My mother has been admitted to hospital 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.
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 person's family doctor may also be notified. With a bit of guidance from the nurse, it is hoped the patient can 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," OTN's CEO Dr. Ed Brown explains.
He notes that patients with congestive heart failure have trouble circulating fluids in their bodies. Fluid will sometimes build up in the lungs. Patients 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 give patients a better understanding of how their activities have a direct effect on their health. "They begin to learn what sorts of things – like eating salty fish and chips – will get them into trouble," Brown explains. "Then, suddenly, it's not worth it any more having salty fish and chips when they know 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," Brown says. 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 hospital admissions by 60 per cent among the patients who got Telehomecare, Brown says.
The program 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 readmissions to hospital 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.
(Other provinces also have various forms of "telemedicine," but Ontario has one of the most extensively developed systems in North America.)
There is just one catch – many doctors don't know about it. That means a lot of patients such as 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," Lois Fillion, Sunnybrook's director of operations for the community and brain sciences programs, says.
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 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.
Paul Taylor is a patient navigation adviser at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters.