1. ...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

2. Conflict of Interest Declaration: Nothing to Disclose Presenter: Laurel O’Gorman Title 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

3. 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

4. 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)

5. Strengthening rural health through research 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.

6. Strengthening rural health through research OTN Sites by Rurality Statistical Area Classification Percent in Northern Ontario (n=552) Percent in Ontario (n=2026) Population (column %) Northern OntarioOntario Urban 48%73%66%89% Rural 52%27%34%11% Total 100%

7. Strengthening rural health through research Driving Distance to OTN Sites for Northern Ontario Communities

8. Strengthening rural health through research 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%0004 10,000 to 50,000100%0003 1,000 to 10,00097%  3%  0  059 50 to 1,00073%  15%  8%5%303 under 5058%  25%  11%  7%433 Total67%19%9%5%802

9. Strengthening rural health through research 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 Urban91%  9%  0  79 Rural65%  20%  10%  6%  723 Total67%19%9%5%802

10. Strengthening rural health through research 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.

11. Strengthening rural health through research 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

12. Strengthening rural health through research 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

13. Strengthening rural health through research 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).

14. Strengthening rural health through research References Agresti, 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

15. ...strengthening rural health through research Thank you Laurel D. O’Gorman, Research Assistant John C. Hogenbirk, Senior Researcher Centre for Rural and Northern Health Research www.cranhr.ca