Rashmi Bhide , BSc , MHA Telemedicine Program, St. Michael’s Hospital

1. Participant and educator feedback informs delivery of an interprofessional inflammatory arthritis education program using telemedicine in rural communities in Ontario RashmiBhide, BSc, MHA Telemedicine Program, St. Michael’s Hospital

2. Disclosures This study is funded by CIORA (Canadian Initiative for Outcomes in Rheumatology Care)

3. St. Michael’s Hospital Academic health sciences centre, fully affiliated with the University of Toronto Home to the Li Ka Shing Knowledge Institute

4. Martin Family Centre for Arthritis Care and Research Multidisciplinary comprehensive care for patients with arthritis Serving over 28 000 patients/year Positions the hospital is a leader in arthritis education at the University of Toronto Ongoing research in arthritis outcomes and education effectiveness

5. The Martin Family CentreAn Interprofessional Approach Rheumatologists Nurses Dietitians Occupational therapists Physiotherapists Pharmacists Chaplains

6. Inflammatory Arthritis • Painful inflammation • Joint destruction • Joint replacement

7. Management of Inflammatory Arthritis and...

8. Patient Self Management

9. Prescription for Education (RxEd) • One day education session delivered by interprofessional team • Program format • Didactic, panel & small group discussions, case studies • Integrated self-management strategies • Wait-listed controlled study showed RxEd improved health-related outcomes (Kennedy, J Rheum 2011) • Arthritis self-efficacy • Arthritis knowledge • Coping efficacy • Illness intrusiveness (daily impact)

10. Even with RxEd, a problem remains…  Thunder Bay  Sault Ste. Marie  Sudbury Toronto   Orangeville

11. The Solution… Increasing access to arthritis education in rural Ontario communities using telemedicine.

12. Study Objectives To evaluate the feasibility of using telemedicine (TM) to deliver RxEd. To explore the process of delivering an interprofessional program via TM. To explore participants’ perceptions of the RxEd program delivered using TM technology.

13. 1. Planning Consult with RxEd educators to: Review the current format/content Determine educators’ learning needs

14. Meeting Educators’ Learning Needs: Videoconferencing 101 for Patient Educators Format: One hour multi-point videoconference Delivered by St. Michael’s Patient Education Specialist & Telemedicine Team Held several weeks prior to RxEd Participants: Local St. Michael’s RxEd Educators Co-facilitators at participating rural sites

15. Videoconferencing 101 Learning Objectives • Participants should be able to: • Identify important factors in facilitating effective patient education. • Modify slides and oral presentations for a patient education session delivered via videoconferencing. • Outline strategies to optimize interactivity during videoconferencing.

16. Videoconferencing 101 Content

17. 2. Implementation RxEd Telemedicine Workshop October 19, 2012

18. Participating Communities

19. I could hear the presenter clearly* *Telemedicine sites only

20. I could hear the discussion between participants at different sites clearly*

21. I could see who was speaking at the remote sites*

22. Interaction between sites was adequately facilitated*

23. The information presented was clear (including presenters’ speed, volume & language)  All sites

24. I understood the slides and I found them helpful

25. Overall, today’s session met my expectations

26. I would recommend this program to other people with inflammatory conditions

27. Post-Workshop Feedback(Educators & Co-facilitators) Quality of videoconference: “Easy to use, it helped to have the telemedicine learning session prior to the education day. The tips that were provided were helpful and allowed for more comfort with the technology and hopefully a more successful day for the participants.”

28. Quality of education via videoconferencing: “[Only one] presenter flipped back and forth between themself and the slides. We watched the slides for the duration of each presentation. This makes for a boring presentation…” “The camera was pointed a the side of their head...it didn’t feel like they were speaking to us.” Post-Workshop Feedback(Educators & Co-facilitators)

29. Small group learning and activities: “It was easy to interact with the other sites.” “I was impressed with the level of interaction and how smoothly the videoconference seemed to function” Post-Workshop Feedback(Educators & Co-facilitators)

30. Additional comments and suggestions: More interactivity throughout the workshop Slide modifications for better visibility on screen Large, clear diagrams Less text Post-Workshop Feedback(Educators & Co-facilitators)

31. Conclusions • It is feasible to deliver the one day RxEd workshop via telemedicine. • There is value in offering the RxEd workshop to remote sites. • The Videoconferencing 101 Patient Education workshop accomplished its overall objectives. • Data and feedback will be used to make improvements for future RxEd sessions.

32. The Future Evaluating the effectiveness of TM delivery of RxEd: Explore remote participants’ perceptions of the program (telephone interviews) Compare health-related outcomes in remote vs. local participants Arthritis self-efficacy Arthritis knowledge Coping efficacy Illness intrusiveness

33. Acknowledgements Co-authors: Carol Flewelling, BSc, MEd Carol Kennedy, BScPT, MSc Kelly Warmington, MEd, PMP Rachel Shupak, MD Angelo Papachristos, BScPT Caroline Jones, BScPT Mark Kinach, BA Denise Linton, HBSc Dorcas Beaton, BScOT, MSc, PhD Collaborators: Educators and co-facilitators The Arthritis Society