...strengthening rural health through research

Driving Distance to Telemedicine Sites in Northern Ontario as a

Measure of Potential Access to Healthcare

Laurel O’Gorman, MA

John C. Hogenbirk, MSc

Conflict of Interest Declaration: Nothing to Disclose

Presenter: Laurel O’GormanTitle of Presentation: Driving

distance to telemedicine in Northern Ontario as a measure of potential access to healthcare

I have no financial or personal relationships to disclose

Strengthening rural health through research

Rationale

• To determine if the location of Ontario Telemedicine Network (OTN) sites can help improve access to medical care in underserved communities in Ontario

• Measuring highest possible potential for access

• Research funded by the MOHLTC’s Health Systems Research Fund

Strengthening rural health through research

Ontario Telemedicine Network (OTN)

• Not-for-profit organization funded by the Ontario Ministry of Health and Long Term Care (MOHLTC)

• Enables access to medical care services by using technology to connect patients to physicians throughout Ontario.

• OTN is the largest telemedicine service provider in Canada (Coach, 2013) and one of the largest in the world (Holmes, 2009).

(OTN, 2012)

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Methods

• Travel time by private vehicle from center of each community to the nearest OTN site calculated using posted speed limits and road distance.

• ArcGIS 10.0 Network Analyst extension MNR Cultural Points data DMTI Ontario Road data OTN Site locations from OTN

• Pearson’s Chi-squared test to determine if there were differences in travel time among community population group or between rural and urban communities.

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OTN Sites by Rurality

Statistical Area Classification Percent in

Northern Ontario (n=552)

Percent in Ontario (n=2026)

Population (column %)

Northern Ontario Ontario

Urban 48% 73% 66% 89%Rural 52% 27% 34% 11%Total 100% 100% 100% 100%

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Driving Distance to OTN Sites for Northern Ontario Communities

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Driving Distance to OTN Sites for Northern Ontario Communities (by Population Group)

Population Group

Less than 30 minutes

30 to 60 minutes

Over 60 minutes

No Roads / Roads not maintained Total

50,000+ 100% 0 0 0 410,000 to 50,000 100% 0 0 0 31,000 to 10,000 97% 3% 0 0 59

50 to 1,000 73% 15% 8% 5% 303

under 50 58% 25% 11% 7% 433

Total 67% 19% 9% 5% 802

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Driving Distance to OTN Sites for Northern Ontario Communities (by Rurality)

Population Category

Less than 30 minutes

30 to 60 minutes

Over 60 minutes

No Roads / Roads not maintained Total

Urban 91% 9% 0 0 79

Rural 65% 20% 10% 6% 723

Total 67% 19% 9% 5% 802

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Summary of Findings

• All communities with populations over 10,000 and 97% of communities with populations over 1,000 are within 1 hour of an OTN Site

• For communities with populations under 50, 83% are within 1 hour of an OTN site

• All urban communities are within 1 hour of an OTN site, compared with 84% of rural communities.

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Discussion

• Proximity ≠ Access Theoretical measure of maximum potential access

• Other considerations Number of sites within a given community Site location (organization, privacy, hours) Support / referrals from health care providers Weather

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Next Steps and Concluding Remarks

• Measuring actual OTN utilization throughout Ontario

• Looking at factors associated with high and low use Qualitative interviews on OTN use in Northern Ontario

• Policy recommendations regarding the (1) use of and (2) modality of virtual care for health service delivery in the north, especially in rural and remote areas

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Acknowledgements

We would like to thank OTN for site data and Tomasz Mrozewski and Jill Sherman for locating map data.

This research was supported by the Ontario Ministry of Health and Long Term Care’s Health System Research Fund (Grant 04254SB).

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ReferencesAgresti, A. (2002). Categorical Data Analysis. New York: John Wiley & Sons, Inc.

Brown, E. M. (2013). The Ontario Telemedicine Network: a case report. Telemedicine Journal & E-Health, 19(5), 373-376.

COACH. (2013). 2013 Canadian Telehealth Report. In COACH (Ed.).

DMTI (Cartographer). (2011). Route File.

Fortney, J. C., Burgess, J. F., Jr., Bosworth, H. B., Booth, B. M., & Kaboli, P. J. (2011). A re-conceptualization of access for 21st century healthcare. J Gen Intern Med, 26 Suppl 2, 639-647. doi: 10.1007/s11606-011-1806-6

Holmes, M., & Hart, A. (2009). Profile: Ed Brown and the Development of Ontario Telemedicine Network. Healthcare Quarterly, 12(4), 28-31.

Mehta, C., & Patel, N. (2011). IBM SPSS Exact Tests: IBM Corp.

Ontario Ministry of Natural Resources (Cartographer). (2013/1995). Cultural Point at 600k.

Ontario Ministry of Natural Resources (Cartographer). (2014/1997). Settlement at 100k.

OTN. (2012). Technical Service Level Agreement. Toronto, ON: Ontario Telemedicine Network,.

Statistics Canada. (2013). Standard Geographical Classification (SGC) 2011. from http://www23.statcan.gc.ca:81/imdb/p3VD.pl?Function=getVDPage1&db=imdb&dis=2&adm=8&TVD=116940

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Thank you

Laurel D. O’Gorman, Research Assistant

John C. Hogenbirk, Senior Researcher

Centre for Rural and Northern Health Research

www.cranhr.ca