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J. Lowey



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    EP03 - e-Poster Session 3 (ID 54)

    • Event: e-Health 2018 Virtual Meeting
    • Type: e-Poster Session
    • Track: Clinical Delivery
    • Presentations: 1
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      EP03.05 - Age and Sex Patterns of Medical Care Utilization Through OTN (ID 456)

      J. Lowey, Lakehead University; Thunder Bay/CA

      • Abstract
      • Slides

      Purpose/Objectives: The Ontario Telemedicine Network (OTN) provides virtual health care services to the Ontario population, with an emphasis on those patients in underserviced regions. This research seeks to determine the associations between age and sex and medical care utilization rates faciliated by OTN and to determine if these associations are modified by geographical location.

      Methodology/Approach: A historical, population-based, retrospective cohort study, utilizing record-level administrative billing data and census data was employed. Utilization was determined by Ontario Health Insurance Plan (OHIP) medical billing data that has OTN listed as the service location. Patient geography was determined by matching OHIP residence codes to Ontario census subdivision (CSD) codes. Patient geography was divided into four regions: rural north/south and urban north/south. North and south classifications were determined using the geographical boundaries defined by the Local Health Integration Networks and urban and rural classifications were defined using Statistics Canada's Statistical Area Classification System. Each OTN visit creates two or more distinct OHIP codes: one telemedicine encounter premium code and at least one specified medical service code. The telemedicine premium codes were used to determine general utilization and the specified medical service codes were used to determine specialty utilization. Medical service codes were organized into therapeutic areas of care. The top utilized specialties were distinguished and reported. The remaining specialties were grouped into an “other” category. Crude and adjusted utilization rates were calculated and associations between the exposures, outcome, and effect modifier were analyzed using multivariate Poisson regression.

      Finding/Results: There were 885,761 completed patient sessions facilitated through the OTN from 2008/2009 to 2014/2015, providing care to 185,061 unique patients throughout the province. Provincial utilization rates were highest in family and general practice, followed by addiction medicine. Addiction medicine was approximately 7-fold higher in young adults (20-44 years of age) residing in Northern Ontario compared with young adults in Southern Ontario. Utilization rates among children (0-19 year of age) residing in rural Ontario were highest in psychiatry and dermatology services, whereas children residing in urban Ontario utilized family and general practice services most frequently. Oncology, internal medicine and surgery services had the highest rates of use in male, older adults (65 years of age and older) residing in Northern Ontario.

      Conclusion/Implications/Recommendations: This project provides a detailed description of telemedicine use in Ontario by sex, age, rurality, and region. While the majority of completed patient sessions through OTN are related to addiction medicine, the findings of this study highlight the variability of telemedicine usage by sex and age across the province. Results provide insight for e-health networks, such as OTN, and local health networks on what services are being utilized and by whom. Future research will investigate OTN service utilization trends, particularly in older adults, and compare OTN service rates with provincial, in-person care services.

      140 Character Summary: Telemedicine services facilitated by OTN have increased access to specialized medical care for all patients, young and old, especially in Northern, rural Ontario.

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    RF05 - Consumer Digital Health Partnership (ID 27)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Rapid Fire Session
    • Track: Clinical Delivery
    • Presentations: 1
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      RF05.04 - Older Adults use of Medical Services Facilitated by the OTN (ID 216)

      J. Lowey, Lakehead University; Thunder Bay/CA

      • Abstract
      • Slides

      Purpose/Objectives: As the population ages in Canada, telemedicine may help meet the challenge of providing care and services to older adults. There are medically underserved regions within Canada that may benefit from increased access to medical services facilitated by telemedicine. The purpose of this study was to determine what medical services, facilitated by the Ontario Telemedicine Network (OTN), were most utilized by older adults between April 2008 to March 2015, and determine if patient sex, and geography influenced utilization.

      Methodology/Approach: A secondary data analyses was performed on data from the Ministry of Health and Long-Term Care. Utilization was determined by Ontario Health Insurance Plan (OHIP) medical billing data that had OTN listed as the service location. All patients who were 65 years of age and older at time of service were included. Patient geography was determined by matching OHIP residence codes to Ontario census subdivision codes. Patient geography was divided into four regions: rural north/south and urban north/south. North and south boundaries were defined by the Local Health Integration Networks and urban and rural boundaries were defined using Statistics Canada's Statistical Area Classification System. Each OTN visit creates two or more distinct OHIP codes: one telemedicine encounter premium code and at least one specified medical service code. The telemedicine premium codes were used to determine general utilization, and the specified medical service codes were used to determine specialty utilization. Medical service codes were organized into therapeutic areas of care. The top utilized specialties were distinguished and reported. The remaining specialties were grouped into an "other" category. Crude and adjusted utilization rates were calculated, and associations between the age, sex, and patient geography were analyzed using multivariate Poisson regression.

      Finding/Results: There were 102,968 completed older adult patient sessions facilitated through the OTN from 2008/2009 to 2014/2015 fiscal year, representing approximately 11% of all recorded OTN sessions. At the population level, 39% (n=40,194) of all patients utilizing medical care through OTN were 65 years of age and older. Family/general practice services had the highest utilization rate in urban, Southern Ontario (20.4/1000). Dermatology services had the highest utilization rate in rural, Southern Ontario (16.1/1000). Oncology services were the highest utilized service in urban (35.6/1000) and rural (22.7/1000) Northern Ontario. Utilization varied by sex, region and age group, but overall, older male patients had higher rates of utilization when compared with female patients, especially in oncology, and urology/nephrology services. Although not consistent throughout all age groups, female utilization rates were higher in dermatology, and psychiatry/mental health services, particularly within the Southern, 65-74 and 75-84 year age groups.

      Conclusion/Implications/Recommendations: This research provides a detailed description of telemedicine use by older adults in Ontario, which has implications for medical service use in aging populations in Ontario and across Canada. Future research should compare OTN medical service utilization rates with in-person care services to determine what OTN facilitated medical services should be made more readily available or more frequently promoted. Increasing such services, would help make health care more accessible to older adults residing in northern, rural communities.

      140 Character Summary: Because of the OTN, older adults in Northern Ontario have increased access to specialized medical care- specifically oncology, internal medicine, and surgery.

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