Exploring Digital Readiness in Rural Community General Practice Professor Suzanne Robinson Curtin University November 2018 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
Contents of presentation 1. Background 2. Methods 3. Results 4. Overall key findings
Background
Project background What is the problem? What is the solution? Digital health technology has emerged as a viable option to reduce • system fragmentation to improve health outcomes in rural locations Health status of people • What are the issues with this solution? living in rural WA is The rural poorer than those living health gap in urban areas Uptake of digital technology in rural general practice has been • inconsistent across WA. Reasons for observed place-based → Lower life expectancy Factors contributing to • inconsistencies are unclear and there is a lack of quantifiable → Higher mortality rate and disease differences in health evidence to inform strategy and policy. status: service types, prevalence workforce shortages, → Lower household income ambiguous patient Project aim → Lower educational performance pathways to care, and employment geographical distance To identify geographical differences in the barriers and enablers that • → Lack of access (workforce influential in enabling or discouraging the use of digital health shortages, limited access to technology in rural community general practice specialist services, scarcity of medical facilities)
Definition of Digital Health ‘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. The term ‘digital health technology’ in the context of this study refers to: Video conferencing Electronic Wearable Medical Digital technology Records Health Technology Mobile Online health appointment apps platforms
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 Stage 1: Desktop Review and Data Stage 2: Survey Design and Stage 3: Statistical and Spatial Exploration Implementation Analysis June – July 2017 August – December 2017 January – May 2018 • The most significant factors influencing the • Desktop review was conducted to guide • Based on methodologies informed by the uptake and engagement of digital health the strategies, methodologies, survey desktop review and tailored for use in rural technology was determined by analysis of design, and influential factors to consider WA general practice, a survey was survey results and feedback interviews when assessing digital readiness developed to measure digital readiness • Subsequent spatial analysis informed the • Based on findings from the review and • Survey was disseminated to general development of an interactive visualisation preliminary data exploration, project site practitioners and practice managers mapping tool selection for survey implementation was working in rural community general determined by project partner consensus practice across the selected regions This is a pilot study and exploratory in nature. The three regions selected were the Wheatbelt, Goldfields and Pilbara. 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 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 BARRIERS External & ENABLERS 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
Access and use 41% 79% 92% 58% 12% Wearable Electronic Mobile Online Video technology Medical apps appointments conferencing Record 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.
Barriers
Barriers External Most frequently reported external barriers were related to inadequate MBS models, followed by lack of 25% leadership and support from health agencies, lack of financial incentives to encourage digital use, and lack of support from health professionals. Infrastructure 25% 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. Patient Most frequently reported patient barriers were lack of patient skills and confidence, followed by patient 22% dislike or disinterest in using digital technology, and patient concerns about privacy and quality of care. Staff 17% 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. Individual Most frequently reported individual barriers were lack of GP and PM time, followed by PM concerns about 7% staff time to support digital use, and GP and PM concerns about patient privacy and confidentiality.
Key action areas 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
Enablers Why
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