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Benjamin Fortin-Langelier

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    OS07 - Spectrum of Virtual Care (ID 11)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Technical/Interoperability
    • Presentations: 1
    • Coordinates: 5/27/2019, 03:30 PM - 04:30 PM, Pod 6
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      OS07.04 - Humans Behind The Machine. Telemedicine Based Shared-Care Psychiatric Services  (ID 233)

      Benjamin Fortin-Langelier, Psychiatry, Royal Ottawa Health Care Group; Ottawa/CA

      • Abstract
      • Slides

      Background: The Royal Ottawa Health Care Group (ROHCG) has been a leader in the use of telemedicine to deliver psychiatric care. It has successfully integrated telemedicine in its regular clinical services and developed specific services based on technology. Those telemedicine-based services include correctional psychiatric care and shared-care (support to primary care) services. In psychiatry, shared-care refers to psychiatrists supporting groups of primary care providers. Typically, psychiatrists travel to family health teams and provide a blend of direct and indirect patient care. The rationale behind shared-care is to optimize the time of specialists and build capacity for primary care providers which then allows for more patients to receive the care they need in a location that is convenient. Purpose: We would like to present the case study of a shared-care partnership between a rural community health center where seven primary care providers support a community of 8000 and a tertiary care mental health center which was established in 2017 using telemedicine. Technology allows for patients to be assessed by a psychiatrist without travelling 250km and the humans behind the technology enable a lasting and successful partnership.

      Approach: In this oral presentation, we will highlight the importance of the key players and their roles in creating a clinical service that benefits all stakeholders and allows harvesting the full potential of the technology. Preliminary contact with the community, training, in-person visit prior to first clinical consultation, iterative feedback loop and follow-up annual education visits have contributed to the success of the partnership and trust between partners.

      Findings: In one year, we were able to set monthly psychiatric telemedicine consultations allowing 42 patients to receive care they would not have been able to access otherwise. This model has been demonstrated as effective and has been replicated in 14 other rural communities and translated for use in correctional institutions. At the moment, we observe two common mistakes in the design of consultation services in psychiatry. One is the over-reliance on technology at the expense of establishing strong relationships. In this mistake, there is a failure to establish consistent relationships and connections when rolling out telemedicine-based consultations. This creates a situation in which multiple remote communities are randomly connected with random providers at inconsistent times. It prevents specialists from understanding the context of the primary care providers with whom they consult and reduces trust as well as the quality and applicability of the consultations. The other mistake is the under-appreciation of technology. This is the belief that only in-person presence can lead to a solid relationship between primary care and specialists. While this is a reasonable model where geography permits, the drawback is lengthy travel time and the perceived impossibility to reach geographically distant communities.

      Conclusions: We believe we have found an effective balance between technology and human factor which enables trust and the development of sustainable partnerships. Appropriately implemented technology can lead to successful shared-care psychiatric services between geographically distant communities

      140 Character Summary:
      The Royal Ottawa will present a case study illustrating the implementation of shared-care psychiatric services using telemedicine in a rural community.

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