The Sumac Creek Health Centre will soon roll out a half-day health promotion program to help patients with chronic obstructive pulmonary disease to breathe easier.
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that includes chronic bronchitis and emphysema, and develops over time. Symptoms include an ongoing cough that produces mucus, shortness of breath, wheezing and chest tightness.
Registered nurse Carolene Garcia is a COPD champion who “quickly recognized this specific population has an extensive needs — especially following discharge from hospital.” Garcia noted the COPD patients she works with are mostly low income, live alone with no social support, and have multiple co-morbidities.
That’s why she is creating a program with a team-based approach: she will work with a pharmacist and dietitian, as well as other healthcare professionals, to assist with managing the disease and, most importantly, to improve patients’ quality of life.
Patients with COPD are fearful of becoming short of breath and often arrive in the Emergency Department with an exacerbation, or a sudden worsening of symptoms.
“I see patients with COPD struggle every day,” she said.
The dietitian will work with patients to prevent or reverse malnutrition by implementing strategies to minimize weight loss and improve the ability to eat. The pharmacist will help with medication reconciliation, treatment optimization and patient education.
Garcia, who will be the COPD resource, and the Sumac Creek RN team will manage patient cases, ensure patients have a good understanding of the disease process, refer patients to other allied health professionals, and connect patients to available community resources/services such as pulmonary rehabilitation and home care.
“Having a well-thought out collaborative plan of care can have a direct impact improving health outcomes and possibly decrease readmission to the hospital,” she said.
Jacqueline Chen, the clinical leader manager at Sumac Creek, said Garcia and the rest of the primary care team were well-positioned to provide tailored care to this patient population. “With good, co-ordinated care and patient engagement, we can help prevent unnecessary visits to the Emergency Department,” says Chen.