A1 - HTA for all: Meeting the needs of healthcare decision-makers in rural and remote communites - Tucker - Salon G

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  • 1. *
  • 2. * Pond Inlet, NU * Norman Wells, NWT* Dawson City, YK* Trinity, NL
  • 3. *Overview of:*Physical and human geography*Health facts and statistics*Clinician focused issues and challenges
  • 4. *The Land
  • 5. *The People
  • 6. *The People
  • 7. *Transportation
  • 8. *Transportation
  • 9. *The Neighbours
  • 10. *Health issues in ruraland Canada
  • 11. *050100150200250300350Trauma&poisonSuicidesCirculatoryDisRuralUrbanRef: How Healthy Are Rural Canadians? CIHI. Sept 2006
  • 12. *Ref: Rural and Remote Health 9: 1286. (Online), 2009Excess mortality especially in the young
  • 13. *Ref: CMAJ 2010. DOI:10.1503/cmaj.100948
  • 14. *Ref: CMAJ 2010. DOI:10.1503/cmaj.100948
  • 15. 020406080100120140160180Canada Inuit Nunangat Inuvialuit Region Nunavut Nunavik NunatsiavutSuiciderateper100.000pop.Inuit regions of Canada1994/19981999/20032004/2008Ref: Statistics Canada. 2012 July.Suicides in Nunangat 1994-2008
  • 16. *Predominant: mentalhealth, addictions, chronic diseases*Unique: TB, residential schoolsyndrome, smoking*Mortality:suicide, injury, poisoning, motorvehicle accidents*Health Issues
  • 17. **Differences in mortality across the urban–ruralcontinuum are mainly amongst the under 45years, and are particularly due to deaths caused byinjury and poisoning, motor vehicle accident (MVA)and suicide.*The proportion of excess deaths relative to urbanplaces for those under 45 years increases withdecreasing age.*Remote places have the highest excess in mortalityfor suicide, MV A, injury and poisoning, relative tourban places.
  • 18. **First Nations men and women live 7.4 and 5.2 years less thanthe average Canadian.*Deaths from circulatory diseases (23% of all deaths) andinjury (22% of all deaths) accounting for a near staggering50% of all deaths.*For ages 1 to 44, the most common cause of death was injuryand poisoning.*Suicide rates for Aboriginal youth range from 5-7 times higherthan the national average.Ref:1. http://www.ainc-inac.gc.ca/pr/info/fnsocec/abhl_e.html - Factsheet on Aboriginal Health.2. CMAJ, Sept 18, 2001; 165 (6).
  • 19. **The potential years of life lost frominjury alone was more than all othercauses of death and was almost 3.5 timesthat of the general Canadian population.
  • 20. **Mortality Rates: Suicide*Crude mortality rate per 100,000 populationhttp://www.statcan.gc.ca/pub/84f0209x/2009000/tablesectlist-listetableauxsect-eng.htmYukon NWT Nunavut NFLD Canada5.9 16.0 65.1 9.4 11.5*Other causes*Injury*Poisoning*Motor vehicle accidents
  • 21. *http://bchealthycommunities.ca/faq
  • 22. *Patient Populations
  • 23. **Distance, infrastructure*Health human resources*Patient population
  • 24. *Distance
  • 25. *Healthcare Infrastructure
  • 26. *Health Human Resources
  • 27. *Health Human Resources
  • 28. **Providing safe and effectivecare*Information systems*Continuity of standards*Legislation*Monitoring indicators*Evaluating care*Evidence-Informed Practices
  • 29. **Health system sustainability*Cost drivers –*New technologies*Health Human Resources*Incidence of chronic disease*Expectations re access to care
  • 30. **Health human resources*Availability*Turnover rates*Time / workload demands*Skill mix*Educational opportunities
  • 31. **Health system structure*Delivering healthcare to large anddispersed populations*Information systems*Determining basic levels of service*Location of health infrastructure*Governance
  • 32. **Health services equity*Quality of care*Lack of specialty care*‘Generalist’ role of the rural clinician
  • 33. Health Technology and Evidence ChallengesOur Story
  • 34. *Telehealth Defined:*The delivery of health-relatedservices and information viatelecommunications technologies.*Can be as simple as two healthprofessionals discussing a case overthe telephone or as sophisticated asdoing robotic surgery betweenfacilities at different ends of theglobe.
  • 35. **Telehealth – broad range of applications*Tele-psychiatry*Tele-cardiology – stroke care, rehab*Tele-dermatology*Tele-radiology*Nephrology consultations*Various other specialist services –Oncology, Ophthalmology, WoundCare, Endocrinology, etc.
  • 36. **Portable technologies*Ultrasound*Mammography*Home Hemodialysis*Implications – improvedaccess*Challenges – quality/accuracycompared to clinic/hospital-based care
  • 37. **Point-of-care testing*Defined as ‘medical testing at or near the site ofpatient care, without sending the sample to alaboratory setting’*Examples include - blood glucose testing, coagulationtesting, blood gas analysis, cardiac testing, completeblood count, and electrolytes analysis*Implications – improved access, potentially lessinvasive, reduced costs*Challenges – quality compared to lab-based testing?
  • 38. **Health Technology Management*Defining process*Opportunities for early adoption*Need for evidence contextualization*Need for whatever evidence is available*Understanding context
  • 39. **What’sworking?*What’s notworking?
  • 40. What does the Future Hold?Challenge:*Geography*Demographic tilt*Burden of illness*Socio-cultural drivers*Human resources*Governance*CostSustainability?
  • 41. Purpose of HealthcareProvide Quality Care to:*Individuals and PopulationsDefinition of Quality (IOM)*Patient Centered*Safe*Equitable*Effective*Efficient*Timely
  • 42. Problem & Solution*Problem has been identified:Delivering Care in North*The Goal has been articulatedQuality Care*The Solution?*Health information technology?Is there a Value Proposition?
  • 43. Health Information Technology:Improve the Quality Quotient?*CommunicationThe ability of Health care providers to function asdistributed teamsNetworked Health*DataThe ability to measure point of care data toestablish if quality care is being delivered
  • 44. Northern SolutionQuality Care*Patient Centered*Safe*Equitable*Effective*Efficient*TimelyCommunication= distributed teamsDataThe ability tomeasure point ofcare data toestablish if qualitycare is beingdelivered
  • 45. The Way ForwardWorking*Technology*The patientNot Working*Health CareIndustry*Teams*Data
  • 46. The Way ForwardCultural Shift*CommunicationAgree to work on common imperfectplatformform teams = circle of care for eachpatient*Embrace the fundamental value of DataBoth will drive Quality
  • 47. Discussion