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Consultations by phone or Internet are urged by think-tank report

Saying "what's up, doc?" to a physician on the phone instead of sitting around for hours in a hospital waiting room could save Quebec's beleaguered public health care system a bundle, a Montreal economic think tank says.

In a report being released today, the Montreal Economic Institute says several studies -including one at Maisonneuve-Rosemont Hospital in Montreal -show telemedicine can significantly reduce costs to taxpayers, increase health care service efficiency and boost patients' well-being because they spend less time travelling to and from clinics and hospitals and waiting around to see a nurse or a doctor.

This isn't shockingly new information, but the institute says booming health care costs make getting a tech upgrade an urgent necessity.

"With a smart phone I can take a picture of a wound on my leg and send it to a doctor," said Germain Belzile, the institute's director of research. "The doctor might say, 'It looks like diabetes; go get a blood test.' Already we've saved 12 hours of waiting in a hospital emergency waiting room."

The Maisonneuve-Rosemont study in 2003 and 2004 involved 2,400 chronic lung disease outpatients. Some had a device in their homes that gauged their lung capacity, cardiac rhythm and blood pressure and sent the results automatically to the hospital over the Internet. These patients were also consulting more frequently by phone with nurses. Other patients had no such devices in their homes and received regular medical care, including short phone calls and frequent visits by nurses to patients' homes.

(Each heart-lung device costs $1,275 every year for five years to pay for and maintain, but they pay for themselves in the end, Belzile said.)

The savings added up to $355 per patient over six months for those with telemedicine compared to those with little or none -a difference of 13 per cent.

A similar study in Ontario in 2007 with 819 chronic cardiac or pulmonary patients showed a 60 per cent reduction in hospital admissions and 70 per cent fewer emergency room visits in most cases.

Belzile -who, at 53, has diabetes -said Quebecers need to apply the latest communications technology to their health care, and fast. Unlike his condition, which is under control, health care costs have gone viral, he said.

Quebec's health care budget -estimated at $28 billion for 2010-11 alone -accounts for 45 per cent of total Quebec government program spending, up from 31 per cent in 1980. To offset that a bit, this year Quebecers began paying an annual "health contribution" of $25 per adult, set to grow to $200 by 2012.

"What are we going to do when (health care spending) reaches 60 per cent?" Belzile asked. "What will be left for education and the roads?"

The province's gross domestic product, or the total market value of goods and services produced annually, isn't keeping pace with the cost of health care. From 1993 to 2009, Quebec health care spending grew by 62.5 per cent, well above GDP growth during that time of 44.5 per cent, Belzile noted.

Quebec's bureaucratic public health care system isn't helping, he added. "It's rigid and top-down oriented. It doesn't encourage innovation."

But Karine Rivard, a spokesperson for Quebec Health Minister Yves Bolduc, said the government is looking at telemedicine. "There are eight projects around Quebec right now, including one on teleconsultations between doctors and patients at the McGill University Health Centre," she said. The emphasis is on doing follow-ups, treating wounds, and specialists looking at patients in photos or via video linkups. Initial diagnoses are reserved for face-to-face doctors' visits, she added.

Paul Saba, a doctor at Lachine Hospital and president of the Coalition of Physicians for Social Justice, said it is great to have a phone consult, "but there still has to be someone on the other side" to answer, referring to Quebec's shortage of doctors and nurses.

Technology "does help, but it can't replace a doctor's human touch," Saba added. "If I see a photo of a person's swollen foot, that's one thing. But if I'm there in person, I can see his environment, check his fridge to see what he's eating. I can see if he has an infection, a heart condition or is depressed."

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Autor(en)/Author(s): Max Harrold

Quelle/Source: The Montreal Gazette, 16.09.2010

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