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K. Tulk



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    OS03 - Geography and Telehealth: It's Not Always Distance (ID 6)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS03.03 - Telehealth Integration for Residents of Long Term Care (ID 298)

      K. Tulk, Long Term Care and Rural Health, Western Health; Corner Brook/CA

      • Abstract
      • Slides

      Purpose/Objectives: The primary purpose of the presentation is to demonstrate how two Regional Health Authorities in Newfoundland and Labrador utilized an evidence-based approach to Telehealth integration for residents of Long Term Care who require healthcare access to urgent and non-urgent care and services. Objectives of this presentation are to: 1. Identify current evidence to support telehealth use in Long Term Care. 2. Identify the process and benefits realized in Eastern Health RHA for telehealth integration for non-urgent care. 3. Identify the process and benefits realized in the Western Health RHA for telehealth integration for residents requiring urgent or emergency care.

      Methodology/Approach: Presentation of highlights of projects that have been developed, implemented and evaluated in the RHA associated with the integration of telehelath in the Long Term Care area for non-urgent and urgent issues that traditionally would have been provided face to face.

      Finding/Results: Use of Telehealth for non-urgent appointments: Telehealth has been integrated into the Long Term Care homes in the Eastern Health region. The process included extensive collaboration with the homes involved in the integration, with associated departments (e.g. Information Managerment) and with residents who reside in the homes and their famiy members . Residents are seen by their consultants/specialists via video, from the comfort of their long term care home with the support of their regular attendantsThis has resulted in a lowered risk to residents, and with cost savings to the health care system. Use of Telehealth for urgent/emergency care: The integration of telehealth for emergency care has been completed using the eHealth Change Management Framework. Challenges and successes have been identified. The results will be tabulated within the pilot period of 6 months. The project will result in the development of criteria and algorithm for appropriate use of telehealth for residents of long term care who require urgent/emergency care.

      Conclusion/Implications/Recommendations: The work completed in both RHAs supports the expansion of telehealth into other programs and sites throughout the regions. In Eastern Health, it supports preplanned appointments to improve access to services required for residents. Recommendations have been identified to improve further expansion: education/training program for future sites based on lessons learned, integration of appropriate technology. In Western Health, lessons learned will support expansion into other sites in the region and to other RHAs who are interested in expanding services in long term care for urgent and emergency care for residents.

      140 Character Summary: Reducing risks and increasing access to urgent and non-urgent healthcare services for older adults residing in Long Term Care homes in Newfoundland and Labrador!

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    OS21 - Advancing Telehealth: The Next Wave of Opportunities (ID 33)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS21.02 - Mixed Method Exploration of Telehealth for Autism Intervention Services (ID 299)

      K. Tulk, Long Term Care and Rural Health, Western Health; Corner Brook/CA

      • Abstract
      • Slides

      Purpose/Objectives: Western Health serves a catchment area of approximately 70,000 residents across a large geographic area of Newfoundland and Labrador (NL). Children who are diagnosed with autism spectrum disorder (ASD) within the jurisdiction of Western Health are eligible to receive early intervention services in the form of Applied Behavioral Analysis (ABA) therapy. Traditionally, orientation and ongoing follow-up for these services have been provided in face-to-face format, requiring travel by family members and healthcare providers (HCP). This modality has many limitations for families as well as for involved HCPs, primarily due to the rural nature of the area as well as needs of families who care for vulnerable children. Telehealth has been implemented to ensure adequate access for families as well as maximal efficiency for all involved at three distinct phases of the Western Health ABA delivery process, including the three-day ABA training, mentorship and support for healthcare providers, and to facilitate ongoing evaluation/communication with the family and home therapist in the child’s home. The research team leading this mixed methods study have followed a patient-engagement framework perspective. Quantitative data provided insight into registration information and family/healthcare provider participant satisfaction with using telehealth. Qualitative data from focus groups and interviews provided more extensive exploration of the processes and experiences of families and HCPs involved in the program. The program and evaluation framework are based on the Patient Provider Expectations Model. The final evaluation of the various phases of the project have informed changes required to transform the program to one that is truly “home based.” Based on study results, the researchers conclude that telehealth is a viable method of delivery for the three phases of the ABA program delivery, with the results having implications for improving efficiency of additional programs. The aim of this study is to build upon the existing use of telehealth for the ABA program’s three-day training and then expand into a telehomecare component for the mentoring phase. The objectives of the study include: 1. Implementation of telehomecare in the delivery of ABA parent/caregiver training 2. Explore the experiences of healthcare professionals and clients in the implementation of telehomecare 3. Summative and formative evaluation of health professional and client satisfaction with use of telehomecare for delivery of ABA orientation and ongoing mentoring 4. Review of cost and clinical effectiveness of telehomecare implementation to determine clinical efficacy of this mode of program delivery 5. Provide recommendations for further implementation of telehomecare initiatives

      Methodology/Approach: Mixed method methodology

      Finding/Results: Surverys received from over 60 participants of the three day ABA training. Results include: 87% satisfaction rate among participants; significant cost savings of participants (up to $2000 per participant); emotional benefits (avoidance of travel and separation from children for training). Individual interviews and focus groups provide insight into the challenges and solutions to identified issues.

      Conclusion/Implications/Recommendations: The first phase of this project included a one year pilot of telehealth use for the three day ABA sessions. Based on the results and feedback received from this review, the program has been adapted by the facilitators to be “telehealth-friendly”. Based on the successful results and subsequent change to the program, Telehealth is now used to assist in the delivery of all sessions of the three-day ABA training. Recommendations have been made based on the surveys and other feedback from participants and facilitators, including the recommendation that all staff who will be involved in facilitating the sessions via Telehealth participate in comprehensive telehealth orientation.

      140 Character Summary: Celebrating successes in telehealth -- bridging the gap for families of children with ASD and healthcare providers involved in ABA program delivery!

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