Tele-Oncology Through the Ontario Telemedicine Network

Transcription

Tele-Oncology Through the Ontario Telemedicine
Network
Integration Into Follow-Up Care at the
Northeast Regional Cancer Program
Mark Hartman MRT(T), MBA
Administrative Director
Carole Mayer MSW, RSW, PhD (C)
Clinical Lead & Manager, Supportive Care Oncology Research Unit
AKA: The Emmy for
Tele-Oncology Goes to…
James Bay
Northeastern
Ontario
LHIN 13 +
LHIN-13
Quebec
Northwestern
Ontario
Kapuskasing
Cochrane
Timmins
Kirkland Lake
Chapleau
New Liskeard
Lake
Superior
Sault Ste. Marie
Elliot Lake
Sudbury
Blind River
Mindemoya
Lake
Michigan
U.S.A
.
Lake
Huron
North Bay
Sturgeon Falls
Parry Sound
Huntsville
Bracebridge
Greetings from Sudbury
NE Regional Cancer Program
•Medical, radiation &
surgical oncology
consultation
•3,500 New patient
consultations
•24,000 Follow up
visits
• Canada’s busiest telemedicine service
provider
• Provides health professionals with twoway videoconferencing and telediagnostic devices to interact with and
examine patients from remote areas
OTN - Northeast
NW
NE
Who Uses Telemedicine?
16000
OTN Event Types 2008
14000
12000
10000
Number of
Events
Northeast
8000
Ontario
6000
4000
2000
In
M
en
t
al
H
te
ea
rn
l th
al
M
ed
ic
in
e
O
nc
ol
og
y
Su
rg
er
Pa
y
ed
ia
tr i
cs
An
es
th
es
ia
D
ie
ta
ry
C
G
om
er
ia
m
t ri
un
cs
i ty
Su
pp
Ps
or
t
yc
ho
lo
gy
0
Type of Event
Source:
OTN 2009
What is Tele-Oncology?
• “Tele-Oncology may be defined as the
delivery of clinical oncology services from
a distance, often using an interactive video
telecommunications system” (Doolittle & Allen,
1997, p. 63)
• For the purpose of this presentation the
term OTN and Tele-Oncology are used
interchangeably
What are we doing in TeleOncology?
Tele-Oncology
Follow-up Care
•
•
•
•
•
•
•
Test results
Symptom review
Medication review
Vital signs taken at the remote site
Auscultation of heart and lung, if required
Viewing skin lesions, wound healing
Future care coordination via OTN,
Peripheral Clinic or Regional Cancer
Centre
Studio Set-ups
OTN Scheduling
Primary Nurse and Doctor
Teams
How did we get here?
1. Identifying the need.
• Providing Care Closer to Home
embedded in mission in mid90’s.
• Peripheral clinics from 1992.
• Satellite chemotherapy 1995.
• Needs assessment 1999.
2. Seizing the opportunity.
• 2001-Approached by North
Network
• December 2001- 6 oncology
patient events offsite at Sudbury
Memorial Hospital
• April 2002 - Equipment in place
• Guidelines established for patient
consultation
3. Consistent growth.
NE -RCP Telemedicine activity 02-09
6000
5487
5000
3602
3389
4000
2973
Total
Activity
2335
3000
2000
1000
1203
102
265
0
2002
2003
2004
2005
2006
Year
2007
2008
2009
(projection)
Source:
OTN 2009
Challenges
• Remote hospital resources
– Net new activity for patient sites
• Space
– Initially challenging, now replaces face to face
space
• Support resources for early adopters
– Initial technical support for each case
• Scheduling workload
– Approximately 1.5 times more labour
Success Factors
• Patient driven need
• Suitable application
• Clinicians in control
• Physician champions
• Accessibility
• Proximity
• Ease of use
The Future is Now
•
•
•
•
•
•
•
•
Psychosocial Support
Nutritional Support
Physiotherapy Support
Genetic Counselling
Palliative Consultation
Satellite Chemotherapy
Satellite Radiation Treatment
Research
Reaching Out to Oncology
Patients Living In Rural
Northeastern Ontario:
Results of a Patient Satisfaction
Survey with the Use of
Tele-Oncology
Study Objectives

Assess patients’ satisfaction with
Tele-Oncology/OTN
Identify benefits
Identify areas to improve and required
actions
Identify which oncology patient
population most benefits utilizing this
technology (e.g. new radiation
consults, well follow-ups, on treatment)
Survey Method
•
•
•
•
•
May-August 2006
Patients were asked to complete the
survey after their OTN appointment
10 minutes to complete the survey
Self-addressed stamped envelope
was provided
Follow-up telephone call (n=43)
Survey Results
Demographics
•
Age
– Female 64 mean years (std 13.7)
– Male 69 mean years (std 10.7)
• Gender
– 37% (n=85) female
– 63% (n=143) male
Marital Status
•
•
•
•
66% (n=149) married/common-law
14% (n=32) widowed
10% (n=23) divorced/separated
9% (n=21) single
Education Level
30
30
25
25
Elementary (n=53)
20
Some Secondary
(n=66)
19
15
10
5
0
16
10
Completed
Secondary (n=43)
College (n=23)
University (n=35)
Language
88% (n=195) English
12% (n=26) French
Did you get your services in your
preferred language?
95% (n=214) yes
5% (n=11) no
Type of Cancer
6%
10%
6% 4% 3%
14%
32%
25%
GU (n=73)
GI (n=56)
Breast (n=32)
Lung (n=24)
Skin (n=14)
Other (n=13)
HEM (n=10)
GYNE (n=6)
OTN Utilization
Medical Radiation
Oncology Oncology
New Patient
Adjuvant
Local
Recurrence
Palliative Care
Total
Total
0.0%
0.4%
(n=1)
0%
(n=1)
39.5% (n=49)
60.5%
(n=74)
54%
(n=123)
4.9%
(n=2)
95.1%
(n=39)
18%
(n=41)
61.9% (n=39)
38.1%
(n=24)
28%
(n=63)
40%
(n=90)
60%
(n=138)
228
Access to OTN
Number of times patients used OTN
• 28% (n=63) 1 time
• 27% (n=61) 2 times
• 35% (n=81) 3-5 times
• 10% (n=23) More than 5 times
Return to OTN
I would use OTN again
• 68% (n=154) Strongly agree
• 31% (n=71) Agree
• 1% (n=3) Disagree
• 0% Strongly disagree
“Saves everybody time and money (gas, travel, lodging,
etc.) only back fall, lack of hands on.”
“I have difficulties traveling due to a medical condition
and I appreciate the opportunity to use NORTH Network
services.”
Travel to OTN Site
Easier to travel to OTN
• 30% (n=67) Agree
• 1% (n=3) Strongly disagree
“I prefer the telemedicine method and I can achieve the same
dialogue.”
“Yes telemedicine appointment was easier for me but seeing the
doctor face to face would be appropriate from time to time.”
Reduces Travel time
OTN reduced my traveling time
• 21% (n=48) Agree
“Financially I save $500 each time (hotel, gas, meals).”
“I worry about depending on family or a friend, the time and
cost is trying.”
Needs Met
My questions and problems were
addressed
• 40% (n=92) Agree
“My oncologist and primary nurse take their time to fully
explain.”
“Questions are encouraged.”
“Some medical terms were hard to understand.”
Test Results
Tests, x-rays, lab work were available on
time
• 33% (n=76) Agree
“Appointments for lab work/NORTH Network are arranged
at times to suit patient’s schedule. It works well for me.”
“It’s unfortunate the CT results were not ready.”
Time
There was enough time for questions
• 41% (n=92) Agree
“All of my concerns were met by either the oncologist or
the nurse.”
“I like it because I can say what I want and also ask what I
want.”
“Sometimes the network was busy with other
appointments and my appointment was cut short.”
Satisfaction
This telemedicine is as good as a visit at the
Cancer Centre
• 39% (n=89) Agree
“Face
to face will probably always be best but this was a close
second.”
“I agree however there is something rather special about
seeing/being with the specialist nurse.”
“If there is a specific reason to have a face to face appointment
it can be scheduled. For many appointments telemedicine is
equally as good.”
Plan of Care
I was clear about my plan of care
• 41% (n=93) Agree
“I was certainly able to question any further explanations
with the nurse as regards to our explanations.”
“Satisfied that I have a choice of treatment or care after all
is laid out on the agenda.”
Privacy & Confidentiality
I was comfortable with the privacy and
confidentiality of my visit
• 33% (n=75) Agree
Visual
I could clearly see the persons on the
monitor
• 26% (n=60) Agree
Audio
I could clearly hear the persons on the
monitor
• 32% (n=72) Agree
Other findings
Qualitative comments were made on the
following points:
Audio and hearing impaired
Assistance of nurse coordinators
Confidentiality/intimacy issues
Perception of required tests not being
ordered
Summary
1. Many challenges to the care of patients in
large geographical areas
2. Overall high degree of patient satisfaction
with telemedicine oncology visits
3. Well patients requiring limited
interventions, palliative care patients and
patients monitored for local recurrence are
well suited for OTN
4. Reduced travel time ultimately results in
decreased costs for patients
Second Study
The Views of Health Care
Professionals on the Use of
Tele-Oncology
Preliminary Results
May 2009
Research Questions
• What are the views of health care
professionals on the use of TeleOncology?
• How can the system be improved to
support current practices and
encourage greater participation?
Research Method
• Qualitative study
• Data collected from January to April 2009
• 4 focus groups
–
–
–
–
High end users-oncologists (n=4)
High end users-primary nurses (n=4)
Low end users-primary nurses (n=2)
Low end users-supportive care health care
professionals (n=8)
Research Method cont…
• 21 Individual Interviews (face to face or via
OTN)
– Administrators (n=6)
– Nurse Coordinators-OTN site (n=8)
– Booking Clerks (n=5)
– Low end users-oncologists (n=2)
• Total participants for the study=49
Data analysis
• All interviews were tape recorded and
transcribed
• Documents imported into NVIVO (7) software
• Thematic analysis applied to code data (Boyatzis,
1998)
• Interrater reliability to reach consensus on
themes and development of framework
Preliminary Themes
Expanding the
Circle of Care
Making the Right Choices
For Patient Centered Care
A Shift in
Practice
Dealing with
the Unexpected
Resource Allocation
Tele-Oncology
Resolving the
Technical Issues
Culture
Confidentiality
And the Tele-Oncology Emmy
Goes To….
The Research Team
These studies were made
possible with the financial
support from the
Northern Cancer Research
Foundation
For further information
contact:
cmayer@hrsrh.on.ca