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NASH Web inar Presentation May 20, 2019 David Brulé

The use of telemedicine in homeopathy prescribing: A survey of homeopaths and naturopaths in Ontario Canada. NASH Web inar Presentation May 20, 2019 David Brulé. Overview. Origin of the idea Development of Research Questions Methods: Practical and Theoretical Tools Results to Date

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NASH Web inar Presentation May 20, 2019 David Brulé

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  1. The use of telemedicine in homeopathy prescribing: A survey of homeopaths and naturopaths in Ontario Canada NASH Webinar Presentation May 20, 2019 David Brulé NASH Webinar Presentation May 20, 2019

  2. Overview Origin of the idea Development of Research Questions Methods: Practical and Theoretical Tools Results to Date Analysis Plan Discussion Informal Survey NASH Webinar Presentation May 20, 2019

  3. Origin Story – Bedside (or Laptop) to Bench Dystopian vision? NASH Webinar Presentation May 20, 2019

  4. Telemedicine Background • Telemedicine –consultation using online video • Addresses a need1,2: • Difficult to serve populations • Access to specialty services • Patient preference/convenience • Resource savings3 1 O’Gorman LD, et al. Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network. Telemedicine Journal and e-Health. 2016;22(6):473-479. 2 Jennett PA, et al. The socio-economic impact of telehealth: A systematic review. Journal of Telemedicine and TelecareVol 9, Issue 6, pp. 311 - 320 3 Leighton C, et al. Implementation and Impact of a Maternal-Fetal Medicine Telemedicine Program. Am J Perinatol. 2018 Oct 31. [Epub ahead of print] NASH Webinar Presentation May 20, 2019

  5. Telemedicine Background Health Care System administrators want it1 Patients want it2 But do clinicians? 1 Bagot KL, et al. Exploring the benefits of a stroke telemedi-cine programme: an organisational and societal perspective. J TelemedTelecare. 2016;22:489–494 2 Kruse CS, et al. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open 2017;7:e016242. NASH Webinar Presentation May 20, 2019

  6. Telemedicine Background Kane CK, Gillis K. The Use Of Telemedicine By Physicians: Still The Exception Rather Than The Rule. Health Affairs 2018 37:12, 1923-1930 NASH Webinar Presentation May 20, 2019

  7. Homeopathy in Ontario • Regulated Health Profession • Homeopaths have a protected title (Homeopath) • Subject to guidelines of the regulatory College of Homeopaths of Ontario • 500+ registered homeopaths • Oversight by the provincial Ministry of Health and Long Term Care NASH Webinar Presentation May 20, 2019

  8. Research Questions • What is the extent of, rationale for, as well as strengths and challenges associated with, telemedicine-based consulting by homeopaths and naturopaths in active clinical practice? • More specifically, we aim to answer the following questions: • How prevalent is telemedicine in homeopathic and naturopathic practice? • What are the geographic and socio-demographic characteristics of those who engage or don’t engage in telemedicine? • What are the differences (if any) of the prevalence of telemedicine use between naturopaths and homeopaths? • What factors/conditions might contribute to the use of telemedicine in this population? NASH Webinar Presentation May 20, 2019

  9. Methods – Survey Research Conduct a survey of the homeopaths and naturopaths Census-style survey – survey entire regulated profession in Ontario Integrated telemedicine study questions into a larger ongoing, CIHR-funded study of Traditional Complementary and Alternative (TCAM) Practitioners NASH Webinar Presentation May 20, 2019

  10. Methods – Survey Optimization • Use many key elements of the Tailored Design Method1 • Social Exchange Theory • Goal: maximize response rates and elicit high quality survey data 1 Dillman, D, Smyth J, Christian L. Internet, Phone, Mail and and Mixed-Mode Surveys. The Tailored Design Method, Fourth Ed. 2014, Hoboken: John Wiley and Sons, Inc. NASH Webinar Presentation May 20, 2019

  11. Survey Screenshot NASH Webinar Presentation May 20, 2019

  12. NASH Webinar Presentation May 20, 2019

  13. Theory of Planned Behavior First posited in 19851 Adaptation to the Theory of Reasoned Action1 (1967) and self-efficacy theory2 (1977) Predict future behavior 1Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhi & J.Beckmann(Eds.), Action Control: From Cognition to Behavior (pp. 11-39). Heidelberg: Springer 2Bandura, A. (1977). "Self-efficacy: toward a unifying theory of behavioral change". Psychological Review. 84 (2): 191. NASH Webinar Presentation May 20, 2019

  14. Fig.1 – Theory of planned behavior [26, p. 182]1 1Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes.1991;50 (2): 179–211 NASH Webinar Presentation May 20, 2019

  15. Theory of Planned Behavior - Application Explain current use of telemedicine Identify domain(s) which predict use Policy implications – nudging1 1Sweitzer, S.J. et al. (2011) Psychosocial Outcomes of "Lunch is in the Bag", a Parent Program for Packing Healthful Lunches for Preschool children. J Nutr Ed Behav. 43:536-542 NASH Webinar Presentation May 20, 2019

  16. Results – Survey Statistics Survey conducted October 2018 – January 2019 Combined e-mail and letter mail contact. NASH Webinar Presentation May 20, 2019

  17. Results – Telemedicine questions Telemedicine Question 1 - In the past 6 months, have you performed a homeopathic/naturopathic consultation with a patient using face-to-face online video (e.g., Skype, FaceTime, Zoom, WhatsApp etc.)? Telemedicine Question 2 - In the past 6 months, approximately what percentage of your consultations with patients involved face-to-face online video? NASH Webinar Presentation May 20, 2019

  18. Theory of Planned Behavior Questions - Homeopathy Sample Question Survey question: I have the knowledge and skills necessary to use face-to-face video with patients. Strongly Disagree Disagree Neutral Agree Strongly agree NASH Webinar Presentation May 20, 2019

  19. Implications for Homeopathic Practice • Is telemedicine a good thing? • What are the pros and cons of increased use of telemedicine? • Pros: • Convenient for patients • Convenient for clinicians • Resource savings • Other? • Cons: • Poor quality of case taking • Difficult establishing rapport • Other? NASH Webinar Presentation May 20, 2019

  20. Identified barriers to telemedicine use • In previous research, barriers to telemedicine use have been identified and categorized: • Individual influences – patient and practitioner preferences • Technical factors – wifi speed, computer access • Organizational influences – practitioner lack of time, increased workload • Financial considerations – practitioner operational cost, billing issues • Ethical concerns – data security, privacy • Political concerns – regulatory policy, clarity of legislation • Legal influences – practitioner lack of clarity on liability, jurisdictional boundaries • Socioeconomic factors – cultural factors, rural vs urban understanding Ly BA, Labonté R, Bourgeault IL, Niang MN (2017) The individual and contextual determinants of the use of telemedicine: A descriptive study of the perceptions of Senegal's physicians and telemedicine projects managers. PLoS ONE 12(7): NASH Webinar Presentation May 20, 2019

  21. Future Analysis Plan • Perform t-test to determine difference in telemedicine use between naturopaths and homeopaths • Use regression models to explore association between telemedicine use and the following factors: • Attitude, subjective norm and perceived behavioral control within the TPB construct • Geographical location, years of practice, age, income, gender • Explore the policy implications arising from this research NASH Webinar Presentation May 20, 2019

  22. Acknowledgements Project team Heather Boon Sandy Welsh Elise Paradis Nadine Ijaz Kylin Zhang Funding Support NASH Webinar Presentation May 20, 2019

  23. Discussion and Informal Survey Discuss your experience with telemedicine consultations Discuss other pros and cons of telemedicine With your consent, perform an informal survey of telemedicine use NASH Webinar Presentation May 20, 2019

  24. Informal survey NASH Webinar Presentation May 20, 2019

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