Diabetes telemedicine in the rural heartland:
Sandilands has a clinical master’s degree and has been a diabetes nurse specialist for the past 15 years – training at Nelson Hospital before the keen skier shifted five years ago to take up her current position based at Dunstan Hospital in Central Otago.
She supports the more than 300 people with type 1 and type 2 diabetes across an area stretching from Queenstown and Wanaka in the west to Ranfurly in the east and down to Roxburgh in the south. In 2012 – despite of and because of the isolation – she became the first prescribing diabetes nurse specialist in the South Island, which has reduced the barrier of travel for people.
She is employed as part of the Southern District Health Board diabetes specialist team and works in collaboration with her supervisor, Dunedin-based endocrinologist and associate professor Dr Patrick Manning, with whom she holds regular case reviews both in person and by email.
She offers clinics in Queenstown and Wanaka and most of the general practices across Central so she gets to mentor practice nurses in diabetes care. This means that most of the 18 practices she works with now have a nurse competent to start and titrate patients on insulin – though she is always only a phone call away – compared with only two or three when she arrived in 2011.
Since last year she has been involved in offering up to monthly paediatric diabetes telemedicine clinics.
A big screen has been set up in Dunstan Hospital so Central Otago families can skip the six-hour-plus return trip to Dunedin and instead join Sandilands and the local dietitian at Dunstan for a video link consultation with paediatrician Dr Ben Wheeler in Dunedin. The children arrive with their downloaded insulin pump information to see “TV Dr Ben” who is larger than life on the big screen and she can do the physical examination and HbA1c tests while Wheeler from Dunedin can discuss test results, ongoing management and any other issues. And Sandilands can write any prescription needed there and then.
Amongst her rural diabetes patients are those keen on smartphone apps with quite a few using an app to download results from their blood glucose meter to share with her and others using apps recommended by the dietitian as being good for carb-counting. While she is concerned about the lack of validation of the many apps on the market she says with so many patients really keen the key was to work alongside the patients who want to use them.
New blood glucose sensor technology to avoid finger pricking (yet to be released in New Zealand) is also appealing to some of her younger clients who are bringing it in from overseas.