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Using telehealth for diabetic retinopathy screening among the First Nations of Quebec

Using telehealth for diabetic retinopathy screening among the First Nations of Quebec. 2013 E-health Forum May 27, 2013. Faculty / presenter disclosure. Speakers: Louise Tanguay & Emilie Grantham, FNQLHSSC Nothing to disclose. Objectives of the project.

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Using telehealth for diabetic retinopathy screening among the First Nations of Quebec

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  1. Using telehealth for diabetic retinopathy screening among the First Nations of Quebec 2013 E-health Forum May 27, 2013

  2. Faculty / presenter disclosure • Speakers: Louise Tanguay & Emilie Grantham, FNQLHSSC • Nothing to disclose

  3. Objectives of the project • General objective: Providing access to remote diabetic retinopathy screening for First Nations living in the communities • Specific objectives: • Developing First Nations competencies • Creating/consolidating linkages with the provincial health network • Creating collaborative linkages between the communities • Integrating the service into the existing diabetes program • Recommended approach: community development and regional accessibility

  4. Project background • Began in 2008 • Partners • First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC) • Health Canada • RéseauUniversitaireIntégré de Santé McGill (RUIS McGill) • Algonquin Nation Programs and Services Secretariat (ANPSS) • Pilot communities • Funding: Canada Health Infoway and Health Canada

  5. Features of the project • Sharing of the same camera • Creation of service corridors with the provincial network • Training with certification for the community nursing staff • Training of the First Nations photography technicians • Implementation of screening clinics in the communities

  6. Service model

  7. Main findings related to the pilot project’s evaluation

  8. Objectives of the evaluation • Identifying the conditions for the emergence of the project • Evaluating the implementation and application of the pilot project and identifying the facilitating and hindering factors • Evaluating the short-term effects of the pilot project • Documenting the conditions established in order to ensure the adoption, dissemination and sustainability of the project • Performing an economic analysis for the project

  9. Methodology • Methods used for data collection: • Documentary analysis • Non-participant observation • Administrative and clinical data • Interviews and focus groups • Satisfaction questionnaires among the users • First Nations Research Protocol (AFNQL, 2005) • OCAP Principles (ownership, control, access and possession)

  10. Implementation of the new service

  11. Number of participants and screenings *In 2011, one of the communities did not perform screenings. Over the course of the pilot project, nearly one out of every four screenings led to an ophthalmology referral The long-term trajectory of the patients with ophthalmology referrals raises questions

  12. Facilitating and hindering factors

  13. Effects of the new service

  14. Main short-term effects observed • ↑ knowledge and a better understanding of the diabetes complications among the workers • ↑ local autonomy • Creation of linkages between the health centres and the various health players • More complete approach among the patients: health prevention and promotion • ↓ travelling • Earlier screening • Regular and more frequent follow-up among the patients • User satisfaction

  15. Anticipated medium- and long-term effects •  treatment complexity •  costs and disadvantages associated with blindness •  costs and disadvantages related to wait times • Decongestion of the public health system

  16. Economic analysis •  costs related to the new trajectory of the patients • Amounts saved: •  travel expenses •  ophthalmology consultations for patients not requiring treatment

  17. Conclusion

  18. Conclusion • 6 major stakes of the project: • Participation of the diabetic population • Organisation of the services • Partnerships • Technological stakes • Project management and follow-up mechanism • Sustainability of the project • To date, 10 communities are providing the service • The service will be implemented in 10 other communities over the course of the upcoming months

  19. Recommendations • Promotion of the service • Awareness and ↑ knowledge among the patients • Clear definition of the roles of the partners • Defining the long-term trajectory of the patients with ophthalmology referrals • Adequate training for the workers and knowledge refreshers • Adequate computer resources in the communities • First Nations capacity-building and self-determination development • Financial resources for the communities

  20. Thank you! Questions? Louise Tanguay ltanguay@cssspnql.com Emilie Grantham egrantham@cssspnql.com

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