‘Telehomecare’ for COPD patients pioneered in Ontario by DSB, CCAC

MANITOULIN—Ten patients on Manitoulin Island are part of a unique telehomecare program in the province, one that sees Manitoulin-Sudbury District Services Board (DSB) paramedics partner with the North East Community Care Access Centre (CCAC) and local physicians to help ease the burden on primary health care services, such as the emergency department, while helping those patients better manage their conditions.

The telehomecare program is open to anyone living with congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), either through referral or self referral, which sees them set up with a number of tools that are directly monitored by a CCAC nurse from Monday to Friday. The program is open to everyone, no matter where they live in the region.

“When we get a patient for telehomecare in the area, we tell them they will receive a visit by a paramedic and a brief description of what will take place,” explained Tammy Windsor, manager, clinical services, North East CCAC.

“The paramedics are basically the eyes in the home,” she added, “and they do the first visit.”

Once in the home, the paramedic will install a tablet, blood pressure cuff, scale and pulse oximeter (which monitors oxygen levels).

That data is automatically sent to the tablet and then uploaded to the nurse, who has already been briefed by the patient’s doctor on what typical vitals should look like. The patient must also answer a daily set of question on the tablet, such as ‘how did you sleep?’ how is your appetite?’ and ‘do you have a cough today?’

“As soon as they see vital signs that aren’t normal, the nurse will call the patient and say ‘hey, what’s going on’,” Ms. Windsor said. “If the vital signs don’t come in, they will call, if no answer, they will try again, or try a different contact. If there is still no answer, the nurse will call the paramedics and get them to go and check on the patient.”

One Little Current woman who lives with both CHF and COPD told the Expositor she is very happy with the program.

“I was in the hospital for two weeks, I was pretty sick,” the woman, who asked to go unnamed, told this newspaper. “My blood pressure was all over the place and my oxygen was low.”

The patient said she’s been part of the program since June and is pleased with the good habits she is learning from the process, such as checking her vitals each day.

“It gives you the opportunity to share more information and it’s easy to use,” she shared.

The woman was pleased to note that, since her time in hospital and her time on the program, she hasn’t had any flareups and suggests other people with her conditions take advantage of the telehomecare program. “You keep track of yourself, and they keep track of you too.”

“It’s really quick at capturing something that’s gone wrong, right away,” Ms. Windsor added. “The paramedics can either address the issue there or refer them to the hospital and their physician.”

Fern Dominelli, Manitoulin-Sudbury DSB CAO, explained that this program fits nicely into the DSB’s paramedicine program, noting that every medic is trained by the CCAC on how to install the units, as well as how to give referrals to the CCAC about patients they see who would be good fits for telehomecare.

“The reception has been great,” Mr. Dominelli said of the program.

“This is all about becoming a greater part of the healthcare system,” added DSB Chief of Paramedic Services Michael MacIsaac. “There are a lot of gaps where we can assist, and if we can avoid 911 calls…”

The six nurses who cover the whole northeast region also do medication reconciliation with their patents. “The nurses will go through all the medications in the home, compare it to the pharmacy records and what the doctor says is best,” Ms. Windsor said. “The nurse also sets up healthy coaching sessions on how to better manage their condition.”

When the telehomecare program is wrapped up in five months, the paramedics will again go to the home and retrieve the equipment. “The patients really like that the paramedics are there,” she said. “We’ve had many successes and feel good moments.”

Ms. Windsor explained that the paramedic-partnered telehomecare program is unique in the province, adding that the North West CCAC is also looking to start its own program and the hope is that it will expand across the province.

“Telehomecare has been around since 2012, but the partnership with paramedics is brand new,” she added, noting that in 2012, patients with CHF and COPD were identified as the group with the highest number of hospital and emergency department visits.

“It’s been a success story,” Ms. Windsor said proudly. “It means better care for the patient.”