Chronic disease management and OTN telehomecare program (in Ontario)

Chronic obstructive pulmonary disease (COPD) and heart failure (HF) exert tremendous pressure on individuals and community healthcare system throughout the world. In Canada, highest numbers of deaths are caused by COPD and nearly half a million Canadians are affected by HF. These chronic diseases are responsible for very high number of avoidable hospitalizations and extended medical expenditure. Telehomecare is a highly potent tool to reduce incidents of avoidable hospitalization, improve quality of life, and enhance access of people with COPD and HF to health care. Chronic diseases such as diabetes, cancer, COPD, and others, are these kind of diseases that are accompanying a person throughout their life. When a person is diagnosed with any kind of chronic disease, he/she is facing with a new situation that challenges their coping methods, and therefore causing them to constantly seek for medical support. In today’s world, specifically focusing in Canada, inadequate chronic conditions management do not only impact the chronically ill patient’s quality of care but also plays an important role in the way health care is delivered for all Canadians. As stated in CIHI “Health Care Cost Drivers: The Facts” report, “Survey data shows a stronger correlation between the presence of multiple chronic diseases and higher utilization of health services than between age and utilization.” (2011, pg.16).
To put it differently, chronic ill patient will tend to utilize health care resources more frequently than others, which in other words means increased cost in health care for both clients and the government. This paper will emphasis on how a chronic disease such as chronic obstructive pulmonary disease for example, can be more self-manageable, reduce ER visits and be more cost effective for both patients and health care providers. A program in Ontario called OTN Telehomecare may be the future solution for improving chronic diseases management across Canada. The telehomecare program, which uses technology methods to deliver the best care to a client with a Chronic disease, at home rather than in health care facilities. Giving the opportunity to patients to educate themselves about their chronic illness, allow them to learn how to monitor their vital signs, and mostly give them more independence can lead to greater health outcome in chronic disease management.
The Ontario Telemedicine Network (OTN) launched the largest Telehomecare program in Canada in 2007. The program was launched with 800 COPD and HF patients. In 2012 the program was expanded to three local health integration networks (LHIN) in North East, Toronto Central, and Central West. Till July 2015, 6,334 patients with COPD and HF in these LHINs have been referred to this program. The second phase of expansion involving more LHINs is now taking place. Each LHIN is entrusted with Telehomecare program planning and implementation and has one Community Care Access Centre (CCAC) or hospital through which the Telehomecare program can be accessed at the community level (Brown, 2013).
The twin goals of Telehomecare are to impart self-monitoring skills of treatment to patients with COPD and HF, and to improve treatment monitoring of such patients by remote health care system.  The different segments of Telehomecare are; i) informal telephonic interaction between patient or caregiver and a designated Telehomecare nurse, ii) daily updating of patient data, e.g. blood pressure, sugar level, oxygen level, etc. along with answers to questionnaire to a designated Telehomecare nurse, iii) individual care if the data are on the wrong-side of the range, iv) communication regarding patient’s health condition between Telehomecare nurse and other member of the care.

Canada’s chronic health care system is immensely pressurized due to wide prevalence of chronic obstructive pulmonary disease (COPD) and heart failure (HF). This results in avoidable hospitalization and unreasonable medical expenditure. Patients with such chronic diseases also require to be monitored as a continuous process and medicines administered accordingly.
Telehomecare has the potential to reduce number of avoidable hospitalization and medical expenditure as well. It has been seen that patients with COPD or HF can be more closely
monitored and the healthcare system can work more productively when patients are brought under remote controlled health monitoring system.

However there are certain issues with Telehomecare that need to be addressed. Studies show that there seem to be no improvement in number of hospitalization, number of days confined in hospitals, self-management skill, and risk of death. Some studies have shown increased mortality rate in patients under Telehomecare program. It has also been found that there have been instances of reluctance or refusal from patients, caregivers, Telehomecare nurses, and even physicians. Another important issue is cost and reimbursement. Telehomecare needs expensive equipment and also that telephonic consultations by physicians are not reimbursed.

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