NEW MODEL OF HEALTHCARE DELIVERY-TELEHOMECARE PROGRAM FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) AND HEART FAILURE (HF) PATIENTS IN ONTARIO, CANADA

Purpose:

   Telehomecare is a patient self-management program introduced in 2007.  Program supports patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF) through coaching and remote monitoring. Purpose of this abstract is to describe program volume, patient population, and services provided to patients accessing Telehomecare in the Central West (CW), North East (NE) and Toronto Central (TC) Local Health Integrated Network (LHINs).

Methods:

   Analysis included enrolled HF and COPD patients across CW, NE and TC LHINs. Data was extracted from the Patient Management Monitoring System (PMMS) database from July 2012 to March 2015. Continuous variables were described with median and interquartile range, and compared across 3 LHINs using a one-way analysis of variance ANOVA or Kruskal-Wallis test. Categorical variables were described using contingency tables and compared by Chi-square test. 

Results:

   Since program's roll-out, 4751 participants were referred, out of which 3093  enrolled. Highest enrollment rate was reported in CW (78.3%), followed by NE (64.1%), and TC (58.8%) LHIN.  According to THC definition, 456 (56.1%), 423 (51.4%), and 487 (46.0%) patients were ‘successfully discharged’ in the CW, NE, and TC LHINs respectively. About 20-25% requested to leave before completion and mostly within first two months of enrollment. Average age of enrolled patients was 74.5±11.2, 52% were women and there was  a slight predominance of HF patients (55.6%). Overall, 42 – 45 % patients had diabetes and 50-75% lived with hypertension. Majority of patients (77-94%) were taking five or more medications, with 50% of NE LHIN patients taking 10 medications or more. At time of enrollment, weekly coaching sessions were planned for 80-90% of patients and monthly planned for remaining 10-20%. However only 10% of patients received weekly coaching, 27% received 2-3 sessions/month, and majority of patients received monthly coaching (30%) or even less frequently (33%).

Conclusion:

   THC users are elderly with high prevalence of diabetes and hypertension, taking five or more medications. Issues were identified at different phases of the participation starting with enrolment, continuation and completion of the program. Considering only half of patients successfully completed the program, we are currently focusing on careful examination of the process outcomes that may reduce drop-out rates and improve successful completion of the program. Due to challenging documentation, conclusions regarding low numbers of coaching sessions are speculative.