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Question: My mother has been hospitalized several times for congestive heart failure. Each time the same thing happens. After her condition is stable, the hospital sends her home. But my mother has a hard time managing her illness and she ends up back in the ER. Is there any type of medical help she can get at home? She lives in Ontario.
Answer: There actually is a program that’s aimed at patients just like your mother. It’s called Telehomecare and it was developed by the Ontario Telemedicine Network (OTN), a not-for-profit organization funded by the provincial government and Canada Health Infoway.
Patients are supplied with equipment so they can take daily measurements of their own blood pressure, weight, pulse and the oxygen levels in their blood. They are also given a tablet device to answer a few questions about how they are feeling. A technician comes to the home to set everything up.
All this information is automatically transmitted to a data centre where it is monitored daily. If the data suggest a patient is having a problem, a specially trained nurse will call the home. The family doctor may also be notified. With a bit of guidance from the nurse, the patient can hopefully get back on track and avoid another trip to the hospital. Weekly telephone coaching sessions are also arranged with each patient.
“The goal of the program is to motivate and educate patients on how to look after themselves,” explains OTN’s CEO Ed Brown.
He notes that patients with congestive heart failure have trouble circulating fluids in their bodies. Fluid will sometimes build up in the lungs. They often feel short of breath and may need to be readmitted to hospital. There is no cure for the condition, but the symptoms can sometimes be managed through lifestyle changes such as eating a healthy diet and keeping weight under control.
The daily monitoring and feedback gives patients a better understanding of how their activities have a direct impact on their health. “They begin to learn what sorts of things – like eating salty fish and chips – will get them into trouble,” explains Brown. “Then suddenly, it’s not worth having salty fish and chips when they know that they are going to up end up in the hospital.”
The program lasts for six months, at the end of which the equipment is returned. “Data show that the effect lasts well beyond the six months,” says Brown. Many patients buy their own blood pressure cuffs and weight scales “and they continue to monitor on their own – which is a great advance in self-management.”
The program, started in 2012, has helped to reduce hospitalizations by 60% among the patients who got Telehomecare, says Brown.
It also provides remote monitoring and health coaching for patients suffering from a lung ailment known as Chronic Obstructive Pulmonary Disease or COPD.
Heart failure and COPD are among the leading causes for re-hospitalizations in Canada.
Telehomecare is now available for these two conditions in most of Ontario. The service is usually delivered through local Community Care Access Centres (CCAC) or hospitals.
There is just one catch – many doctors don’t know about it. That means a lot of patients like your mother are missing a chance to benefit from the program.
Brown says OTN has been working with hospitals to make sure more patients are referred to Telehomecare.
At Sunnybrook Health Sciences Centre, for instance, consideration of Telehomecare has been integrated into regular discharge planning. “We are promoting it as best we can,” says Lois Fillion, Sunnybrook’s director of operations for the community and brain sciences programs.
Patients are assessed to determine what services they may need once they leave the hospital and this process helps identify those who could potentially benefit from Telehomecare. “The referral is automatic,” she explains.
But, even if patients are at hospitals where the referral isn’t automatic, they can still hook up with the program on their own.
Patients, or their family members, can go to the website of OntarioTelehomecare.ca to find the program in their area. They just need to type in their postal code – and up pops the contact information.
Or, if they don’t have a computer, they can phone OTN at 1-855-991-8191.
Other provinces also have various forms of “telemedicine,” but Ontario has one of the most extensively developed systems in North America.
Indeed, OTN has been at the forefront of using new technology to put patients in touch with health-care providers.
OTN was formed in 2006 to make it easier for people in remote parts of the province to access health services. In particular, OTN made it possible for patients to have appointments with physicians and specialists through “video conferencing,” instead of travelling hundreds of kilometers to a medical centre in a distant city.
“Originally, the patients would go to a local hospital or medical office that had the [video-conferencing] equipment,” explains Brown. The doctors, in turn, would go to video-conferencing studios near where they practice.
Some of the earliest Telemedicine pilot projects were carried out using Sunnybrook’s studio as a base for medical specialists who provided care to people living far from Toronto. And that service continues to this day.
With the latest Internet advances, however, it’s now possible for a growing number of patients and doctors to connect directly without having to go to a studio.
OTN has created a secure video-to-home network that allows doctors to do “virtual” house calls. It’s being used for a wide range of purposes, including palliative care in some parts of Ontario. “People who have limited time left don’t want to spend it in the emergency department, hospital or doctor’s waiting room– they want to be at home. So, it is hugely valuable for end-of-life care.”
Meanwhile, OTN is now turning its attention to smartphone apps. “There are probably 100,000 apps related to health-care,” says Brown. “We’re looking for the ones that have demonstrated real value to patients and we’re trying to figure out a way of implementing them into the health care system.”
It’s possible that some of these apps eventually will be able to help patients like your mother who are living with chronic and debilitating illnesses.
For now, though, OTN’s Telehomecare appears to be her best-available option.
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Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
The comments section is closed.
Hi Paul: You wrote that “OTN is now turning its attention to smartphone apps”. Please, could you clarify, how you assess “their real value to patients”? I work with a doctor on implementing mHealth app in Workers’ Compensation service in California. We have only generic information about scientific validity of some technologies in this area to detect health changes (improvement and impairment), but not ad-hoc info of value in this specific service. Do your conduct trials with all “100,000 apps related to health-care” or have adhoc selection criteria?
Thank you.
The Ontario Telemedicine Network is in the early stages of evaluating apps. You would need to connect directly with OTN if you want more detailed information about the methodology. The website is https://otn.ca
Hello
Please re-read the study again!
The study randomized patients and enrolled everyone in the intervention group into the program, regardless of whether they judged to be interested and engaged candidates or not. Most of the enrollees did not adhere to the basic intent of the study – monitoring or coaching – and hence had no opportunity for behavior change. The whole point of this kind of intervention is to engage, educate and motivate patients to improve their behaviours and self-management skills.
HOWEVER, the sub-set of patients that did engage in the monitoring and coaching had excellent results. Here is the relevant result:
“Individuals with better adherence to monitoring—defined as greater than 50% of days monitored—had a significantly lower rate of hospital readmissions at 180 days compared with those who monitored their weight, blood pressure, heart rate, and symptoms on less than half of the study days (41.3% vs 61.1%, respectively; P<0.001). Similarly, mortality at 180 days was significantly lower among heart-failure patients who completed more telephone calls with the nurses (>50% of calls completed) and monitored their risk factors and symptoms more diligently (>50% of days monitored).”
Thanks for your comment and noting the fact that those who actually participated did significantly better.
I’m very enthusiastic about the work you are doing. Wrote this feature a year ago:
http://viewer.zmags.com/publication/e8d4d2f9#/e8d4d2f9/16
Hi Pat:
I am glad Dr. Ed Brown was able to shed some light on that latest U.S. study — and point out how the situation here in Ontario is different.
Thanks for sharing the link to the feature you wrote. The more information, the better.
Hi Pat
Great article – I hadn’t seen it before.
Bottom line for me – I think we are seeing more and more evidence showing that if we can engage, educate, empower and motivate people living with chronic disease to self-manage and make the lifestyle changes they need, we will see dramatic results.
Very timely that the large BEAT-HF telemonitoring trial for chronic heart failure just released at the AMerican Heart Association conference in Orlando failed to show a reduction in hospitalization rates https://t.co/NZ9EC8KiQn compared to usual care.
Shows the importance of rigorously controlled trials.
Reasons for lack of impact may have been dated nature of the technology (circa. 2011) and some real issues around engaging patients to actually participate and use the technology