Telemedicine improves community management of chronic respiratory diseases

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Gerry Townend, a Carleton Place resident, recently completed a consultation with Dr. Stephen Bencze, a respirologist with the Ottawa Hospital using the Ontario Telemedicine Network (OTN).

“At first I was a little apprehensive about using this service to see my doctor. I can’t put my finger on why I was uneasy, but I was,” admits Townend. “However now that the experience is over I must admit that it was very positive. It eliminated the time and cost associated with traveling to Ottawa and it made it easier for my family to be involved with my care. If the opportunity presented itself again I would be quite happy to use telemedicine for my doctor’s visits.”

Carleton Place District and Memorial Hospital (CPDMH) is a 22-bed acute care facility providing services to a catchment area of approximately 23,000 residents within the Champlain LHIN. Outpatient programs include emergency, diagnostic imaging, laboratory, ambulatory care, surgical day stay, physiotherapy, patient information and diabetic counselling services. Telehealth services in collaboration with the former CareConnect Network, now OTN, commenced at the hospital in 2002 and telehealth visits have increased to 400 visits annually.

“Our hospital is located in a rural community and for many of our patients, traveling to Ottawa or elsewhere to see a specialist may be quite difficult or in some cases not possible,” states Malcolm D. Robinson, CEO. “Telemedicine provides an alternative way for patients to access needed health care within their own community and we are very happy to see how the program has grown to include additional specialities.”

As part of the LHIN three year plan (2007 to 2010), two of the six Champlain priorities identify a need to improve access to treatment closer to home and enhance chronic disease prevention and management. In its blueprint for health integration in the region, the Champlain LHIN cites the need to build a strong foundation at the community level, through the use of enabling technologies such as telehealth. Aligned with this blueprint, a recently developed strategic plan for CPDMH supports the commitment of integrated health care closer to home. This same plan expands on a need to standardize care, incorporating best practices, research, care maps and partnerships within a LHIN framework.

In 2007, the hospital launched a telehealth respirology program in collaboration with the Clinical Telehealth Program at The Ottawa Hospital, St Francis Memorial Hospital and respirologist Dr. Stephen Bencze. The goal of this innovative service is to provide patients living in the Champlain rural communities of Lanark, Leeds and Grenville and the Barry’s Bay area the opportunity for respirology consultation, assessment, care and education support through videoconferencing.

Several sources of patient information supported the need for this innovative program. Admitting diagnoses of Chronic Obstructive Pulmonary Disease (COPD) on the inpatient unit and asthma in emergency, constitute top case mix group’s for CPDMH. According to the Ontario Hospital Association’s (OHA) Clinical Utilization and Outcome report 2005, the hospital’s return rate for asthma within 24-72 hours exceeded small hospital averages and target thresholds. Eighteen family physicians refer approximately 60 patients to respirologists at the Ottawa Hospital. These patients require pre-visit pulmonary function tests prior to every consultation and follow up visit. A large portion of this population reside in retirement or assisted living residences, requiring travel companions and transportation assistance. This burden of travel and way-finding contribute added stressors to this vulnerable group.

Model development was deliberately collaborative with St Francis Hospital to ensure sufficient volumes to secure blocked time from the respirologist. The collaborative pooling approach to telemedicine patient referral management and scheduling is unique and allows for increased volumes and sustainability. The telehealth coordinator oversees patient referral and scheduling and this decentralized structure reduces costs incurred by the OTN related to telemedicine patient scheduling.

The model provides several levels of care ranging from respirologist assessment including spirometry testing to patient support via telehealth education sessions hosted by the Lung Association in collaboration with Kemptville hospital.

In 2007/2008, respirology visits totalled 70 visits, growing incrementally each month. As part of the Champlain Aging at Home Community of Care proposal, the hospital in partnership with North Lanark Community Health Centre, will incorporate the services of a respiratory therapist within this program. The addition of this discipline will expand multi-disciplinary assessment and enhance patient self-management competencies.

Patient satisfaction with the program has been positive.