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Introduction: For rural and remote clinicians, quality education is often difficult to access because of geographic isolation, travel, time, expense constraints and lack of an onsite educator. The aims of this integrative review were to examine what telehealth education is available to rural practitioners, evaluate the existence and characteristics of telehealth education for rural staff, evaluate r Rural and Remote Health rrh.org.au

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The recent introduction of self-treatment has dramatically improved the management of severe haemophilia A and B (Christmas disease), and most sufferers in Britain can now inject themselves intravenously with factor VIII or IX concentrate whenever they suspect bleeding.' This change in management has reduced dependence on hospital treatment, increased social independence and morale,2 and possibly will delay, if not prevent, the development of chronic haemophilic arthropathy.3 The potential effect, however, of this advance on employment prospects has yet to be determined.In previous studies on the employment of haemophiliacs4 the reported incidence of unemployment varied from 18% to 35% compared with a national unemployment rate of around 7%. It might be expected that improved treatment would increase employment prospects and help offset the approximate cost of £2000 a patient a year for purchasing blood product concentrate. We describe a study of the factors that currently affect the employment prospects of the haemophiliac, together with an assessment of the impact of self-treatment. MethodsIn 1978 a study group on employment was established by the Home Therapy Working Party of the United Kingdom Haemophilia Centre Directors. Members of staff of four haemophilia centres (Birmingham, Glasgow, Newcastle, and Oxford) participated and sent questionnaires to 636 patients with all degrees of severityof haemophilia A and B aged from 16 to 65. The questionnaire had five main sections with which it was hoped to determine:(1) Severity of haemophilia and the patient's general qualifications for employment.(2) Details of present employment. (3) Influence of self-treatment at work. (4) Details of previous employment of those who were unemployed at the time of the study.(5) What career advice and help patients had received. The doctor in charge of each patient's treatment was asked to give details of diagnosis and severity, and to state whether or not there was some other medical condition likely to affect employment prospects. To ensure confidentiality, all patients were identified by a code known only to the doctor in charge at each participating centre. The data from the completed questionnaires were processed on an IBM 34 computer and the results analysed both by region and by three grades of severity (severe: coagulant activity factor level < 1 unit/ml; moderate: 1-5 units/ml; mild: >5 units/ml).When a comparison was made between haemophiliacs and the general population the distribution was assumed to be binomial and, depending on the sample size, the confidence levels were determined using Poisson or t-test approximations to the binomial distribution. When a comparison was made between groups of haemophiliacs, the x2 test was used. The statistical test used is shown against each p value in the text. ResultsOf the 636 questionnaires posted, 79% were returned for analysis. Altogether 429 patients (86%) suffered from haemophilia A, 66 (13%) from haemophilia B, and seven (1%) were undefined. There was a preponderance of y...

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