Telemedicine

This project was undertaken for Hywel Dda Local Health Board. The aim of the project was to evaluate how telemedicine is being used to help in the treatment of dermatology patients in the Ceredigion region of Wales. The project began by analysing the patient travel data of 143 patients who have attended dermatology clinics in their local area and determining the distance they travelled to attend their clinic. The travel distance was compared against the distance they would have travelled if they had attended an outpatient clinic in Glangwili Hospital, Carmarthen. For all the patients, there were savings in the distance they travelled. For certain groups, the travelling distance was reduced by up to 80 miles.

The second part of the project involved developing a simulation model which represented out patients move through the system when they use telemedicine compared with the traditional outpatient approach. The model showed that telemedicine provides a more efficient service with all the patients being seen. The traditional outpatient appointment system was less efficient with a large proportion awaiting treatment.

The final part of the project considered the costs involved in running a telemedicine clinic. The results showed that the direct travelling costs are reduced using telemedicine. However, these savings need to be compared against the cost of setting up the clinics and buying the equipment. In the telemedicine approach there is also an added staff cost with a nurse running the teledermatology clinic. The cost implications are further complicated by the cost associated with the time a patient spends travelling to their appointment and how different it would be if they travelled to the traditional outpatient appointment.

The project showed that Operational Research (simulation modelling and cost analysis) was very useful in evaluating the effectiveness of teledermatology in treating patients from the Ceredigion area.

Maternity Direct Access to a Midwife

The aim of this project was to model the way that women in Wales access their midwife. In some areas of Wales, pregnant women go straight to their local midwife once they suspect they are pregnant. In other areas, women go to their family GP before they are referred to the midwife. The model used simulation models to represent the pathway a woman might take on her journey through antenatal care. Separate simulation models were developed for each local health board as the parameters (such as the proportion who visit a midwife first) were different for each health board. The models were used to represent the current situation and what would happen if each health board implemented a “direct access to a midwife” approach (women are always directed to their local midwife).

The project showed that the workload for midwives would increase and that more women would receive midwife-led care and slightly fewer women would experience high-risk births. However, it should be noted that it was very difficult to obtain data despite over 35,000 women giving birth each year in Wales. The difficulty in getting the data is due to the fact that all the data is captured on the All Wales Maternity Notes which the woman keeps hold of during her pregnancy and the information isn’t necessarily transferred to a standard electronic record system. The models developed in this project relied on expert opinion gathered from the heads of midwifery in each of the 7 local health boards.