St. Michael`s Powerpoint template - e

Report
Participant and educator
feedback informs delivery
of an interprofessional
inflammatory arthritis
education program using
telemedicine in rural
communities in Ontario
Rashmi Bhide, BSc, MHA
Telemedicine Program,
St. Michael’s Hospital
Disclosures
This study is funded by CIORA
(Canadian Initiative for Outcomes in Rheumatology Care)
St. Michael’s Hospital
• Academic health sciences
centre, fully affiliated with
the University of Toronto
• Home to the Li Ka Shing
Knowledge Institute
Martin Family Centre
for Arthritis Care and Research
• Multidisciplinary comprehensive care for patients with
arthritis
• Serving over 28 000 patients/year
• Positions the hospital is a leader in arthritis education at
the University of Toronto
• Ongoing research in arthritis outcomes and education
effectiveness
The Martin Family Centre
An Interprofessional Approach
• Rheumatologists
• Nurses
• Dietitians
• Occupational therapists
• Physiotherapists
• Pharmacists
• Chaplains
Inflammatory Arthritis
• Painful inflammation
• Joint destruction
• Joint replacement
Management of Inflammatory Arthritis
Assessment
& Diagnosis
Medication
Exercise
and...
Patient Self Management
Prescription for Education (RxEd)
• One day education session delivered
by interprofessional team
• Program format
– Didactic, panel & small group discussions,
case studies
– Integrated self-management strategies
• Wait-listed controlled study showed RxEd
improved health-related outcomes (Kennedy, J Rheum 2011)
–
–
–
–
Arthritis self-efficacy
Arthritis knowledge
Coping efficacy
Illness intrusiveness (daily impact)
Even with RxEd, a problem remains…

Thunder Bay


Sault Ste. Sudbury
Marie
 Toronto
Orangeville 
The Solution…
Increasing access to arthritis
education in rural Ontario
communities using telemedicine.
Study Objectives
To evaluate the feasibility of using telemedicine
(TM) to deliver RxEd.
a) To explore the process of delivering an
interprofessional program via TM.
b) To explore participants’ perceptions of the
RxEd program delivered using TM technology.
1. Planning
Consult with RxEd educators to:
a) Review the current format/content
b) Determine educators’ learning needs
Meeting Educators’ Learning Needs:
Videoconferencing 101 for Patient Educators
Format:
• One hour multi-point videoconference
• Delivered by St. Michael’s Patient Education Specialist &
Telemedicine Team
• Held several weeks prior to RxEd
Participants:
• Local St. Michael’s RxEd Educators
• Co-facilitators at participating rural sites
Videoconferencing 101 Learning Objectives
Participants should be able to:
1) Identify important factors in facilitating effective patient
education.
2) Modify slides and oral presentations for a patient
education session delivered via videoconferencing.
3) Outline strategies to optimize interactivity during
videoconferencing.
Videoconferencing 101 Content
Adult Learning
Principles
Patient
Education
Principles
Videoconferencing
Best Practices
Strategies to
Enhance
Interactivity
2. Implementation
RxEd Telemedicine Workshop
October 19, 2012
Participating Communities
Site
In-person site:
St. Michael’s Hospital
# of attendees
12
Telemedicine sites:
Thunder Bay
9
Sault Ste. Marie
10
Sudbury
10
Headwaters (Orangeville)
8
Total:
49
I could hear the presenter clearly*
3
Headwaters
2
2
Sudbury
0
7
0
Strongly agree
4
Sault Ste Marie
2
Agree
1
Disagree
Strongly disagree
5
Thunder Bay
4
14
Overall
0%
10%
20%
0
15
30%
40%
50%
60%
70%
1
80%
90%
100%
*Telemedicine
sites only
I could hear the discussion between
participants at different sites clearly*
2
Headwaters
1
Sudbury
3
4
0
3
1
Strongly agree
2
Sault Ste Marie
2
3
0
Agree
Disagree
Strongly disagree
Thunder Bay
2
Overall
7
0%
10%
6
1 0
15
20%
30%
40%
50%
7
60%
70%
80%
1
90%
100%
I could see who was speaking
at the remote sites*
3
Headwaters
1
Sudbury
1
4
0
3
1
Strongly agree
2
Sault Ste Marie
4
1
0
Agree
Disagree
Strongly disagree
4
Thunder Bay
5
10
Overall
0%
10%
20%
0
14
30%
40%
50%
60%
4
70%
80%
90%
1
100%
Interaction between sites was
adequately facilitated*
3
Headwaters
2
1
Sudbury
6
0
2
Strongly agree
5
Sault Ste Marie
1
Agree
1
Disagree
Strongly disagree
5
Thunder Bay
4
14
Overall
0%
10%
20%
0
13
30%
40%
50%
60%
70%
3
80%
90%
100%
The information presented was clear
(including presenters’ speed, volume & language)
3
Headwaters
1
1
Sudbury
8
2
Sault Ste Marie
5
Strongly agree
Agree
4
Thunder Bay
Disagree
5
Strongly disagree
10
St. Michaels
2
20
Overall
0%
10%
20%
21
30%
40%
50%
60%
70%
80%
90%
100%
 All
sites
I understood the slides and I found them helpful
3
Headwaters
2
3
Sudbury
6
4
Sault Ste Marie
3
Strongly agree
Agree
5
Thunder Bay
7
St. Michaels
0%
10%
20%
30%
Strongly disagree
5
22
Overall
Disagree
4
20
40%
50%
60%
70%
80%
90%
100%
Overall, today’s session met my expectations
2
Headwaters
3
3
Sudbury
6
6
Sault Ste Marie
1
Strongly agree
Agree
5
Thunder Bay
8
St. Michaels
0%
10%
20%
30%
Strongly disagree
4
24
Overall
Disagree
4
18
40%
50%
60%
70%
80%
90%
100%
I would recommend this program to other people
with inflammatory conditions
2
Headwaters
3
5
Sudbury
4
7
Sault Ste Marie
1
Strongly agree
Agree
6
Thunder Bay
Disagree
3
Strongly disagree
10
St. Michaels
1
30
Overall
0%
10%
20%
30%
40%
12
50%
60%
70%
80%
90%
100%
Post-Workshop Feedback
(Educators & Co-facilitators)
Quality of videoconference:
“Easy to use, it helped to have the telemedicine
learning session prior to the education day. The tips
that were provided were helpful and allowed for more
comfort with the technology and hopefully a more
successful day for the participants.”
Post-Workshop Feedback
(Educators & Co-facilitators)
Quality of education via videoconferencing:
“[Only one] presenter flipped back and forth between
themself and the slides. We watched the slides for the
duration of each presentation. This makes for a boring
presentation…”
“The camera was pointed a the side of their head...it
didn’t feel like they were speaking to us.”
Post-Workshop Feedback
(Educators & Co-facilitators)
Small group learning and activities:
“It was easy to interact with the other sites.”
“I was impressed with the level of interaction and how
smoothly the videoconference seemed to function”
Post-Workshop Feedback
(Educators & Co-facilitators)
Additional comments and suggestions:
• More interactivity throughout the workshop
• Slide modifications for better visibility on screen
– Large, clear diagrams
– Less text
Conclusions
• It is feasible to deliver the one day RxEd
workshop via telemedicine.
• There is value in offering the RxEd workshop to
remote sites.
• The Videoconferencing 101 Patient Education
workshop accomplished its overall objectives.
• Data and feedback will be used to make
improvements for future RxEd sessions.
The Future
Evaluating the effectiveness of TM delivery of RxEd:
1) Explore remote participants’ perceptions of the program
(telephone interviews)
2) Compare health-related outcomes in remote vs. local
participants
–
–
–
–
Arthritis self-efficacy
Arthritis knowledge
Coping efficacy
Illness intrusiveness
Acknowledgements
Co-authors:
•
•
•
•
•
•
•
•
•
Carol Flewelling, BSc, MEd
Carol Kennedy, BScPT, MSc
Kelly Warmington, MEd, PMP
Rachel Shupak, MD
Angelo Papachristos, BScPT
Caroline Jones, BScPT
Mark Kinach, BA
Denise Linton, HBSc
Dorcas Beaton, BScOT, MSc, PhD
Collaborators:
•
•
Educators and co-facilitators
The Arthritis Society

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