SFT 15. Outline. Introduction. Introduction. Introduction

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1 Outline Development of a planning framework for telemedicine health services based on need assessment in small rural communities Sharifah Al Dossary Dr Melinda Martin Khan Dr Natalie Bradford Associate Professor Anthony Smith Introduction Framework aim The Framework Need assessment Access Need Developed Framework Discussion Introduction Introduction Telemedicine the use of information technology (IT) to deliver medical services over distances (2) Telemedicine benefits in rural and remote areas Slow uptake of telemedicine (3,4) 1 Smith AC, Gray LC. Telemedicine across the ages. Med J Aust. 2009;190(1): Tanriverdi, H., & Iacono, C. S. (1999). Diffusion of telemedicine: A knowledge barrier perspective. Telemedicine Journal: The Official Journal of the American Telemedicine Association, 5(3), Broens, T. H. F., Huis in t Veld, R. M. H. A., Vollenbroek Hutten, M. M. R., Hermens, H. J., van Halteren, A. T., & Nieuwenhuis, L. J. M. (2007). Determinants of successful telemedicine implementations: a literature study. Journal of Telemedicine and Telecare, 13(6), Van Dyk, L. (2014). A review of telehealth service implementation frameworks. International Journal of Environmental Research and Public Health, 11(2), Seven steps of telehealth planning for program success (5) 1. Evaluate needs 2. Develop a care services plan 3. Develop a business plan 4. Plan technology 5. Train personnel 6. Test care and technology plans 7. Evaluate outcomes 5 Burgiss, S. (2006). Telehealth technical assistance manual. National Rural Health Association. Introduction Telemedicine should be driven by needs. Each community has its own unique requirements (6). Health Needs Assessment: An evidence based method of planning for health services (7,8). 6 Coiera, E. (1995). Recent advances: medical informatics. BMJ, 310(6991), Stevens, A., & Stephen, G. (1998). Needs assessment: from theory to practice. BMJ, 316(7142), Wright, J., & Williams. R. (1998). Development and importance of health needs assessment. BMJ, 316(7140),

2 What is Health Service Planning? Little evidence is available about planning prior to the implementation of telemedicine services (9). Health service planning that appraises the overall health needs of a geographic area or population and determined how these needs can be met in the most effective manner through the allocation of existing and anticipated future resources (9) 9 Thomas, R. K. (2003). Health services planning. New York: Kluwer Academic / Plenum Publishers. 9 AlDossary, S., M. Martin Khan, N. Bradford, and A. Smith. (2015). A systematic review of telemedicine services initiatives in hospitals facilities incorporating evaluation strategies. Manuscript submitted for publication. The Framework Aim: To assess the needed health services in a community prior to the implementation of telemedicine services This planning framework is based on: The key processes in need assessment. Penchansky and Thomas s (1981) dimensions of access. Bradshaw s (1972) types of need. Key processes in needs assessment: Need Bradshaw (1972) Economist view ( ) The essential steps for conducting a needs assessment are: Consultation with Data collection ( and qualitative). Priority setting, analysing the health problems and providing possible solutions (10). Access Andersen & Aday (1974) (1992) Doyal and Gough Julio Frank (1985) Andersen & Aday (1995) 10 Eagar K, Garrett P, Lin V. Health planning: Australian perspectives. Crows Nest, N.S.W: Allen & Unwin; (1981) Penchansky and Thomas (1992) Julio Frank 2

3 Needs: Bradshaw (1972) considered four different perspectives on need (11). Describes what people say they want. People s use of services, determined by utilisation of services. The expert s evidence based opinion on what is needed. Comparative need Is derived from comparing services that are provided in different locations. Access: Penchansky and Thomas discusses access as a general concept that contains a set of dimensions (12). Illustrating the fit between the healthcare system and patients. Availability Volume and type of existing services. Users volume and types of needs. Location of supply and the location of the users. Accommodation Users travel time, distance, transportation resources and cost. The manner in which the supply resources are organised Users ability to adjust to these factors. The users perception of value in relation to its cost. Acceptability Users perceptions on the practice and personal characteristics of the providers. 11 Bradshaw, J. (1972). The taxonomy of social need. In McLachlan, G. (Ed.), Problems and Progress in Medical Care, Oxford: Oxford University Press. 12 Penchansky, R., & Thomas, J. W. (1981). The concept of access: definition and relationship to consumer satisfaction. Medical Care, 19(2), Access Availability Framework variables Needs Accommodation Cost of travel qualitative and Acceptability Comparative need Phase 2 Determine strategic issues and priorities Review the evidence on the priority issues Provide telemedicine as a solution was chosen for pragmatic reasons. Relationships with this town s Hospital Clinicians Patients To Brisbane km 2 h 38 min 3

4 : Assessment of needs Part one : : : Objective measure Quantitative Available specialist health services Services that patients needed and had to travel outside of their area/town to receive. : Assessment of needs Part one : : Data collection : The source of : Routinely collected Hospitals or the ministry of health bases. Inpatient ICD 10 Outpatient Referral (13) 13 Thomas RK. Health services planning: Kluwer Academic Plenum Publishers; Part one : : : De identified referral Patients who reside in Queensland public hospitals Requested from: Health Statistics Unit Queensland Health Princess Alexandra Hospital (PAH) Part one : : Referred to Year Total Hospital Referred to Year Total Toowoomba Hospital Princess Alexandra Hospital Royal Children s Hospital The Prince Charles Hospital Major Cities Outer Regional Inner Regional Remote and Very remote Total

5 Part one : : : Assessment of needs Part two: and cost of travel Spatial accessibility is based on: Travel distance Travel time The spatial distribution of both consumers and health service providers (14). Geographic information systems (GIS): Is a tool that helps examine the healthcare needs of small geographical areas (15). : Assessment of needs Part two: and cost of travel GIS Modeling: A number of input sets are required to support this application to cover the following parameters: Population Road network Health facility locations and their capabilities 14 Apparicio, P., Abdelmajid, M., Riva, M., & Shearmur, R. (2008). Comparing alternative approaches to measuring the geographical accessibility of urban health services: Distance types and aggregationerror issues. International Journal of Health Geographics, 7, McLafferty, S. L. (2003). GIS and health care. Annual Review of Public Health, 24, Part two: and cost of travel Part two: and cost of travel Population : from the population projections of the Australian Bureau of Statistics (ABS). The road network for Queensland: The Queensland Spatial Portal of the Queensland Government. The health facility : Queensland Health. 5

6 Part two: and cost of travel Cost of travel: Cost will be calculated using the output from: The accessibility study (distance and time for traveling) The availability study (frequency of travel and destination of travel) qualitative and Reimbursement information from the: Patient Travel Subsidy Scheme : Assessment of needs Part three: and This part of the framework can be divided into two sections: 1) Clinicians perception. 2) Population perception and affordability. Data collection : Qualitative & Interviews focus groups Survey Part three: and Clinicians from Hospital Semi structured interview 9 interviews out of 12 Nurses GPs Anaesthetics Non Consenting 0 1(10%) 0 Consenting 6 (60%) 2 (20%) 1 (10%) Years of Clinical Experience SD; Range (12.5 SD; Rang 5.5yrs 20yrs( ) 17.5yrs 5 30) Duration in 12yrs (8.4 SD; Range 1 23) 7yrs (5.7 SD; Rang1.5 13) 2.5yrs Born in 1 (11%) 0 0 Male 0 1 (11%) 1 (11%) Female 6 (66%) 1 (11%) 0 Part three: and A representative sample from population Questionnaire Pilot (n=29) GP private clinic waiting room qualitative and 22 7 Phase 2 Determine strategic issues and priorities 6

7 Phase 2 : Priority setting 1) Determine strategic issues and priorities: Needs will manifest after the process of analysis and consultations, and these issues should be priorities. Based on Frequency Ranking from the community Using economic analysis Consulting with knowledgeable groups (16). Determine strategic issues and priorities qualitative and Phase 2 Review the evidence on the priority issues 16 Eagar K, Garrett P, Lin V. Health planning: Australian perspectives. Crows Nest, N.S.W: Allen & Unwin; 2001 Phase 2 : Priority setting 2) Review the evidence on the priority issues and balance needs against supply Identify if telemedicine is a suitable solution to the defined issue. Balance the needs against the known limitations of supply (17). qualitative and Phase 2 Determine strategic issues and priorities Review the evidence on the priority issues 17 Eagar K, Garrett P, Lin V. Health planning: Australian perspectives. Crows Nest, N.S.W: Allen & Unwin; 2001 Provide telemedicine as a solution Phase 2 : Priority setting Discussion Provide telemedicine as a solution : Provide a tailored telemedicine service to the studied community based on need assessment. Continue collection Assess the planning framework A) Establish an expert panel B) Framework review C) Evaluation 7

8 Conclusion Thank you 8