Exploring Digital Readiness in Rural Community General Practice - - PowerPoint PPT Presentation

Exploring Digital Readiness in Rural Community General Practice

This project has been commissioned by WA Primary Health Alliance through funding provided by the Australian Government under the Primary Health Networks Program, and delivered in partnership with Rural Health West, Curtin University, and the Cooperative Research Centre for Spatial Information.

A global university with campuses in Asia and Western Australia Perth | Malaysia | Singapore

November 2018

Professor Suzanne Robinson Curtin University

Contents of presentation

• 1. Background
• 2. Methods
• 3. Results
• 4. Overall key findings

Background

Project background

• Health status of people

living in rural WA is poorer than those living in urban areas

• Factors contributing to

differences in health status: service types, workforce shortages, ambiguous patient pathways to care, geographical distance

What is the problem?

• Digital health technology has emerged as a viable option to reduce

system fragmentation to improve health outcomes in rural locations

What is the solution?

• Uptake of digital technology in rural general practice has been

inconsistent across WA. Reasons for observed place-based inconsistencies are unclear and there is a lack of quantifiable evidence to inform strategy and policy.

What are the issues with this solution?

→ Lower life expectancy → Higher mortality rate and disease prevalence → Lower household income → Lower educational performance and employment → Lack of access (workforce shortages, limited access to specialist services, scarcity of medical facilities)

The rural health gap

• To identify geographical differences in the barriers and enablers that

influential in enabling or discouraging the use of digital health technology in rural community general practice

Project aim

Definition of Digital Health

Digital Health Technology

Video conferencing Electronic Medical Records Online appointment platforms Mobile health apps Wearable technology

The term ‘digital health technology’ in the context of this study refers to:

‘Digital health’ broadly refers to enabling health professionals to deliver care remotely via teleconference, in addition to the use of online tools and technology to collect, coordinate or share information.

Children a are act ctive with t tech chnology

• between the ages of 11 and 16, children

post on social media 26 times a day, on average

• by the time they reach adulthood, they

are likely to have posted 70,000 times

• by the age of 13, a child's parents will

have posted on average 1,300 photos and videos of them to social media

Be Before r e rep epla lacin ing a a carer w er with a a robot, we n e nee eed t to assess t the p e pros and cons s

Helen D Dickinson a and C Catherine S Smith N Nov 2 2018

Study stages

June – July 2017

Stage 1: Desktop Review and Data Exploration

August – December 2017

Stage 2: Survey Design and Implementation

January – May 2018

Stage 3: Statistical and Spatial Analysis This is a pilot study and exploratory in nature. The three regions selected were the Wheatbelt, Goldfields and Pilbara.

• Desktop review was conducted to guide

the strategies, methodologies, survey design, and influential factors to consider when assessing digital readiness

• Based on findings from the review and

preliminary data exploration, project site selection for survey implementation was determined by project partner consensus

• Based on methodologies informed by the

desktop review and tailored for use in rural WA general practice, a survey was developed to measure digital readiness

• Survey was disseminated to general

practitioners and practice managers working in rural community general practice across the selected regions

• The most significant factors influencing the

uptake and engagement of digital health technology was determined by analysis of survey results and feedback interviews

• Subsequent spatial analysis informed the

development of an interactive visualisation mapping tool

This presentation will provide a brief overview of Stage 2 survey design and methods, with a focus on presenting Stage 3 survey results.

Methods

Survey design

BARRIERS & ENABLERS

• Findings from the Stage 1 desktop review informed survey development.
• The survey explored barriers and enablers related to five key themes:

Individual Patient Staff Infrastructure External

• The survey also explored:

Key workforce, patient and respondent demographics Access and use of digital technology Satisfaction with access & confidence using technology Beliefs about value of digital technology Intentions for future use

Survey distribution and respondents

The survey was distributed both electronically and via hard copy to General Practitioners (GPs) and Practice Managers (PMs) currently working in rural community general practice settings in the Wheatbelt, Pilbara and Goldfields regions. GPs and PMs working exclusively for Aboriginal Medical Services and non-community general practice settings (e.g., hospitals) were excluded.

Data analysis

Mixed methods were used to explore the survey results and focus interview data. Results throughout focus on a relatively high level snapshot of findings. Quantitative

• Given the small sample size and exploratory nature of the project, descriptive statistical

analysis explored data trends: Across regions (i.e., respondents combined across all regions); Within regions (i.e., comparison of respondents within each of the three regions); and, Between regions (i.e. comparison of respondents between each of the three regions). Qualitative

• Interviews were guided by semi-structured questions to specifically explore:

Key challenges faced by GPs and PMs Most important enablers to support frequent and confident use Priority issues to be addressed to increase use Interest in incentives to encourage use, financial otherwise Opportunity to provide other feedback related to access and use

• Thematic analysis was conducted to identify themes and patterns in responses.

Results

Majority of respondents have access to multiple types of digital technology, with access to most technology in the Goldfields. High access to EMR and VC across regions, but consistently low use of VC, indicating opportunities to increase engagement with VC platforms across regions. Low access to mobile apps across regions, but high use in Goldfields in Wheatbelt. Exploring enablers to using mobile apps in these regions may inform how to support and encourage increased use of mobile health tools in the Pilbara.

Access and use

92% 41% 58% 79% 12%

Electronic Medical Record Video conferencing Wearable technology Mobile apps Online appointments

Barriers

Most frequently reported infrastructure barriers were poor internet connectivity, followed by lack of practice funds, lack of practice IT support, and lack of practice equipment. Most frequently reported external barriers were related to inadequate MBS models, followed by lack of leadership and support from health agencies, lack of financial incentives to encourage digital use, and lack of support from health professionals.

Barriers

25% 17% 22% 25% 7%

External Infrastructure Individual Staff Patient

Most frequently reported patient barriers were lack of patient skills and confidence, followed by patient dislike or disinterest in using digital technology, and patient concerns about privacy and quality of care. Most frequently reported staff barriers were lack of practice staff time and skills, followed by lack of staff confidence, and lack of overall support from practice staff. Most frequently reported individual barriers were lack of GP and PM time, followed by PM concerns about staff time to support digital use, and GP and PM concerns about patient privacy and confidentiality.

Influence and advocate for improved MBS models and increased financial incentives across regions Encourage leadership across and within health agencies to promote the adoption of positive digital health behaviours and attitudes Influence and advocate for improved internet connectivity Increase opportunities for practices to receive funds to invest in required infrastructure Increase IT support to practices to support alignment and efficiencies across platforms Increase patient, GP, PM and staff knowledge, skills, confidence, like and interest in using digital technologies, platforms and tools Address patient, GP and PM concerns about privacy, confidentiality and quality of care using digital technology Promote positive staff behaviours and a supportive learning environment, such as by providing training and education to support the development and implementation of practice systems and processes to increase skills, confidence and time and resource efficiency associated with using digital tools and platforms

Key action areas

Why

Enablers

Most important staff enablers were practice staff skills and knowledge, followed by staff confidence, overall support from practice staff to use digital tools, and practice staff having time to support planning and coordination of digital technology Most important infrastructure enablers were good internet connectivity and adequate practice IT support, followed by adequate practice equipment and adequate practice funds.

Enablers

98% 77% 89% 93% 75%

External Infrastructure Individual Staff Patient

Most important individual enablers were PM satisfaction that staff have time to plan and coordinate use of digital technology, GPs and PMs having skills and knowledge to use digital technology, and GPs and PMs having time to plan and use digital technology. Most important external enablers were adequate MBS models and support from health professionals to use digital technologies, followed by support from health agencies, and financial incentives to encourage use. Most important patient enablers were patient satisfaction with quality of care and privacy and confidentiality, followed by patients liking or being interested in using digital technology, and patients having the knowledge, skills and confidence to use digital technology.

Influence and advocate for improved internet connectivity Increase IT support to practices to support alignment and efficiencies across platforms Increase opportunities for practices to receive funds to invest in required infrastructure and equipment Increase GP, PM, staff and patient knowledge, skills, confidence, like and interest in using digital technologies, platforms and tools Support the development and implementation of practice systems and processes to increase knowledge, confidence, time efficiency, and overall support to use a range of digital tools and platforms Address patient, GP and PM concerns about privacy, confidentiality and quality of care using digital technology Influence and advocate for improved MBS models and increased financial incentives Encourage leadership across and within health agencies to promote the adoption of positive digital health behaviours and attitudes

Key action areas

Priority y focu cus

• Integrated, coordinated and sustainable systems and processes
• Collective action and decision making
• Local education, training and resources
• Monitor and evaluate – promote learning and success through evidence

Conclusions

• Access to adequate infrastructure is essential for readiness – no

brainer!

• Confidence to use technology came through strongly (especially in –

interview) – so how do we support confidence development and change behaviour?

• Incentives in system are important payment and others – but we

always need to consider perverse incentives and there impact

• We need more evidence (limited research in this space) – although

growing activity funding of Digital Health Cooperative Research Centre

• The information from this study is being used to inform DH strategy

in rural and remote WA

Make tomorrow better.

Thank you for listening

High levels of self and staff confidence across regions, with low level of perceived patient confidence, particularly in the Wheatbelt. Suggests an opportunity to increase patient confidence in using digital health tools and platforms across regions. Majority of respondents satisfied with level of access, particularly in the Wheatbelt. Overall, highest levels of satisfaction with access in Wheatbelt (60%; n=28), followed by Goldfields (56%; n=14) then Pilbara (50%; n=6).

Satisfaction with access

13% 75% 57% 30% 87%

Low Moderate Staff Self High

16%

Patients

Confidence with use

Majority have an optimistic outlook towards increased use of digital technology, with three in four intending to increase the amount of digital technology used in the next 12 months. With intention rates slightly lower in the Wheatbelt, this may be one region that may benefit from targeted encouragement and support to reduce barriers and implement enablers to increase feasibility and use of digital health platforms in the near future. Majority of respondents have positive beliefs about the value of technology, particularly in the Goldfields, and that digital technology has the potential to bridge service gaps in country regions. Lower agreement in the Pilbara that digital technology has the potential to improve the quality

• f care, and lower agreement in the Wheatbelt and

Goldfields that digital technology has the potential to improve patient engagement. This provides some insight into what strategies may be most meaningful within each region to increase engagement.

Beliefs about usefulness

7% 13% 81% 12% 80%

Low Moderate Staff Neutral High

8%

Pessimistic

Intentions for future use

Spatial Mapping

Health Services

• Left view represents all GP practices

within the selected regions.

• The key above indicates the practice

types, and diversity

Survey Results

Above are the beliefs and intentions regarding digital health for the Goldfields region compared to the state average. Able to use the tool to compare the regions against the full sample in terms of the survey results at the click of a

• mouse. Can also compare subregional levels or postcode levels to the regional average in order to see if different rural

settings have impacts on the variables of digital health readiness within regions.

Survey Results

• This map represents the levels of satisfaction

with current technology use, with the more

• paque regions being the more satisfied.
• For some variables, able to visually see

differences between regions through choropleth maps, comparing variables for which a scale was used in the survey.

• Can also drill down to the subregional or

postcode level to compare within regions.