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EMPRAC
REHABILITATION 2030 & TELEHEALTH IN OT
| Term | Definition | Definition 2 | Definition 3 |
|---|---|---|---|
| RATIONALE OF REHABILITATION 2030 | ● One in three people are living with a health condition that benefits from rehabilitation ● Rehabilitation needs will grow in the coming years ● Low and middle income countries ● Supports SDG 3 | ||
| Rehabilitation | is an essential part of the continuum of care; investment in the human capital (health, economic, social development) | ||
| REHABILITATION 2030 PRIORITY AREAS | ● Launched in February 2017; key objective in the WHO Global Disability Action Plan 2014-2021 ● Create strong leadership and political support for rehabilitation ● Strengthen rehabilitation planning and implementation | ● Improve integration of rehabilitation into the health sector and strengthen intersectorial links ● Incorporate rehabilitation in UHC ● Build comprehensive rehab service delivery models ● Develop a strong multidisciplinary rehab workforce | ● Expand financing for rehabilitation ● Collect information relevant to rehabilitation to enhance health information systems ● Build research capacity ● Establish and strengthen networks and partnerships in rehabilitation |
| DRRM | emergency preparedness and response → ______ | ||
| REHABILITATION AND UHC | ● All individuals should be able to access quality rehabilitation services ● Full spectrum quality services (health promotion, prevention, treatment, rehabilitation, and palliative care) | ||
| TELEHEALTH IN OT - WFOT PUBLIC STATEMENT (MAY 20, 2020) | ● Broad variety of rehabilitation services to people affected by COVID-19 ● Research shows high need for OT ● Equal opportunities for rehabilitation | ||
| Research shows high need for OT: | ○ Initial acute stage, recovery stage ○ Deconditioned, mental health problems | ||
| Initial acute stage, recovery stage | ■ Improving respiratory function, endurance, performance of daily activities, psychological/cognitive factors | ||
| Decondition | - Weakness d/t prolonged inactivity Muscle atrophy | ||
| Telerehab | you assume that there’s a disability/dysfunction already; providing direct solutions to the disability or problem | ||
| telehealth | it is an all encompassing term that includes promotion and prevention of disability. | ||
| TELEHEALTH | ● Application of evaluative, consultative, preventive, and therapeutic services delivered through telecommunication and information technology | ||
| Synchronous | – live | ||
| Asynchronous | – store and forward | ||
| MODELS OF CARE | ● Tele-evaluation ● Tele-consultation ● Tele-intervention ● Tele-monitoring ● Tele-supervision | ||
| Tele-consultation | ○ Sharing of knowledge and expertise | ||
| Tele-monitoring | ○ Progress over time | ||
| Tele-supervision | ○ Intern and Supervisor | ||
| TELEHEALTH EFFICACY (Cason & Cohn, 2014) | ● Prevent unnecessary delays | ||
| TELEHEALTH EFFICACY (Carson, 2012) | ● Increased access to services; Facilitates IPC | ||
| TELEHEALTH EFFICACY (WHO, 2010) | ● Leads to similar or better clinical outcomes | ||
| TELEHEALTH EFFICACY (Kairt et al., 2009) | ● Supports the use of telehealth as a service delivery model in OT | ||
| TELEHEALTH EFFICACY (AOTA, 2013) | ● Compelling research in various areas | ||
| TELEHEALTH EFFICACY | ● High satisfaction among service recipients ● Interventions requiring handling may not be as effective when delivered through telehealth | ||
| TELEHEALTH ACROSS PRACTICE AREAS | ● Supports early intervention services and school-based services (IPC) ● Promotes home modification services ● Promotes health and aging in place, saves resources | ● Circumvents barriers of stigma and cultural issues for clients with mental health disorders ● Supports rehabilitation, reintegration into the community, and worker education/injury prevention | |
| Supports early intervention services and school-based services (IPC) | ○ Themes on compatibility with daily life, collaborative relationship, and parent empowerment (Wallisch et al., 2019) | ||
| Promotes home modification services | ○ Effective, addresses individual needs ○ Eliminates the burden of leaving their homes | ||
| CONSIDERATIONS IN TELE-EVALUATION | ● Health care needs ● Preferences ● Access to technology ● Ability to measure outcomes ● Copyright laws and requirements | ||
| Health care needs | ○ You are still accountable on what will happen to your client at home, that’s why this can be prevented through preparation. | ||
| Access to technology | ○ During pandemic, 1 free session, not 1hr just for them to experience and see if they want to avail | ||
| Ability to measure outcomes | ○ Standardized tools are being used; it cannot be improvised. It can be received in their respective houses, but instructions cannot be accurately followed. | ||
| Copyright laws and requirements | ○ Sharing materials, acknowledge san nakuha yung materials, cite! | ||
| CONSIDERATIONS IN TELE-INTERVENTION | ● Technology availability and options ● Safety, effectiveness, and quality of interventions ● Client's choice and desired outcomes ● Guidelines and policies | ||
| Technology availability and options | ○ Troubleshoot before the session to maximize session time | ||
| Safety, effectiveness, and quality of interventions | ○ Checking the place, sharp edges of table | ||
| TYPES OF TELE-CONSULTATION | ● Remote provider and client ● Remote provider and local provider with the client ● Remote provider and local provider without the client | ||
| Remote provider and local provider with the client | ○ Especially if you have a certification/specialization | ||
| Remote provider and local provider without the client | ○ Sila lang naguusap, wala si cx | ||
| TELE-MONITORING | ● Chronic disease management (degenerative cases) ● Prevention of health crises, emergency department use, and hospitalization ● Monitoring adherence to an intervention program, ADLs, cognitive changes, and fall risk | ||
| ADMINISTRATIVE PRINCIPLES (BRENNAN ET AL., 2010) | ● Compliance with state and regulatory requirements ● Traceable documentation ● Requirements for privacy and confidentiality, inclusive of access to records ● Rights and responsibilities of clients, including communicating complaints | ● Protection in research protocols ● Appropriate technology expertise and reasonable care and diligence in the selection of equipment ● Secondary modes of communication and emergency plan | ● Systematic quality improvement and performance management process |
| Traceable documentation | ○ Avoid legal complications ○ Even in telehealth, you are bound to make documentation for your patients ○ No document = no basis for Cx’s progress | ||
| Requirements for privacy and confidentiality, inclusive of access to records | ○ Informed consent process should be given before giving telehealth. Clients and caregivers should be enlightened about the session and its implications. | ||
| Rights and responsibilities of clients, including communicating complaints | ○ Orienting the clients/caregivers of their responsibilities ○ Privacy and confidentiality should also be protected ○ Complaint system ○ Safety considerations of activity | ||
| Appropriate technology expertise and reasonable care and diligence in the selection of equipment | ○ Must know better than cx/family (digitally literate) | ||
| Contingency measures | - give alternatives in case of disconnection during telehealth of either party. It must always be prepared. | ||
| ● Systematic quality improvement and performance management process | ○ Keep soliciting feedback on how to improve the services in telehealth | ||
| CLINICAL PRINCIPLES (BRENNAN ET AL., 2010) | ● Adhere to practice guidelines ● Appropriateness of telehealth ● You cannot force a client to have telehealth ● Appropriate education, training and ongoing CPD ● All persons at both sites are identified | ||
| Appropriateness of telehealth | ○ Case to case basis, clinical judgment, client’s informed choice, and standards of care | ||
| Appropriate education, training and ongoing CPD | ○ Seminars, be updated to emerging practices ○ Use of equipment with client considerations ○ You cannot be obsolete, and you need to further study the current trends of the profession. | ||
| TECHNICAL AND ETHICAL (BRENNAN ET AL., 2010) | ● Functional equipment at the time of clinical encounter ● Infection control policies and procedures ● Trained in equipment operation and troubleshooting ● Formal process for resolving ethical issues | ||
| PRACTICE CHALLENGES AND OPPORTUNITIES (CASON, 2012) | ● Adherence to Standards and Practice and Code of Ethics ● Privacy and security of confidential information ● Apprehension by stakeholders ● Limited infrastructure and interoperability | ||
| MEASURES TO ADDRESS ETHICAL CONSIDERATIONS | ● Privacy and confidentiality ● Justice ● Non-maleficence (Avoid harm) ● Autonomy | ||
| Privacy and confidentiality | ○ use headphones | ||
| Justice | ○ Everyone can avail the service ○ Baka kasi hindi need ng visual feedback for OT ■ audio-only options where appropriate | ||
| Non-maleficence (Avoid harm) | ○ presence of e-helper (parent, guardian or the caregiver); clear emergency protocols | ||
| Autonomy | ○ Consent forms before you run the telehealth, ○ Backup plans and other options if the patient does not want | ||
| LOCAL POLICIES - PAOT OFFICIAL STATEMENT (MARCH 16, 2020) | ● Proclamation No. 922 (State of Public Health Emergency) ● The organization acknowledges the risk of contracting COVID-19 ● Adoption of safe, alternative, and innovative means of service provision | ● All OTs are mandated to adopt a safe, alternative and ● innovative means of service provision ● Assumption of other roles ● Alternative teaching-learning for OT ● Adherence to OT Standards of Practice and OT code of Ethics | |
| Assumption of other roles | ○ Promote health and well-being ○ Mediate in redesigning routines and lifestyles ○ Address psychosocial and mental health concerns ○ Promote occupational justice | ||
| PAOT OFFICIAL STATEMENT (MARCH 17, 2020) | ● Imposition of ECQ and stringent social distancing measures over Luzon ● OTs are bound to comply with those measures ● Reflect on how quality services are to be delivered given ● the restrictions ● Reiteration of previous call | ||
| BR NO. 2020-001 (MARCH 16, 2020) | ● Guidelines on the use of telehealth as an alternative form of OT service provision ● Telehealth ● Encompasses the broad range of OT services ● Direct and in-person service delivery supersedes all other forms of service provisions | ● Meet the same standards of cares, principles of evidence-based practice (EBP), and reflective practice ● Adherence to ethical principles ● Monitoring mechanisms ● Continuing education and on-site training | ● Documentation should not cease ● Resumption of direct service delivery, hybrid; should not be used to avoid clients ● Fair and reasonable rates ● Discussed and agreed among various parties |
| Guidelines on the use of telehealth as an alternative form of OT service provision | ○ To prevent unnecessary delays in attainment of cx goals and provision of services | ||
| Telehealth | ○ Utilization of ICT to deliver health-related services | ||
| Direct and in-person service delivery supersedes all other forms of service provisions | ○ Uncertainty of when quarantine will end and face-to-face service will resume | ||
| Adherence to ethical principles | ○ OT should possess the necessary KSA: ■ Knowledge ■ Skills ■ Attitude ○ Identification of clients ○ Preparedness of stakeholders ■ Train the family/caregivers | ○ Anticipated risks and solutions/plan, accountability of OT ○ Informed consent - written or electronic ■ Services, duration, risks, benefits, options, rates, limits to privacy, confidentiality, materials/tools/equipment | ○ Confidentiality (compliance with Data Privacy Law) ■ You cannot share your Cx’s info with everyone |
| Monitoring mechanisms | ○ Effective ○ Efficient ○ Gather perceptions or feedback | ||
| Fair and reasonable rates | ○ No fixed rates from PAOT, ethical rates ○ Provide equal access | ||
| OBTAINING CONSENT | ● Mail the clients in advance ● Easy to understand language= (layman) ● Confirm client understanding ● Ask for clarifications ● Document consent done verbally ● Mail a copy of the consent form to keep | ||
| BR NO. 2020-003 (MAY 28, 2020) | ● Updated interim guidelines on the practice of OT amidst the COVID-19 situation ● Acknowledges professional duty and rights of PWDs in compliance with state guidelines even if there is relaxing of quarantine measures | ● Applicable even if there is total lifting of quarantine measures ● Discuss first alternative forms of service provision, determine if in-person therapy is an urgent and feasible option ● Informed consent process | ● Consider alternative form of service provision for the following: ○ Not accommodated for in-person services d/t limited slots ○ In-person service is not an urgent of feasible option ○ Not passed the screening protocol ○ School-based setting |
| Discuss first alternative forms of service provision, determine if in-person therapy is an urgent and feasible option | ○ Life-threatening circumstances (outpatient psychosocial) ○ Risk for continuing regression, complication, and further deformity ○ Procedure may only be performed in-person | ○ Existing protocols and referrals ○ Presence of strict personal protection and hygiene, social distancing measures | |
| ADVISORY NO. 2021-001 (MARCH 5, 2021) | ● Continuing education on telehealth and professional competency advisory ● Telehealth is a form of service delivery ● Not a specialized area of practice | ● Does not necessitate the acquisition of a certification ● No recognition for any certification body yet ● OTs to be critical in attending Continuing Professional Development (CPD) activities | |
| 3 years | - renewal of OT license ■ At least 45 units | ||
| Continuing Professional Development (CPD) activities Rationale: | Evolving practice | ||
| Continuing Professional Development (CPD) activities | ○ Keep on learning and acquiring knowledge ○ Telehealth CPD is not required, does not make you less of an OT if you do not have certification | ||
| HOW SIR KIM DOES TELEHEALTH ● Explain the guidelines and perform the informed consent process, *trial session | ○ To see if it works/matches ○ If not, then proceed to on-site session | ||
| HOW SIR KIM DOES TELEHEALTH ● Share the goals and the plans for the next sessions | ○ Prepare own materials ○ For the caregivers = setup, materials, printed forms, and contacts (prior to the session) ○ Prepare beforehand, NOT ON THE DAY! | ||
| HOW SIR KIM DOES TELEHEALTH ● Implement the session (OT led, caregiver led) | ○ Who will instruct every session (included in house rules) ○ “Mommy for the 1st activity po, its OT-led so ako lang po magsasalita, ang gagawin lang po natin ay hahawakan kamay ni cx for assistance” | ||
| HOW SIR KIM DOES TELEHEALTH ● Feedback and homework | ○ Usually 5-10 mins only | ||
| REINFORCEMENT | ● Access the AOTA Telehealth Resources for additional materials and for guidance ○ Decision making guide ○ Ethics advisory ○ Telehealth etiquette |
Created by:
avemaria