Transcript Exploring Use of Tele-health with a First Nations Population

Using Telehealth to expand our
reach: What works & what’s
available?
GF Strong Rehab Centre
December, 2006
What is Tele-health?
“TH broadly refers to the use of
information and telecommunication
technology to assist with the delivery of
health information and services by
facilitating the transmission of images,
voices, and other data over large and
small distances” BC Ministry of Health Planning
 Other terms – Tele-medicine, e-health
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Benefits of Tele-health
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Research has shown care to be effective
Increases family involvement
Cost-effective and time-efficient for both
practitioners and clients
Improved access to specialty services
Improve continuity of patient care
Can incorporate culturally-appropriate care
Can lead to capacity-building
Types of TH Applications
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Reviewing the literature I have found
examples of TH as applied to physical
therapy, occupational therapy, nursing,
social work*, psychiatry, rehabilitation,
and many others
TH Processes
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TH has been used for patient
assessment, consultation, case
management, exercise monitoring, prescreening for treatment options, postprogram follow-up, case conference,
and patient education
TH Modes of Delivery
Store and Forward transmission of
information (e.g., fax machines, e-mail)
 Real Time transmission (e.g.,
telephone, video-teleconferencing)
 Combination of Store and Forward &
Real Time transmission
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TH Telecommunications and
Network Links
Plain Old Telephone System (POTS)
 Dial-up Digital Telephone Lines (ISDN)
 Asymmetric Digital Subscriber Line
(ADSL)
 World Wide Web – Internet
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Rural Stroke Rehab Project
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Typical problems encountered when patients
discharged from rehab hospital to home:
– Medication non-adherence, isolation, limited access to
specialists, difficulty coordinating home-based services,
inadequate supervision, minimal communication between
hospital & community care providers re patient history and
discharge plans
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Technology – home Internet videoconferencing units
Strengths – early identification & resolution of
problems, patient isolation, continuity of care
Barriers – complexity of equipment
Multidisciplinary approach to
treating eating disorders
Study of 12 patients
 Patients received CBT & nutrition
education
 After 1st session 50% would prefer
videoconferencing to physical visits
 Reasons for preference – convenience,
feel more in control, less intimidating
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Trauma centre case management
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Pre-identified a subset of complex patients
who were high service utilizers
Interactive home telehealth equipment
18 of 30 patients received TH intervention
Advanced nurse practitioner did case
management
6 months prior to intervention vs. month of
intervention - admissions,  LOS,  ED
visits, and  GP visits
Use of TH by Social Work
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Mental health earliest & most frequent users
 Use of videoconferencing slow to catch on
 E-mail or interactive e-mail (real time chat)
 Issues –
privacy/confidentiality/security/informed
consent, impact on therapeutic relationship*,
charting
MPAP First Nations TH Project
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Carrier Sekani First Nations Band
Combination of physical clinics and TH followup clinics
Rheumatology, PT, OT, nursing
Partnership of Band, MPAP, TAS, ARC
Benefits – cost-effective, improved continuity
of care, better care to more people
Issues – community readiness (assess &
promote), division of roles, ongoing
evaluation, how to facilitate culturallyappropriate care
British
Columbia
Communities
with
Telehealth
Facilities
Provincial Status of TH
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Psychiatry uses TH for assessment and Rx
Provincial site - BC Women’s & Children’s
Hospital
Each health authority has own network, and
First Nations network
Most sites are located in community health
centres or hospitals, do not have paid staff,
and typically have one or two cameras and
two television sets
Larger sites have peripherals for education
(Leslie & Gordon Diamond Centre)
First Nations TH Sites
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Fort Nelson, Gitxsan (Hazelton), ITHA
(Nanaimo), KDC Health (Campbell River),
Kispiox (Hazelton), Kitkatla, NTC (Port
Alberni), Old Massett, Sea Bird Island
(Aggasiz), Sh’ulhe-tun (Ladysmith),
Skidegate, Sliammon (Powell River),
Snuneymuxw (Nanaimo), Sto:Lo (Chilliwack),
Three Corners (Williams Lake), Tse-shaht
(Port Alberni)
The future is now
Role of TH for GFS?
 Role of TH for social work?
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