“Our lives have been completely changed by the services we now receive over the network. Having telehealth care and also having secondary education services available in our communities is making us stronger as a people.”
- Geordi Kakepetum, Executive Director
The Keewaytinook Okimakanak Telehealth/NORTH Network Expansion Project began with 5 First Nations communities and has since expanded to 22 First Nations communities located in the Sioux Lookout Health Zone. Geographically isolated and culturally distinct communities such as these have lower access rates to health services and lower health status relative to the rest of Ontario. The Expansion Project used telecommunications technology compared to travel to span geographic distance. This evaluation represented a comprehensive effort to measure short-term changes in access and sets the stage to measure the potential long-term health effects.
Access: KOTH usage varied from 66 to 224 telehealth sessions/month (average=122/month). First Nations communities averaged 12 sessions/month. Clinical consultations comprised 42% of the 2926 sessions, followed by training (19%), education (17%), meetings (13%) and demonstrations/tests/family visits (8%). The number of medical specialties, educational events and health programs offered via telehealth also increased. The stories and the statistics suggest that telehealth has "virtually" decreased the geographic distances that have, in the past, restricted access to health information and health services.
Acceptability: Over 90% of the 73 patients said that they found the telehealth session helpful, 96% would repeat the same appointment by telehealth and 89% would recommend telehealth to another person. These sentiments were echoed by many health providers. A frequent qualification was that flying patients or providers in and out of a community was still needed as a viable, workable option, should it be required by the situation.
Integration: Many stakeholders recognized the potential and need for telehealth to integrate the programs and the people involved in health education, prevention, early diagnosis, treatment and follow-up (e.g., diabetes). The benefits of improved continuity of care and greater family involvement were also emphasized.
Quality: Many physicians felt comfortable with using telehealth for most follow-up and also for initial consultations provided that face-to-face was available should it be required by the situation. Many stakeholders concluded independently that the role of locally recruited, fulltime Community Telehealth Coordinators (CTCs) was of paramount importance to telehealth success and had implications not only for quality of service, but for access, acceptability and integration. Stakeholders advocated for ongoing efforts to educate and retain qualified personnel.
Financial Impact: The Pilot Project provided proof of concept as the telehealth service was rolled-out to 22 First Nations communities and provided cost and utilization data that were used to model a fully operational and sustainable telehealth program. Different estimates and monetary values were assigned to telehealth sessions that averted travel versus those that were in addition to travel ("new" telehealth). Costs for the Sustainable Program were estimated at $2.81M/year. Estimated savings were $4.16M/year for averted travel and $6.09M/year if “new” telehealth was assigned a dollar value. Estimates were based on 1346 averted trips for 4810 telehealth sessions/year. The breakeven point occurred when there were 915 averted trips for 3271 telehealth sessions/year.
Conclusions: The preliminary findings of the evaluation suggest that the KOTH/NORTH Network Expansion Project has increased utilization. The Sustainable Program has the ability to become a financial success in the near future. Feedback from stakeholders in the communities and in support centres testified to emerging benefits and significant potential for the future.