Wayne Warry

Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network.

Abstract Introduction: Northern Ontario is a region in Canada with approximately 775,000 people in communities scattered across 803,000 km2. The Ontario Telemedicine Network (OTN) facilitates access to medical care in areas that are often underserved. We assessed how OTN utilization differed throughout the province. Materials and Methods: We used OTN medical service utilization data collected through the Ontario Health Insurance Plan and provided by the Ministry of Health and Long Term Care. Using census subdivisions grouped by Northern and Southern Ontario as well as urban and rural areas, we calculated utilization rates per fiscal year and total from 2008/2009 to 2013/2014. We also used billing codes to calculate utilization by therapeutic area of care. Results: There were 652,337 OTN patient visits in Ontario from 2008/2009 to 2013/2014. Median annual utilization rates per 1,000 people were higher in northern areas (rural, 52.0; urban, 32.1) than in southern areas (rural, 6.1; urban, 3.1). The majority of usage in Ontario was in mental health and addictions (61.8%). Utilization in other areas of care such as surgery, oncology, and internal medicine was highest in the rural north, whereas primary care use was highest in the urban south. Conclusions: Utilization was higher and therapeutic areas of care were more diverse in rural Northern Ontario than in other parts of the province. Utilization was also higher in urban Northern Ontario than in Southern Ontario. This suggests that telemedicine is being used to improve access to medical care services, especially in sparsely populated regions of the province.

Cross-cultural simulation to advance student inquiry

This article reviews how and why the authors have used the cross-cultural simulation BAFA BAFA in a 1styear social sciences inquiry course on social identity. The article discusses modifications made to Shirts’s original script for BAFA BAFA, how the authors conduct the postsimulation debriefing, key aspects of the student-written reflection of the simulation, and research results on how students perceive and rate BAFA BAFA relative to their learning. Students enrolled in the course find the simulation to be important to various aspects of their learning, including helping them to understand cultural diversity. This is particularly true for students who score highly on measures of deep learning, that is, the ability to connect course content with meanings in other situations and experiences in reflective ways.

Predictors of frequent emergency department visits among rural older adults in Ontario using the Resident Assessment Instrument-Home Care.

OBJECTIVE To describe factors predicting frequent emergency department (ED) use among rural older adults receiving home care services in Ontario, Canada. DESIGN A cross-sectional examination of Ontario hospital administrative data linked to provincial home care data compares frequent ED users (i.e. >4 visits/year) with regular users (i.e. 1-3 visits/year) and no ED use over a 1-year period. Multiple logistic regression analysis was performed using independent variables from home care health assessments. MAIN OUTCOME MEASURES Predictors of frequent ED use among rural older adults receiving home care services using adjusted odds ratios (ORs) and 95% confidence intervals (CI). RESULTS Ontarios rural home care clients visited the ED an average of 4.9 times (SD = 11.9) over a year. Frequent ED users were observed in 170 cases per 1000 home care clients. Congestive heart failure was the most frequently cited reason for frequent ED use; however, it was not a main driver in the adjusted model. Frequent ED use was predicted by younger age (i.e. 60-74 years) (OR = 1.9; 95% CI, 1.7-2.2), a recent ED visit in the last 3 months (OR = 1.5; 95% CI, 1.4-1.7), regularly taking >9 medications (OR = 1.5; 95% CI, 1.3-1.6), and poor self-rated health (OR = 1.4; 95% CI, 1.2-1.5). CONCLUSION Despite popular assumptions, the main drivers for frequent ED use among rural older adults in Ontario included a mix of sociodemographic and clinical characteristics, rather than disease diagnoses.

Informal Dementia Caregiving Among Indigenous Communities in Ontario, Canada.

Recent studies suggest dementia is an emerging health issue for Indigenous peoples in Canada. In this article, we explore findings concerning informal dementia caregiving in Indigenous communities. Our research has been carried out in partnership with Indigenous communities in Ontario, Canada, over the past 4 years. Semistructured in-depth interviews were carried out with informal Indigenous caregivers (primarily family) to Indigenous people with dementia at 7 geographically and culturally diverse research sites (n = 34). We use a critical interpretive and postcolonial lens to explore common caregiving experiences and patterns to gain insight into Indigenous models of care and better understand how to appropriately support Indigenous families dealing with a dementia diagnosis. Themes from the interview data are explored through a storyline beginning with why and how participants came to the caregiving role; the challenges, struggles, and decisions along the way; and reflections on the rewards and benefits of caring for a loved one with dementia. The findings suggest that underlying Indigenous values created a consistent family caregiving model across the Indigenous cultures and geographic contexts included in the study. Family caregiving was found to facilitate cultural continuity through intergenerational contact and the transmission of cultural knowledge. Diverse community contexts presented significant challenges most immediately attributable to the nature of relations between Indigenous and non-Indigenous Canadians and the continued colonial policies governing access to services.

SUPPORTING DEMENTIA TECHNOLOGY DEVELOPMENT IN INDIGENOUS COMMUNITIES IN CANADA: RESPECTING “THE WAY THAT WE ARE”

used (Figure 2). These data also highlight groupwise differences between the PCA and control groups, for example the PCA group was significantly more likely to repeat the wake word when using the devices (p< 0.034, U1⁄424877238). Conclusions:For this group of people with PCA the Amazon Echo facilitated independence overall. The Echo is also a useful device for collecting large, rich datasets from people with dementia in a naturalistic setting. We hope that findings from this proof of concept trial can inform further research into voice-assistive technologies for people with dementia. References: 1. Firth et al, arXiv:1706.06176 [cs.HC].