Program overview :

Supporting Rural and Remote Communities with Virtual Rehabilitation Services

Health Link 811 - Alberta Health Services

With a shortage of rehabilitation providers in rural and remote communities across Alberta, Health Link 811 implemented virtual care innovations to triage, assess and treat patients in need of occupational therapy (OT) and physical therapy (PT) support appropriate for virtual care. This promising practice aimed to adapt an existing virtual care framework from other communities to enhance access, ensure equitable care and to deliver safe and effective services through a collaborative partnership between virtual providers and local healthcare teams. By leveraging virtual solutions, the Health Link 811 Rehabilitation Advice Line team was able to serve more patients, alleviate the workload on contracted OT services and local providers, and address urgent referrals efficiently.

Objective and purpose of the promising practice

Rural communities, including High Level, La Crete and Fort Vermillion, face a critical shortage of rehabilitation services due to prolonged vacancies of key positions. Long waitlists for OT (n=30+) and PT (n=500+) services are exacerbated by broader clinician shortages in Alberta. Health Link’s 811 virtual care solutions aimed to support community rehabilitation patients by providing OT and PT services remotely.

This initiative’s goal was to utilize virtual technology to triage, assess and treat eligible patients and leverage therapy assistant in-person support within the patient’s home community, thereby reducing waitlists and improving health outcomes.

Approach

Engagement

Health Link’s 811 Rehabilitation and Advice Line staff engaged with patients early through shared decision-making, providing information about virtual rehabilitation services and offering options for virtual appointments. This early introduction allowed for conversations with patients to determine the feasibility and appropriateness of virtual care for each patient.

Additionally, engaging therapy assistants in pilot cases in rural and remote communities proved essential. These assistants offered critical support services virtually, ensuring safety of the patient, reducing the burden on teams and enhancing patient satisfaction.

Outcomes

At the time of project implementation at the beginning of April 2023, there were over 30 people on the OT waitlist and over 500 people on the PT waitlist. As of January 2024, 308 of these patients were reached. The virtual rehabilitation services led to the elimination of the OT waitlist by October 2023, with all new referrals assessed and managed within the acceptable time frame of 1-2 weeks. The PT waitlist was reduced by over 50 percent, with 227 referrals remaining by January 15, 2024, and a goal to address the remaining waitlist in the coming year.

Patient feedback was gathered through 112 completed Telehealth Usability Questionnaire (TUQ) surveys which indicated the following:

84% felt virtual health (e.g. Zoom, telephone care) provided for their healthcare needs (n=94).
87% felt virtual health (e.g. Zoom, telephone care) improved access to healthcare services (n=97)
86% felt it was simple to use Virtual health (e.g. Zoom, telephone care) (n=96)
91% felt they can easily talk to the clinician using virtual health (e.g. Zoom, telephone care) (n=102)
92% felt they were satisfied overall with virtual health (e.g. Zoom, telephone care) (n=103)

While not an initial objective, an unexpected outcome was improved workplace culture. Existing relationships and positive outcomes contributed to the project’s success.

Impacts and learnings

Key takeaways

Initially piloted in 2021, existing relationships facilitated managers’ openness to virtual rehabilitation.
Patients were generally indifferent between virtual and in-person care, provided their needs were met.
Insights from patients highlighted that virtual care may not be suitable for everyone, such as those with specific rehabilitation needs.
Patients adapted quickly to new approaches, making follow-ups simpler.
Virtual care complements rather than replaces in-person care, serving as a method of delivering care in certain communities.
Virtual care’s process-heavy nature requires workflow adjustments to improve efficiency.
Real-time improvements enabled better wait-list management and reduced staff stress levels.

Facilitators

Access to experienced rehabilitation staff and open communications between in-person teams.
Willingness and open-mindedness of all teams to support the project.
Strong administrative support in communities, aiding early workflow development.

Barriers

Significant orientation was required due to numerous electronic records systems.
Unexpected staff absences left gaps in managing referrals.
Administrative burdens included policy reviews, training for new hires and refining the triage process.

The implementation of virtual care innovations by Health Link 811 has reduced waitlists and enhanced access to rehabilitation services in rural and remote communities across Alberta. By addressing clinician shortages and long waitlists, this initiative demonstrated the potential of virtual care to deliver equitable, safe and effective therapy services.

For more information:

Kira Ellis, Program Manager
Health Link 811 – Alberta Health Services
kira.ellis@ahs.ca