On the eve of National Close the Gap Day, we look at how telehealth improves access to ear health services for Australia’s remote and very remote Indigenous communities.
Australia’s National Close the Gap Day is about raising awareness on the disparity between Indigenous and non-Indigenous health outcomes.
The campaign’s goal is Indigenous health equality by 2030.
An important tool for achieving this goal is telehealth: Telehealth technology supports Indigenous-led health services to deliver culturally appropriate remote healthcare to local communities.
Indigenous ear and hearing health
According to the Australian Institute of Health and Welfare (AIHW), 43% of Indigenous Australians aged seven years and older, had measured hearing loss in one or both ears in 2018-19. The most affected group was Indigenous Australians living in remote areas.
A significant cause of hearing loss is otitis media (inflammation and infection of the middle ear). In Indigenous children, this disease is characterised by earlier onset, higher frequency, greater severity, and greater persistence than in non-Indigenous children.
The impacts of hearing loss are broad: For children, it can be connected to learning difficulties at school, behavioural issues, and loss of future vocational opportunities, ultimately affecting overall health and quality of life.
In most cases, ear disease and the associated hearing loss are preventable. However, this largely depends on regular access to ear health services to detect, treat and manage ear disease.
The AIHW says a shortage of available specialists means thousands of Indigenous children and young people are on long wait lists for hearing health services.
The telehealth solution
Telehealth technology has emerged as an important tool to deliver ear health programs (EHP) to remote and very remote Aboriginal and Torres Strait Islander communities.
Here are three examples of successful ear health programs that incorporate telehealth:
Deadly Ears Program, Queensland
Queensland Health’s Aboriginal and Torres Strait Islander Ear Health Program – the ‘Deadly Ears Program’ – operates cross 11 partner locations.
The program uses telehealth to support the delivery of:
- ear and hearing information to children and parents
- assessment and treatment of children by an ENT specialist
- surgical intervention
- diagnostic audio review
- specialist nursing review
- targeted engagement by speech pathology and occupational therapy.
In the QLD community of Cherbourg, the Visionflex ProEX Telehealth Hub and Video USB Otoscope are installed in an Indigenous-operated mobile van service that travels around the region, conducting ear-health assessments of local children.
Recordings and images of the ear examination are shared with ENTs based at the Royal Children’s Hospital in Brisbane, for remote assessment, diagnosis, referrals, treatment, surgery, and ongoing management of ear disease.
Deadly Ears, which is also supported by the University of Queensland’s Centre for Online Health, has resulted in improved ear and hearing health for Aboriginal and Torres Strait Islander children:
- From 2007 to 2019, more than 6,100 children and young people attended about 18,200 visits with the Deadly Ears Program.
- Around 17,600 ENT clinic assessments, 11,800 audiology assessments and 1,900 ENT surgery services were delivered through the Deadly Ears Program to these children.
- Improvements in ear condition status and hearing were seen in around half of children who had a Deadly Ears ENT surgery service.
- Almost half of children who had an ear condition and conductive hearing loss at their first service had a substantial improvement in their hearing within 2 years.
Hearing health outreach services, Northern Territory
Since 2012, the Australian Government has funded the Northern Territory Government’s hearing health outreach services to Indigenous children and young people aged under 21.
Services are primarily delivered via the National Partnership on Northern Territory Remote Aboriginal Investment (for children aged under 16); and the Healthy Ears – Better Hearing, Better Listening Program.
Outreach services include audiology services; ear, nose, and throat (ENT) services; and Clinical Nurse Specialist (CNS) services.
The program utilises teleotology: An offsite service delivery whereby nurse specialists and audiologists obtain full diagnostic hearing assessments, assess middle ear function, diagnose middle ear conditions, and recommend further actions/treatment to an ENT specialist through a store-and-forward data collection service delivery model.
- In 2020, 701 ENT teleotology services were provided to 639 Indigenous children and young people.
- From July 2012 to December 2020, a total of 7,542 services were provided to a total of 3,904 children and young people.
The service has seen hearing health improve among children and young people who received outreach services between 2012 and 2020:
- The percentage of Indigenous children and young people with at least one ear condition decreased from 66% (483 of 727 children and young people) to 58% (1,037 of 1,802 children and young people).
- Among children and young people who received audiology services, the proportion with hearing loss decreased from 55% (388 of 710 children and young people) to 43% (768 of 1,772 children and young people).
Ear hearing program, Western Australia
In remote Western Australia, an Indigenous-operated ear health program (EHP) that incorporated a telehealth service had a major impact on increasing screening rates of local school children. It also improved timely ENT review, and primary care management of cases.
A 2014 analysis of EHP results found that:
- 96% of Indigenous children were screened
- 74% had middle ear disease
- 4% required urgent referral to specialist ENT services
- 62% required ENT referral overall.
The EHP also incorporated a customised electronic referral template to ensure all patient data and media (eg otoscopic image, tympanometry, and audiometry) was captured for review by a remote ENT, via telehealth.
In the local clinic, an ear-health educator was employed to train local staff and an ear-health nurse was employed to coordinate screening and follow-up visits. An ear-health education program was also implemented for patients and their families.
During an 18-month period:
- Waiting times for ENT review were substantially reduced (from previously being measured in months to a median of 22 days)
- 78% of cases were reviewed via the telehealth service
- the number of children screened increased by almost 380% (from 148 children up to 710)
- the number of ENT referrals increase by more than 91% (from 32 referrals up to 66)
- having essential information available electronically allowed for triaging cases and clinic decision making even when patients were absent during the telehealth consultation
- patients who did not attend in person were able to discuss with the ENT, and due to the availability of otoscopic photo and diagnostic test results in the electronic referral, appropriate management was able to be arranged.
The Visionflex telehealth solution
The Visionflex stable of clinical telehealth technology enables Indigenous-operated health services to deliver ear health programs to remote and very remote communities. This model of telehealth-supported care aligns with the National Aboriginal and Torres Strait Islander Health Plan 2021-2031 by providing an Indigenous health service that is:
- Culturally safe and responsive.
Visionflex’s ear-health toolkit includes:
with Telehealth Cart
Stream HD video and data via secure video conferencing link. Previously recorded patient data/images can be easily reviewed. Video conferencing is transmitted via a local network, satellite and 4G data links.
Transport the ProEX system easily around the clinic with the ergonomic Telehealth Cart.
The ruggedised, state-of-the-art ProEX Mobile tablet is designed for field visits and asynchronous telehealth consultations. Super-bright, touch-screen display; water resistant (IP54) and shock-proof housing.
The ProEX Mobile and peripherals fit snuggly in the Backpack with built-in wheels for a portable telehealth solution, ideal for field visits.
Precise positioning, faithful colour, and translucency representation along with a broad field of view to easily observe the external auditory ear canal and tympanic membrane.
Attachments for ear, nose and throat; dermatology; ophthalmology; audiology; women’s health; and general examinations are just some of the potentials of this unique system.
Kimberley Aboriginal Medical Services in remote Western Australia, is using Visionflex technology to perform ear, nose, and throat examinations via telehealth.
Learn more about the National Agreement on Closing the Gap.