To Skype or Not to Skype, That is the Question Judi Platt RN, CARN Jordanna Graves MSW, RSW...

To Skype or Not to Skype, That is the Question

Judi Platt RN, CARNJordanna Graves MSW, RSW

Physician Health ProgramToronto, Ontario

Canada

Dedicated to Doctors. Committed to Patients.

Who we are...

• Since 1995 the Physician Health Program of the Ontario

Medical Association has provided monitoring, advocacy, and

clinical referral services to physicians in Ontario.

• Over the years the program has expanded to include all

Substance Use Disorders, Axis 1 Disorders as well as our

newest program, the Physician Workplace Support Program

(PWSP).

• Our services are also extended to students, residents,

veterinarians and pharmacists.


PHP Monitoring Program:

• All monitoring programs include:» Case Manager» Primary Monitor » Treating Clinician(s)» Family Physician» Workplace Monitor(s)» Family Member

Depending on the type of contract it may also include:» Therapist» Caduceus Group Facilitator» Self Help Groups and Sponsor» After Care Facilitator» Mentor» Biological Monitoring


Primary Monitor Interviews

• An instrument used to gather information and build relationships with our

participants.

Questions reflect:Status/stability of participant’s wellness, recovery programAttitudes, including acceptance, insight, progressMaintenance program i.e. aftercare, support groups, sponsorshipClinical ResourcesRelationships with others and selfSelf Care incl. exercise, nutrition, sleep, hobbiesSpirituality Readiness to return to work/ability to manage work/school, work hoursAbility to manage life stressors


An important component of the primary

monitor interview is the relationship between

the participant and the primary monitor.


Why Videoconferencing?

• Growing program and case loads.

• Creating more efficient practices.

• Increasing demand for services far away from Toronto.

• Cost and time of travel for both participant and primary monitor.

• No local/regional primary monitor available.

• For clinical reasons, the case manager may be the “best fit” as the

primary monitor even with the distance.

• Phone interviews do not provide a “full picture” i.e. Non verbal

presentation and cues, and it can be difficult to build a relationship.


Project Development

• Literature search

Quote from literature search:

“The results provide support for the reliability of structured

interviews administered via teleconferencing, suggesting

that providers can expect remote interviews to provide

clinical information similar to that obtained by interviews in

person” Lexen, Hawk, Herrick & Blank, 2006


Project Development continued:

• A six month time line was decided for this pilot.

• Comparison of the different types of Videoconferencing

technology which resulted in the selection of using Skype

for this pilot project.



• Consent forms:

1. “Acknowledgement to Release of Liability.” This consent form

described the utilization of Skype in the videoconferencing project as

well as acknowledgement of the loan of the video camera from the

PHP.

Skype is not entirely a secure technology.

Skype offers an encryption for direct communication between users,

however, a Skype spokesperson refused to deny the possibility that

communication could be intercepted.

2. Criteria Agreement



Criteria for Involvement in the Pilot Project:

1. The participant may have any psychiatric and/or substance use

diagnosis as long as he or she is considered stable by the PHP.

2. The participant’s contract must be at least two years in length.

3. The participant must be willing to participate in primary monitoring

interviews every one to two months.

4. The participant can live in any location across Ontario .

5. The primary monitor and case manager must be the same person.

6. The participant must have had previous experience with both in person

and telephone primary monitor interviews.


Criteria for Involvement in Pilot Project cont.:

7. The participant must be entirely willing to participate and commit to the six month

duration of the pilot project.

8. The participant must be willing to complete the evaluation form after each

videoconferencing interview and the final evaluation form at the end of the pilot.

9. The participant must be willing to sign the “Acknowledgement to Release of

Liability.”

10. The participant must have access to a computer with high speed internet.

11. The participant agrees to pay for their internet access.

12. If the participant experiences a period of instability and/or if a situation were to

arise where the PHP believes it is more appropriate to meet in person during

the pilot project, the participant must agree.



• Evaluation process developed for both participants and

primary monitors: An evaluation form was completed by both the participant and the

primary monitors after each Skype primary monitoring interview.

Each participant and primary monitor also completed a final evaluation which provided feedback regarding the overall Skype experience.

The areas targeted in the evaluation forms were:1. Technology and Equipment 2. Impact of Technology on Clinical Relationship 3. Confidentiality4. Cost Effectiveness5. Overall Satisfaction



• A Technology Use Guide was developed


Implementation

• 4 Case Managers, 2 participants each, for a total of 8 participants in

pilot.

• All Case Managers participated in an inservice describing in detail the

pilot project and the evaluation process.

• Participants that met the criteria were randomly chosen.

• Case Managers discussed the project with each chosen participant and

if the participant was agreeable, the participant signed the consents

and was provided a video camera.

• Following each Skype interview, Case Managers submitted both their

participants’ and their own evaluation forms.


Other Considerations:

1. Impact on the clinical relationship with the participant

2. Impact on the clinical relationship with the other supports, i.e. spouse/partner,

workplace monitor

3. Cost effectiveness

4. Does the use of this technology exclude certain participants? i.e. High speed

internet

5. Accessibility

6. Ease of use

7. In what capacity will videoconferencing play a role at the PHP (replace telephone

interviews, face to face or both?)

8. Will videoconferencing enhance the PHP practices?

9. Participant acceptability

10. Confidentiality


Evaluation Results

• A 5-Point scale was used: Very Satisfied,

Satisfied, Neutral, Dissatisfied, Very Dissatisfied

• Overall feedback from all was in the satisfied to

very satisfied range.

• However, there were certain themes and

considerations consistent throughout both the

participant and case manager evaluations.


Evaluation Results


Evaluation Results continued:


Evaluation Results Continued: Impact of Technology on Clinical Relationship



Cost Effectiveness:

Cost saved for participants: $30-$1000. Total of $3650, with an avg. of $213.

Time saved for participants: From 1.5 hours to 48 hours. Total of 191 hours,

with an avg. of 11.2 hours.

Case managers were not asked to estimate their savings in cost or time since

most of these interviews would have been conducted by telephone or the

participant would likely have travelled to the case manager.

The large cost and time savings were very appreciated by the participants.


Considerations for Results

• Only a small number of participants used in this pilot project.

• Participants really appreciated the time and cost savings, especially

the rural individuals and perhaps were willing to overlook technological

difficulties because of convenience and savings (Especially during the

winter time).

• Plan to continue to explore new technologies in the future.

• There were a few participants who declined to participate in the

videoconferencing pilot project stating that they appreciated meeting in

person.


Final Conclusion

• Great overall support from the participants for the continued use of

videoconferencing technology for Primary Monitor interviews.

• Case Managers were satisfied with continued use of videoconferencing

technology as long as certain criteria is initially established.

• It was found that videoconferencing is better than telephone only interviews,

but in person interviews are preferred by both Participants and Case Managers.

Regional monitors preferred.

• It is recommended if utilizing videoconferencing for primary monitor interviews

that in person interviews be conducted at least once per year and once initial

relationship has been established.

To Skype or Not to Skype, That is the Question Judi Platt RN, CARN Jordanna Graves MSW, RSW...

Documents

Transcript of To Skype or Not to Skype, That is the Question Judi Platt RN, CARN Jordanna Graves MSW, RSW...