New clinics focus on health promotion

When Ruth LeBlanc arrived at Markham Stouffville Hospital’s emergency department after suffering stroke-like symptoms, she viewed the experience as a warning sign and was committed to recovery. Only days later, LeBlanc was seen in the hospital’s Stroke Prevention Clinic for diagnostic testing, treatment and follow-up care and began her journey towards a healthier lifestyle.

The hospital’s Stroke Prevention Clinic is the only one of its kind serving the communities of Markham, Stouffville and Uxbridge and, along with the hospital’s newly opened Chest Pain Clinic, reflects the hospital’s commitment to disease prevention and health promotion.

“So often when we think about healthcare, we think about fixing something – setting a fractured bone, stitching an open wound or medicating a patient who is ill,” says Markham Stouffville Hospital Vice President of Clinical Programs and Chief Nursing Executive Julia Scott. “But, the future of medicine is in prevention – preventing your need for inpatient care through outpatient programs that are based on best practice and are well-coordinated and thorough.” Markham Stouffville Hospital’s belief statement, we believe our role is to maximize your health, reflects this shift and is one of four commitments the hospital has made to its patients and community.

“About 2400 patients visited our hospital’s emergency department last year with stroke- or transient ischemic attack (TIA)-like symptoms or unspecified chest pain,” says Scott.  “We knew that if we could get to patients whose symptoms are worrisome but not urgent at an early stage in their illness, we could do more to prevent these negative episodes from happening again and greatly improve these patients’ chances of slowing or stopping the disease progression that caused the early warning signs.”

Markham Stouffville Hospital’s Chest Pain Clinic opened in October 2011 and sees an average of 30 patients per week, all referred to the clinic by emergency department physicians. Patients are seen in the clinic within two days of their emergency visit, where they have diagnostic tests and a consultation with the nurse practitioner and cardiologist. They leave the clinic with a diagnosis, care plan, and instructions to stay in touch with their primary care physician.

“There can be many reasons for chest pain – it could be cardiac-related, but it also could be referred gall bladder pain, pneumonia, esophageal spasms, or the result of many other conditions. This is why interviewing the patient and obtaining a thorough history is key in determining what caused their symptoms,” Nurse Practitioner Sue Feltham explains. “We also do non-invasive diagnostic tests to help risk stratify the patients, allowing us to either rule out cardiac disease or expedite further testing and perhaps intervention if the initial testing is worrisome.”

“This is a huge service to patients and the community,” says Dr. Joseph Minkowitz, Cardiologist. “Chest pain is the most concerning symptom a person can have. It is very frightening.” Although physicians may be able to rule out a myocardial infarction, or heart attack, during a patient’s visit to the emergency department, the reason for the pain can go unknown without proper follow-up care. “These are patients who could otherwise be left hanging,” he says.

Like the Chest Pain Clinic, patients are referred to the Stroke Prevention Clinic through the hospital’s emergency department physicians. The clinic opened in June 2010 and is part of the Central Local Health Integration Network’s Aging At Home initiative that integrated common elements of the stroke prevention program through a clinic in each of the area’s five acute care hospitals. The clinic sees an average of 50 new patients each month.  Patients seen in the Stroke Prevention Clinic have suffered from stroke- or TIA-like symptoms, which can include sudden neurological deficits that impact the ability to move or feel one side of the body, speech or vision changes or confusion. Urgent patients are seen at the clinic within one to two days of their emergency department visit, with semi-urgent patients being seen within one week.
“The risk of having a stroke following an event like this can be as high as 30 per cent and it is likely that, if a stroke occurs, it will be within the first few weeks following the event,” Dr. David Kim, Neurologist, explains. “This is why there is a need to have an assessment as quickly as possible to mitigate that risk.”

Once at the Stroke Prevention Clinic, patients are assessed through a thorough history, examination and diagnostic tests, followed by appropriate treatment including best evidence-based practice for pharmaceuticals and referrals to lifestyle and rehabilitation programs.

“There are several benefits to patients,” explains Dr. Kim. “They are seen faster by neurologists for assessment, have faster investigations, receive all necessary interdisciplinary care in one stop and are often referred for ongoing support.”

In addition to treatment and support, both clinics also provide a sense of comfort to patients, as Nurse Practitioner Linda Johnson-Clatworthy says, “Patients feel reassured that we have identified the cause of their symptoms and are proactively managing their care.”

“Stroke and heart disease have identical risk factors and lifestyle changes are a huge component in reducing the patient’s risk,” Dr. Kim explains, which is why many patients from the Stroke Prevention Clinic are also referred to the hospital’s Lifestyle Education and Exercise Program (LEEP) following their treatment. The hospital looks forward to expanding this program to include referrals from the Chest Pain Clinic in the near future.

The LEEP program at Markham Stouffville Hospital promotes overall wellness in patients with confirmed cerebral vascular disease, including those who have had a stroke or TIA, as well as individuals with risk factors including high cholesterol, high blood pressure, obesity, diabetes, increased stress levels or inactive lifestyles, as well as smokers.

When the Stroke Prevention Clinic team suggested LeBlanc participate in the LEEP program, she signed up without hesitation. “Any help, any learning, anything at all – I was open to it. I intend to live a long and full life,” she says.

Attending just one day per week for six months, participants in the program can improve their fitness and overall well-being, as well as their blood pressure, blood sugar control and cholesterol and triglyceride levels.

“I noticed a change within a month – I started feeling better,” says LeBlanc, whose family and friends could hardly believe the dramatic change in her lifestyle as she progressed through the program. Now, LeBlanc works to maintain her healthy diet and exercises regularly, thanks to education and encouragement she received from the hospital’s interdisciplinary team.

“Each week during education sessions our team of nurses, physiotherapists, pharmacists, and dieticians focuses on a different topic such as stress management or healthy eating, providing our participants with the knowledge they need to make healthy choices,” says Elaine Goulbourne, Director, Surgical Services, Markham Stouffville Hospital. “The program emphasizes self management principles in attaining a healthy lifestyle by assisting participants in setting weekly goals and developing action plans such as reducing salt intake and regularly checking their blood pressure.”

In addition, the program includes weekly exercise sessions where participants follow their individualized exercise prescription in a supportive environment, helping them become more active both during the sessions and at home.

“By moving this body, I make this body better,” says LeBlanc, who now makes time for physical activity every day. You get out as much as you put in. They give you the tools and support you,” she says. “It changed everything for me.”