THUNDER BAY – Healthbeat – A new multidisciplinary clinic for COPD patients launched by the Internal Medicine Clinics (IMC) will reduce admission rates and length of stays at the Thunder Bay Regional Health Sciences Centre. Called the COPD Chronic Disease Management Clinic, it is a home-grown program that combines several coordinated services.
At the heart of the new clinic is TeleHomeCare, a secure home monitoring system provided through the Ontario Telemedicine Network (OTN). Every day, patients measure their vital signs like blood pressure and answer a series of questions through a device called a “Turtle” connected to their phone line. A Nurse Practitioner at the clinic reviews the results to catch the early warning signs of a symptom flare-up, intervening before the patient needs hospitalization.
This part of the clinic is modelled after the Ontario Telemedicine Network’s TeleHomeCare Heart Failure Monitoring Program, introduced last year. It’s cutting edge when it comes to COPD care.
“There are very few studies out there looking at how we can monitor COPD at home compared to heart failure,” said Dr. Zaki Ahmed, Chief of Internal Medicine and IMC lead.
“What we do know is that people who come into hospitals recurrently with COPD are people who have symptoms 3-5 days prior to them coming in,” he said.
These symptoms include increased phlegm, fever, cough, shortness of breath, and wheezing.
“If we can get to them earlier, we can treat them earlier so they don’t get that bad,” Dr. Ahmed said.
Home monitoring is just one part of the COPD Chronic Disease Management clinic. IMC also provides support and education for patients including visits to a Respiratory Therapist, Nurse Practitioner, and Dr. Ahmed as necessary at IMC.
This clinic is separate from but works closely with the Pulmonary Rehabilitation Program, an exercise and education program provided by the St. Joseph’s Care Group. Patients are referred to the COPD Chronic Disease Management clinic from the Pulmonary Rehabilitation Program, providing another level of care – including TeleHomeCare – for those who would benefit from it.
The goal of the program as a whole is to monitor COPD patients for about 8-12 weeks, and educate them about self-managing their disease.
“During that time, we try to change personal habits and try to educate them, eventually giving them the tools and education to manage their disease themselves,” Dr. Ahmed said.
“Personal habit” changes may include stopping smoking or ensuring they are taking their medication as prescribed. Similar programs have found that patients are more likely to become more involved in their own healthcare and take positive steps to managing their disease better with this type of focused care and/or home monitoring.
The program – especially the TeleHomeCare portion of the clinic – is ideally suited for patients across the region.
“Because we can do this remotely, we can really reach all of Northwestern Ontario,” Dr. Ahmed said.
Soon after the clinic launched in January, there were already two patients from Dryden in the program. Dr. Ahmed said he expects more patients from across the region as they get the word out about the clinic.
Ultimately, it should be extremely beneficial to all COPD patients who join the program.
“This program is unique in that we are using a multidisciplinary approach, as well as a multi-location model of care,” Dr. Ahmed said. “It’s actually a more comprehensive approach to COPD care.”
Cutting Edge COPD Clinic Should Reduce or Eliminate Hospital Stays
By Graham Strong