The team from Nova Scotia Health Authority (NSHA) asked the audience who has had video conference appointments via a secure connection at the private location of their choice to open the session. A healthcare delivery program in Nova Scotia was rebranded to provide virtual care via secure video conference in rural communities using a web-based platform. Patients in rural communities can receive specialized services without leaving their community or even their homes. The conference is meant to complement, not replace a face-to-face visit, and it saves the patient’s time, stress and the expense of traveling. For patients in Nova Scotia, one to six hours of time is saved because travel is no longer required.
NSHA investigated gaps in service delivery. In 2017, they started a five-month pilot to bring virtual care to the home. NSHA collaborated with 10 providers to determine if Medeo was a viable solution for NSHA, and if it had the ability to improve accessibility and healthcare in Nova Scotia.
A toolkit for providers took several months to develop. Data was collected using servers, provider forms and ad hoc and scheduled check-ins. Biweekly check-ins with providers were meant to foster a shared environment to provide a way to discuss how well Medeo was working, but attendance was lower than expected.
Onboarding consisted of training (30-minute practice visit). Virtual care leads provided training to healthcare providers and a mock visit with program leaders. Patients were also given an information guide to tell them about the pilot and Medeo software. Clients were given a link to Medeo, and technical support was offered through an online form through the Medeo website.
The program had a total of 159 offered, and 57 were accepted and completed. Visits were declined for the following reasons:
· Lack of technology
· Poor Internet connection issues
· Preference for in-person appointment
· Distress with technology
Travel time was eliminated, and there was minimal setup time prior to the appointment. 94% of people who used Medeo stated that they would use it again, and 87% were satisfied overall. People who have used Medeo had positive feedback (e.g. easy to use, well managed and especially convenient for seniors).
Providers expressed positive feedback for using Medeo (good image quality, easy to use and use of Medeo when clients cannot leave their home). Two concerns expressed were a loss of control of the therapeutic environment and a different level of intimacy, including distractions that may not occur in the office setting. Conversely, the change in setting provided an insight into the home environment. Overall, the program received positive feedback from providers, and they viewed it is a change agent for the delivery of care in Nova Scotia.
The LEADS framework guided the pilot process. LEADS stands for:
· Leads self
· Engage others
· Achieve results
· Develop coalitions
· Systems Transformation
The presenters responded to the following audience questions:
· What were their demographics associated with people who refused Medeo?
· Did physicians or patients have any issues with sharing confidential information?
· Does Medeo store any patient-based information? An audience member expressed some concerns about privacy, but no information is stored beyond responses to patient screening information
· Would it be worth investing in providing Internet connections to make Medeo available to more patients? The NSHA encourages patients to share or leverage existing technology in the community
· Which industry standards supported the development of Medeo?
· Recruiting physicians to Nova Scotia is a challenge. Does having a virtual care option entice new physicians to settle in smaller communities?
SE Health is a social enterprise. They provide many different types of health care services (home and community care, long-term care, acute care and primary care). Customers include governments, regional health authorities, local health integration networks, hospitals, the seniors’ living sector, community organizations and consumers.
SE Health has been involved in alternative level of care (ALC) programs aimed at integrating patients back into the community for the past eight years. In most cases, approximately 50% of patients could return home with ALC support. SE Health led a collective case study looking for trends across hospitals. Four issues were uncovered:
1. The patient’s admission to the hospital could have been avoided with adequate home care
2. General deconditioning of hospitals
3. A routine estimation of the patient’s capacity for independence by physicians and hospital staff
4. Home care is generally not understood in hospitals
These findings have informed a number of ALC programs.
There is a worldview dissidence across healthcare. In the acute sector, there is a view that care must be immediate, medical and focused on the problem for admission. In the community sector, there is a view that the focus should be on the social context of the person and their level of independence (e.g. a patient’s ability to buy groceries). The acute sector is viewed as powerful, and the community sector is not perceived as very powerful. There is dissidence in the home and community sector, and there can be difficulties with healthcare providers working together.
Despite the challenges, there has been some encouraging progress made improving the transition from hospital to home (i.e. safety, alternative location that is not the hospital or home).
SE transitional programs include PPATH and Southlake@HOME that focus on healing in a home environment, and there are many others.
Transition programs that focused on bedded reactivation (i.e. a hospital-like facility focused on mental health, older patients, patients with dementia). Hillcrest Reactivation Centre is an example of a transition program. The target length of stay (LOS) is 60 days.
Another bedded transition program focuses on less medically complex patients who can transition home from a retirement home sooner with a shorter LOS of 15-45 days.
SE Health conducted a formal research study at Hillcrest Reactivation Centre. It was a two-phase evaluation centre examining people coming into the centre, and documenting what happens when they leave. In phase one, the profiles of patients differed from what was initially anticipated. Patients had more clinically complex issues (mental health was present in all categories). Studies have shown that patient’s conditions improved in the areas of cognitive pain and daily pain, but saw less improvement in the areas of depression. 81% of caregivers had high levels of stress, and they do not feel that the patient will be able to manage on their own. Caregivers had high needs due to high levels of stress.
In phase two, the study more critically examined what is working and what is not as well as planning and reviewing care. The SEIPS model (related to patient safety and outcomes) indicated that collaboration needs to improve within the centre.
In the other programs, SE Health is assessing needs in faster moving healthcare environments. The PPATH (post-cardiac surgery care) program is a highly effective program; this is likely due to the fact it is focused on a single issue and has consistency in care.
SE Health is continuing to learn and spread the information with healthcare providers across the country.
The presenters responded to the following audience questions:
· What are readmission rates?
· In your opinion, is there an opportunity to improve worldview dissidence in a community setting?
· How does SE Health get funding?
· Tell us about your relationship with Hillcrest. How does the project receive funding?
· How do you support caregivers, specifically caregivers exhibiting signs of burnout?
Canadians have the challenge of serving an aging demographic, and meeting the pressing demand for physicians in rural areas.