P-9: Removing barriers to accessing primary care: Implementation of videoconferencing for persons with spinal cord injuries
Dr. Matthew Smith
Dr. James Milligan,
Dr. Matthew Smith,
Dr. Craig Bauman
Centre for Family Medicine
Research and Clinical Trials
Topic: Health Technology Assessment
Angle: Implementation Study – Preliminary Findings
Individuals with spinal cord injury (SCI) face many challenges in accessing primary care. Obtaining physically accessible, knowledgeable, convenient (geographically accessible and timely) care can be some challenges. The Centre for Family Medicine Family Health Team (CFFM FHT) Mobility Clinic was established in 2010 to provide barrier-free, comprehensive primary care for persons with spinal cord injuries. Personal Computer Video Conferencing (PCVC) is promising and has the potential to overcome many barriers but has the disadvantage of not being able to provide an in-person assessment. This study, examined the feasibility of personal computer video conferencing (PCVC) in a complex patient population. This three-year study aimed to recruit 25 patients with one general assessment appointment per year. To date, 32 patients have been recruited for appointments using PCVC and have had 51 PCVC encounters with the Mobility Clinic team.
Patients of the Mobility Clinic with a SCI are consented to participate in the PCVC study. Upon consent, an e-mail from the Ontario Telehealth Network (OTN) is sent with instructions on downloading the Vidyo program necessary to complete to PCVC. A research assistant follows up with the patient to ensure the program was downloaded and to troubleshoot any issues. An e-mail from OTN is then sent on the day of the PCVC appointment, and a research assistant calls the patient prior to the PCVC to provide a six-digit PIN required for the consultation. The patient and the Mobility Clinic team are invited to complete a survey on their experience using the technology following the consultation.
The study is currently in year two and several themes have emerged in the implementation of this technology. Initial appointments using the technology were challenging, both for staff and patients. Challenges included troubleshooting internet browser issues, connecting with patients prior to the appointment to ensure software was installed as well as technical issues that arose during the video appointment such as audio or internet connections. While the initial appointment was cumbersome, subsequent appointments had less technical issues and its benefit to patients far outweighed minor technical issues.
Patients have reacted to the new service with 75% of consultations resulting in a “very satisfied” response to the service, and have favourably said, “It reduces travel, makes travel to in person consultation irrelevant to solving issues often (but not necessarily always.)” and “Not having to leave my house was amazing and very convenient. I liked that I was able to speak with so many people at once.
PCVC can be an effective means to communicate with individuals with spinal cord injury and overcome important barriers to receiving medical care (travel, accessible office).