Identification of Change
Telemedicine is one of the most recent forms of services that has been started in the remote and rural parts of Australia. It is becoming one of the most essential models of care in the remote areas of the community where there is a lack of adequate health facilities. If the comparison is made between the aboriginal people of the rural community with the non-indeginous urban population then the picture is clear. It depicts life expectancy of the aboriginal people is lower than the urban none-indigenous population of the country. This study mainly focuses on the evaluation of the telemedicine health service given to the rural community of Australia. The evaluation will comprise of total six steps. The identification of the change and formulation of the evaluation questions will be done in an effective manner. The next step will comprise of the different boundaries of the evaluation. In this step, the different aspects and dimension of the evaluation of teledermatology program in the rural community of the indigenous population will be done. Subsequently, the comparison between the rural indigenous community before and after implementation of the program will be performed to see the effectiveness of the program. Moreover, in the next step, the techniques needed to measure the outcomes of the programs will be determined and evaluated. This technique will be important to measure the holistic outcome of the teledermatology program. In the next step analysis of the planning process for the organizational settings will be performed in a prominent manner. The next step will be a discussion of the results of the evaluation study. At last a conclusion will be made summarising every point of the study in a concise manner and recommendation to improve the program will be made.
The first part for a systematic evaluation (1) process consists of formulization of evaluation questions. The evaluation questions are the most essential component to analyze the goal of the evaluation program. According to the researchers, the skin problems in Australia represent 16.5 of each 100 visits to the general physician. According to the Australian Institute of health and welfare dermatology represents 10.8% of the total health problems. It is seen that 0.6 in 100 patients get effective treatment from the dermatologist. According to the Australian medical records it is seen that in the rural community there is high demand for the dermatologist. Due to this the teledermatology program is set to provide proper treatment to the affected people of the rural community. There are some specific goals that should be achieved by implementation of this teledermatology program (3). The goals are as follows.
- To record 70-80% or maximum clinical cases of dermatology in the rural community settings by using this advanced technology
- The clinical cases those are recorded must be provided with an effective and efficient management system(2). This is one of the most important points of the program.
- To increase the cost efficiency by using the new teledermatological technology in an appropriate manner.
- To reduce the overall morbidity and mortality rate of the rural and indigenous population (16) of the country.
After analysis of these goals, the evaluation questions must be formulated in an effective manner. The evaluation question should be formulated in such a way that particular results may be extracted from the question. This should help in a comprehensive analysis of the teledermatological program (4) in the rural and aboriginal health care setting of the country. The questions that are formulated to evaluate the program are as below:
- According to the perception of the rural and the aboriginal community what is the effectiveness of the program?
- By how much percentage the morbidity and the mortality have reduced due to the teledermatology services in the rural and aboriginal community (14) settings in Australia.
The boundaries and the dimension of the program are very useful for the effective evaluation of the program. It is essential to fix proper boundaries for the program. Since the teledermatology program has been implemented in the northern part of the country. The study aims at finding the effectiveness of the teledermatology impacts all over the country but mainly focuses on the effects of the service on the rural community (13). The study mainly focuses on the Teledermatology program in the far North Queensland and the Torres strait island program. It also tries to evaluate the positive effect on the aboriginal and the rural community of Australia.
Boundaries and Dimensions of the Evaluation
Different dimensions and aspects are covered in the study. The most important dimension is the economic dimension (6). It is one of the most important aspects of evaluation. The analysis of teledermatology service by using sophisticated cameras and laptops is done with respect to the cost benefit. Another important dimension is the political and environmental dimension that is evaluated in the study. According to the researchers, it is clear that the rural and indigenous community is less aware of the problems of Dermatitis then the urban community. This dimension is analyzed. The technological dimension (15) should be analyzed in a prominent manner. The technology comprises of the information gathering and storing devices laptops those are used by the community workers to report the clinical cases of dermatology for the proper interventions. The political dimension (7) comprises the analysis of initiative and the support from the government to implement the Teledermatology technology in the rural parts of the country mainly in the far north and in the Torres Strait island. These dimensions are analyzed before the implementation of the program as the baseline and after few months of implementation of the program in the rural and aboriginal community. This will help in recognizing the effectiveness of the Teledermetological program in a prominent manner. Moreover, it is important to measure the rate of morbidity and mortality (8) before and after the implementation of the teledermatological program.
The comparison among the selected groups is one of the major components to evaluate the effectiveness of the Tele dermatological program (9). In this evaluation process, the comparison groups should be the Australian rural and aboriginal community. The baseline data of the rural and aboriginal communities suggest that 25% of the rural population is affected by dermatological (17) problems. It is essential to mention that before the implementation of the teledermatological program 1 out of 166 patient were referred to the dermatologist for the effective treatment. The morbidity in the rural and aboriginal community due to several skin problems are well over 30 %. However, the rate of mortality due to the dermatological (10) condition is not much compared to the rate of morbidity. In the evaluation study, this data is collected for the comparison purpose. It is seen that there is an insufficient number of dermatologist present in the Australian rural healthcare settings. This is another main reason for the lack of proper service in rural settings. The implementation of the teledermatological program may help in increasing the efficiency of the service. According to the analysis it is seen that many nursing and hospital care setting do not have proper dermatological ward and dermatologists.
The data are taken after few months of implementation of the Tele dermatological program in the rural communities including the Torres Strait island. Mainly it is seen that after the implementation of the teledermatological program the reporting percentage among the rural and the aboriginal people has increased by 66%. It is seen that the clinical documentation of the outpatients mostly residing in the rural community settings has increased by more than 65%. Most of the case are the pediatric case. This is an important analysis that implies the positive effects of the program on the rural and the healthcare settings. The average time for the response of the physician has also decreased. It is now 5.5 hours on an average. The first reply is possible due to communication by using information technologies. According to the data, it is seen that appropriate and effective clinical photos (18) are provided in 83% of the total cases of dermatology in the rural health care setting. This is one of the essential points of comparison that shows a good positive effect due to the implementation of the program. About 21 % of the morbidity due to dermatitis is reduced in the rural and aboriginal population after the implementation of the program. This is some of the important comparison done to evaluate the teledermatology program in the Australian rural community setting.
Comparison Groups
There are several techniques those may be used to measure the effectiveness and changed that has occurred due to the implementation of the teledermatological health program. The most essential techniques used to extract data for the evaluation of this kind of programs are qualitative and the quantitative data. Both the qualitative and the quantitative data are important in the measurement of the effectiveness of the program in the rural community.
The qualitative method of measurement includes focus group discussion and unstructured interviews from the communities. This is one of the essential methods to know and analyze the perception of the rural and aboriginal community people about the implementation of the Tele dermatological program. The unstructured interview should help in performing open-ended discussion with the community. This help in generating different perspective of the community people towards the outreach program. Open-ended and in-depth interview of the community people and the community workers those are implementing the program are really helpful in evaluating the efficiency of the program in the rural and aboriginal community of the country. Through an in-depth interview, the different perceptions and viewpoints of the community people are taken.
The quantitative methods comprise data collected by structured surveys with close-ended number oriented values. The quantitative data are mainly gathered from the different documents present in the government offices. Previous literature may be analyzed to gather statistical data about the implementation of the teledermatological program. The quantitative data comprises of the percentage of clinical cases reported to the dermatologist by the use of the Tele dermatological technology. It is one of the most important points that should be remembered in the holistic evaluation of the Tele dermatological program in the rural and aboriginal care setting. The quantitative data also includes the financial and funding data of the program. The data for the cost benefits analysis by the sophisticated statistical tool should be performed by using the cost quantitative method of survey. This helps in gathering proper information about the cost-benefit analysis. Moreover, one data shows that by the help of the implementation of the Tele dermatological program in the rural care setting in far North Queensland and in the Torres Strait Island 20000$ of medical cost, travel, and accommodation have been saved. This implies that the use of sophisticated information technology helps in reducing the overall cost for treatment of the dermatological problem in the rural and aboriginal community of Australia. These are the main techniques to measure the viable change due to the implementation of the Tele Dermatological program in the rural community of Australia.
The quasi-experimental design may also be done to extract the data to evaluate the program. The quasi-experimental design helps in analyzing the data in an effective manner. Through the quasi-experimental design, the relationship between the intervention steps and change in the outcomes by implementing the teledermatological program may be done.
Planning is one of the most essential steps that is required in the evaluation process of the program. The first point, to be remembered during planning is the identification of the stakeholders is the most important point. In this case, the rural and aboriginal community people and the community workers nurses and dermatologist and the health administration associated with this programs are the stakeholders of the program. The next step included in the planing process is the data collection tools those are used to evaluate the process. Moreover, to evaluate the teledermatology process both the qualitative and quantitative methods are used. Different data includes the financial data, the clinical documentation data (12), and the compared morbidity and mortality data due to the implementation of the teledermatology program in the rural community settings.
The data are mainly divided into primary and secondary data. The primary data are the data gathered by the interview and focused group discussion within the community. The secondary data are the data those are taken from the previously existing literature present. Moreover, it also includes different census reports and data from the local health administration.
The next part of the planning comprises of the different techniques by which the data analysis is done for the effective evaluation of the program. In this case for the financial data the cost-benefit analysis is performed. This is one of the most efficient tools to analyze the cost-effectiveness of the teledermatology program in the rural community of Australia. It is seen that in remote places like Torres strait island this teleservice has saved up to 20000$. The different statistical analysis should be done with the quantitative data. The correlation between the clinical cases (20) recorded due to teledermatology and the rate of morbidity and mortality may be performed to analyze the relationship.
Subsequently, budgeting and timelines are essential for the evaluation program. Effective budget and timeline are required to perform the evaluation program in a proper manner. Optimize use of resources should be done to make an efficient and effective evaluation of the teledermatology program.
The next part is to document the results of the evaluation in an efficient manner. It helps in representing the evaluation results to the stakeholders like the government authorities. Funding may be generated from the government to strengthen the teledermatological program. If the programme is spread to all the rural communities through adequate funding (19) it may help in holistic development of the health service.
The results of the evaluation are one of the most important components. After the sophisticated statistical analysis, the results are generated. According to the evaluation programme of the teledermatological service in the rural and aboriginal health care (11) setting is having a positive effect. Moreover, 83% of the clinical case of dermatitis are documented and reported to the dermatologist. Of the 83% of the reported about 77% cases are assessed and treatment is done in an effective manner. Due to the implementation of the program average time for the reply from the dermatologist has reduced to 5.5 hours. Morbidity due to the dermatological problem has reduced by 21%.
Conclusion
To conclude the teledermatological program is one of the most efficient and effective programs among the rural and aboriginal population of Australia. The evaluation has been conducted in six steps. The results indicate the positive holistic development of the health outcomes in rural settings. Another important perspective is the funding and initiative from the government. If effective allotment of funding is done it will help in increasing the precision and accuracy level of the program.
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