A dedicated IBD nurse embedded in a major metropolitan hospital but available for telehealth consultations with rural and remote patients might be one way to help reduce the need for GI-related aeromedical retrievals.

According to a review of 105,000 RFDS retrievals during four years 2014-2018, almost 10,000 (9.4%) were related to GI disease – well behind diseases of the circulatory system (21.3%) and injuries (17.7%).

However according to the researchers, prevention of acute GI disease and acute worsening of chronic GI conditions was preferable to avoidable emergency presentations.

“Many of the GI conditions resulting in the need for RFDS aeromedical transfer are chronic conditions that intermittently worsen and then improve with the appropriate care. In IBD for example, good education and specialist intervention is essential in minimising flares and progression of the disease.”

The review found most GI patients presented with abdominal and pelvis pain (19%), paralytic ileus and intestinal obstruction without hernia (11.6%) and conditions such as haematemesis, melena, blood in stool or GI haemorrhage (9.5%).

GI haemorrhage alone was 2.2% of the retrievals with many being of a high severity. Liver disease represented 3.6% of the retrievals, IBD 2.9% and GI cancer 1.4%.

“Patients presenting with acute symptoms related to underlying GI disorders, such as IBD, require long term follow-up and management from a specialist via dedicated clinical support mechanisms to reduce acute care needs, yet specialist gastroenterology support in rural and remote Australia is generally lacking.”

The paper noted there was evidence that rural and remote populations have higher rates of untreated hepatitis C and excessive alcohol consumption, “both of which are linked to liver cirrhosis and cancer”.

“This, coupled with the increasing rates of substance use disorders requiring aeromedical retrieval, indicates a complex clinical environment.”

The authors, including gastroenterologists Associate Professor Susan Connor, Associate Professor Jakob Begun and Professor Jane Andrews, said conditions such as GI haemorrhage rarely occurred in the absence of risk factors.

“Better provision of primary, and specialist, health-care services in rural and remote Australia could improve recognition and management of this condition,” they said.

Dr Fergus Gardiner from the RFDS told the limbic they already had a very robust telehealth service that was GP and nursing led and could be augmented with specialised support.

“A broadening of the service would be better to avoid these acute flare ups requiring aeromedical retrieval,” he said.

“I also think having a telehealth service potentially located at the Royal Adelaide Hospital overseen by Professor Jane Andrews with her medical and nursing staff would be a really good way forward.”

Developing innovative models such as a travelling clinic was also a possibility.

Dr Gardiner said the next step was collecting hospital outcomes such as length of stay, procedures and final diagnoses on the retrieved patients.