Simply teaching people how to manage a disease at home has the potential to dramatically reduce public medical costs, finds a new Fraser Health Authority program. Plus, it can greatly improve a patient’s quality of life.
Chilliwack’s most acute sufferers of Chronic Obstructive Pulmonary Disease (COPD), also called emphysema, are getting at-home support by medical staff to identify an oncoming flare-up, and self-treat, keeping them out of the emergency room.
Chilliwack has one of the most congested hospital ERs in the province. It operates at over 100 per cent capacity, and earned a failed grade in a recent report card by B. C. emergency doctors.
COPD accounts for the highest rate of hospital admissions among chronic diseases, according to FHA. It is the fourth leading cause of death in Canada, because it limits airflow to the lungs over time, and causes sudden “flare-ups,” rushing people to the ER.
FHA found that since April 2012, BreatheWELL program clients across Chilliwack, Langley, Burnaby, and New Westminster, visited the emergency room 35 per cent less than before, and ended up in acute care half as frequently. Of those admitted, the length of stay decreased by half as well.
Client Rosemary Trehearne says the program is “awesome” and has helped her catch a COPD attack before it gets out of control. She is one of 30 people in Chilliwack who have signed on since the program started here in September.
With BreatheWELL, Trehearne has access to a two-staff program team consisting of a nurse and a respiratory therapist, who regularly come to her home to teach her how to manage the disease, and check-in on her.
Before the program, if 72-year-old Trehearne had a COPD flare-up, a common attack of extreme shortness of breath, her only recourse was to go to the emergency room.
“It was bad for me,” she says. “I would stay home and try to take care of myself, but it was always so hard to breathe.”
Then the BreatheWELL nurse and therapist started visiting. They explained what triggers to avoid, how to detect the early stages of an attack, how to control breathing, and the importance of having current medication on hand always.
This galvanized Trehearne to change her habits, such as avoiding large crowds. Trehearne has not visited the ER in over a year.
“It’s coming to your home. That makes an awful big difference. When you have to go to meetings or groups, its harder to do. And I have problems with my legs, and it would have been harder, and I may not have gone to groups,” she says of the program’s success.
Christine Laslop, program leader in Chilliwack, explains that the magic lies in the follow-up and education.
“There’s the teaching that they do with the clients, so that clients can better manage. It keeps them out of the hospital, and it stops the exacerbations from happening.”
Trehearne’s most recent experience with COPD was under her control.
“I’ve had it, I’m just getting over it, but it was very very mild,” she says. “Because I knew everything. Right from the beginning, I knew it was coming…I had the medicine always. Because when it hits, it goes very fast.”
BreatheWELL targets people whose COPD has redirected them to the ER several times in the last year, “the sickest of the sick,” says regional program lead Julie Fraser.
“We’re seeing a growing trend of older adults, as well as chronic diseases, in our population. We’re also seeing increased capacity demands on our [emergency rooms] and our hospitals,” she says.
Another Chilliwack client, Hidden Wolf, also says that his few months on the program have altered his habits. He hasn’t visited the ER since.
The program team set him up on telehealth monitoring equipment that tracks his blood pressure, heart rate, and oxygen saturation. As Hidden Wolf completes his daily tests, the staff nurse and respiratory therapist immediately receive the readings on their office computer. They detect early warning signs, and advise Hidden Wolf on how to respond.
They also call and drop by to check on him. They remind him to eat, and to take his medication.
“The whole team makes sure I’m doing well,” says Hidden Wolf.
Hidden Wolf has also found that it’s easier to get access to his family doctor since he started on the program.
“In all honesty, I think these people are really really good. Between them, my doctor, and my wife, I’m all covered,” says Hidden Wolf.
The program includes the general practitioner as a partner, and keeps him or her informed of all incidents with the client.
BreatheWELL is one example of a provincial trend to shift care to the home, through a network of community-based health programs.