or an accident and emergency department instead, for nearly half of these patients home treatment was recommended (Royal College of Nursing (RCN), 2012). The use of technology has already demonstrated benefits for numerous patients; it could be argued that the biggest benefit will be for those living in rural communities.
Methods of communicating in the 21st century are changing. Technology and the way it is used will revolutionise health care, information technology (IT) has and will have a considerable bearing on how the paramedic practises in the future. In order for this to be a positive impact, the paramedic and other health care providers must learn and develop a variety of new skills. Paramedics should be working with others in directing and becoming involved in the ways in which the IT revolution is unfolding, as this will have relevance for them as well as the people they serve.
There are healthcare providers in the UK who have engaged with technology in well-dispersed rural areas of the county, this engagement has transformed service provision in partnership with British Telecom (BT). A centre of excellence for telehealth and telecare is being developed in the South West of England, providing opportunity to grow expert knowledge with the intention of sharing their insight with other care providers in the UK. Globally, there are other remote and isolated communities where consultation and monitoring using telehelath is occurring, e.g. in Australia and in America.
The introduction of telehealth services for people living in isolated communities is not without its challenges. Connecting to fast broadband services is a must, but connectivity may not be available in all areas of the country. Working in partnership with organisations such as BT can help overcome these issues but there must be human and financial resources available to make this a reality.
There are already successful telehealth and telecare services being used, provided over broadband, using mobile, wifi and a range of other networks. Whilst the physical resource (the technology) can provide a challenge that can be overcome, the bigger question will be associated with the redesign of health and care processes, ensuring that the technology required is embedded in mainstream services.
Telehealth and telecare can advance the way health care providers (including paramedics) deliver healthcare as well as improving the lives of those with long-term conditions, regardless of where it is they happen to live.
It must be acknowledged that the introduction of telehealth is not intended to replace primary or subsequent face-to-face consultations, nor will it address all the issues that care provision experiences. Just as the paramedic exercises professional judgement when communicating face-to-face with a patient, professional reasoning and judgment must also be employed when using the various forms of technologies.
All forms of telemedicine (and there are many forms) are only complementary to the traditional skilled hands-on care that is provided by the paramedic. Telemedicine is only capable of assisting the paramedic in meeting the needs of the people they care for, helping them to prevent illness or a decline in the individual's condition.
All care providers have to move forward and begin to put into place the technologies that are available and start to consider new ways of working smarter not harder, with the patient central to all activities. Those paramedics and managers who are responsible for the strategic planning of services have a duty to consider more effective, patient-centred ways of delivering care to those people who may live in isolated or rural communities.
An important aspect of the development of services where telehealth is integrated is the evaluation of the intervention. Consideration must be given to how the service will be monitored, methods of evaluation and audit with the intention of maintaining safety, quality and standards. Telemedicine can only assist the paramedic in meeting the needs of those they care for, helping to prevent ill health or a deterioration in the person's condition or their ability to self manage.
In response to changing demographics, along with the ever present drive to offer value for money and a predicted increased demand in services, technology will play a central role in delivering quality and affordable patient care and advice. Improved access to telemedicine has the ability to provide new and innovative ways for patients to benefit from its use.