Introduction: Diabetes-related foot disease (DFD) is one of the most prevalent causes of global hospitalisation and morbidity and accounts for up to 75% of lower-extremity amputations globally. The 5-year mortality rate following any amputation ranges from 53% - 100%. Early identification of wounds and multidisciplinary management can reduce amputation rates by 39 - 56%. Rural and remote communities and Indigenous populations are disproportionately affected by DFD. This is reflected in amputation rates which are much higher in Indigenous than in non-Indigenous Australians and in very remote areas than in major cities or inner regional areas. The large geographical spread of the population in Australia is a substantial barrier for those providing or accessing health services, particularly multidisciplinary and specialist services, which undoubtedly contributes to poorer DFD outcomes in rural and remote communities
Methods: A real-time video-based telehealth service for DFD management was established at the Royal Adelaide Hospital Vascular Services clinic to improve access to specialist services for rural and remote Aboriginal and Torres Strait Islander communities. An exploratory qualitative study which utilised one-on-one, semi-structured interviews was conducted with 11 Aboriginal and Torres Strait Island people who had participated in the telehealth foot service. Interviews were transcribed, de-identified, and analysed using thematic analysis, using an inductive approach.
Results: Four interrelated themes emerged. ‘Practical benefits of staying home’ described the reduced burden of travel and advantages of having local health care providers and support people at consultations. ‘Access to specialists and facilities’ highlights how some participant felt that there was a lack of appropriate facilities in their area and appreciated the improved access telehealth provided. ‘Feeling reassured that a specialist has seen their feet’ reflects the positive impact on wellbeing that participants experienced when their feet were seen by specialist health staff. ‘Facilitates communication’ described how participants felt included in consultations and how seeing a person on screen assisted conversation.
Conclusion: The advantages of real-time video-based telehealth go beyond reduced travel burden and improved access to specialist care. This model of care may facilitate relationship building, patient wellbeing, and feelings of trust and safety for Aboriginal and Torres Strait Islander DFD patients.
Key words: Diabetes-related foot disease, Indigenous, real-time video-based telehealth, rural, remote, Aboriginal and Torres Strait Islander people, qualitative