Telehealth Wheelchair Seating Consultation and Mentoring

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Telehealth Wheelchair Seating Consultation and
Mentoring

• Calgary Health Region (Rural)
• Jacquie Bryce BSc.P.T., MHS
• Betty Whitney B.S.R.
• Doug Gorin B.Sc. P.T.

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Presentation Overview

• Background/history of w/c clinics
• Telehealth project highlights milestones
• Results Key Learning within project
• Discussion of need to integrate sustainability
  planning to ensure future service

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Background/History of Clinic

• HR clinic 1st level one clinic approved in rural
  Alberta, AADL program
• Eventually became a regional service
• Most clinics (approximately 12 annually),
  occurred at HR site
• Therapists travel time limited access to service
  for other area sites
• Team felt that clients needs not met

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Client Centered Rehabilitation

• INDIVIDUAL CLIENT
• -Informed participation in goal setting and
  decision making
• -Outcome evaluation from client perspective
• -Effective communication
• -Family involvement
• -Comfort, skin, mobility, swallowing, pulmonary,
  visual field, hand function
• Colt (2001)

• SERVICE / SYSTEM LEVEL
• -Interdisciplinary approach
• -Coordination / continuity
• -Accessibility
• -System evaluation from service perspective
• -Response to client feedback
• areas where current system might be improved

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From...
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To
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Telehealth Wheelchair Seating Project Goals

• Improve access to wheelchair seating
  prescription
• Enhance learning and skill among practitioners
• Build system capacity and ability to better
  manage complex seating needs

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Description

• Videoconferencing is being used to enhance the
  availability of seating services within the rural
  area of Calgary Health Region (Didsbury, Canmore,
  Strathmore, Black Diamond, Vulcan, Claresholm,
  Okotoks, High River)
• Expertise is being shared from the High River
  site to the remote referring sites

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Project Highlights

• Infrastructure (process) developed
• Inventory of existing resources and gaps
• Hiring of temporary program assistant
• Mock Clinic Day eleven therapists and three
  technicians (vendors) trained in use of
  telehealth equipment and assessment process
• Cabling of referring rehabilitation service sites
• Purchased equipment (pressure mapping, camera,
  tripods, lighting)
• Two therapists attend AADL seating course one
  therapist to attend national conference
• Project evaluation developed with U of C
  Telehealth Faculty of Medicine

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Results and Key Learnings

• Since first telehealth clinic on April 1st,
  2004, we have assessed 30 new clients by
  telehealth
• Energy

• Synergy

• Everyone benefits

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Results and Key Learnings

• OVERALL IMPROVED EFFICIENCY
• ACCESSIBILITY
• IMPROVED CLIENT ACCESS AND THROUGHPUT (gtS, LESS
  SYSTEM REQUIREMENTS)
• TIMELY MANAGEMENT OF COMPLEX CASES (ltWAIT TIME)
• PROCESS ESTABLISHED IN REGION
• INCREASED RESOURCES (EQUIPMENT SUPPORT)

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Results and Key Learnings

• OVERALL IMPROVED SERVICE
• BETTER ENGAGEMENT AND COLLABORATION (referring
  therapists/ family/ vendors)
• IMPROVED CLINICAL EVALUATION PROCESS (experts
  able to concentrate solely on the evaluation
  therapists energized by process)
• INCREASED VOLUME OF CLIENTS MEANS DEVELOPMENT AND
  MAINTENANACE OF EXPERTISE AMONG CLINICIANS
• RURAL TO RURAL SERVICE MODEL ALLOWS FOR IMPROVED
  JOB SATISFACTION AND FLEXIBILITY IN MEETING
  UNIQUE ATTRIBUTES OF RURAL PRACTICE

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Results and Key Learnings
And of Course There Will be Surprises And
Perhaps Even a Few Dust Ups
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Results and Key Learnings

• AMBITIOUS GOAL SETTING
• PROJECTIONS TOO HIGH
• - REVISED ESTIMATE OF NUMBERS OF CLIENTS TO BE
  SERVED ORIGINAL NUMBERS TOO HIGH NOT REALISTIC
  (time line very tight for grant proposal,
  original estimate called for an increased
  capacity of threefold)

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Results and Key Learnings

• BUILD BETTER SUPPORT FOR PROJECT
• MORE CONSULTATION WITH STAKEHOLDERS
• TIGHT TIME FRAME BETWEEN CALL FOR GRANT PROPOSALS
  AND SUBMISSION MADE ADEQUATE CONSULTATION
  CHALLENGING.
• This created a few bumps along the way
• Addressed concerns raised by AADL program
  regarding scope of project and integration with
  their processes
• Concerns with human resource use at sites
  (booking, preparation for clinics, using
  referring site staff)
• Increased hours by experts

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Key Messages

• Grant has fulfilled its seed role, telehealth
  wheelchair seating clinics proven a viable option
• Sustainability of service will require ongoing
  support
• Clinical rehabilitation applications using
  telehealth significant good potential for
  further development

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Future? What happens after grant runs out?

• SUSTAINABILITY OF VIDEOCONFERENCING FOR SEATING
  NEEDS
• REPLACEMENT STAFF AT HR SITE
• ONGOING TRAINING NEEDS
• ONGOING EVALUATION OF SERVICE (DATA COLLECTION
  AND ANALYSIS)
• REFERRING SITES, SUPPORT FOR BOOKING AND CLINIC
  SET-UP

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Thank you

• Questions