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. 2024 Aug 27;6(12):1423-1433.
doi: 10.1016/j.cjco.2024.08.011. eCollection 2024 Dec.

Bringing Care Close to Home: Remote Management of Heart Failure In Partnership with Indigenous Communities In Northern Ontario, Canada

Samuel Petrie  1   2 , Anne Simard  1 , Elaine Innes  3 , Sandra Kioke  3 , Erica Groenewoud  3 , Stella Kozuszko  1 , Mena Gewarges  1 , Yas Moayedi  1 , Heather Ross  1
Affiliations

Bringing Care Close to Home: Remote Management of Heart Failure In Partnership with Indigenous Communities In Northern Ontario, Canada

Samuel Petrie et al. CJC Open. .

Abstract
in English, French

Background: The Weeneebayko Area Health Authority (WAHA) is a regional, community-based Indigenous health authority in Northern Ontario, Canada. From September 2022 to March 2023, the WAHA and University Health Network engaged in a partnership that designed a collaborative model of care to address inequities in cardiology specialist access in Northern Ontario. This model implemented a digital therapeutic for heart failure, (the Medly program) and in-person cardiology clinics in the region.

Methods: A WAHA-based Medly program clinical coordinator worked closely with the University Health Network team to deliver care and support patient self-management of HF. The use and effectiveness of the Medly program were tracked through app usage and rules-based algorithm alerts, based on patient self-reported data. Distribution of relevant equipment (a scale, a blood pressure cuff, and a mobile device) for the Medly program was recorded. Surveys to assess patient and provider satisfaction with the Medly program also were administered. A retrospective chart audit of electronic medical records and administrative databases was conducted.

Results: A total of 33 patients in the WAHA were enrolled in the Medly program during a 7-month period, surpassing the enrollment goal of 25 patients. A total of 93% of eligible patients were on optimized guideline-directed medical therapy or were being titrated for it. Of 15 surveyed patients, 100% agreed or strongly agreed that the Medly program facilitated delivery of care close to home, and 86% of surveyed clinicians (n = 7) agreed or strongly agreed that the Medly program addresses a gap in available care in the region.

Conclusions: The implementation of the Medly program in partnership with the WAHA has demonstrated success in terms of the volume of referrals, the quality of care, adherence to evidence-based best-practice guidelines, and satisfaction with the program.

Contexte: La Weeneebayko Area Health Authority (WAHA) est une autorité sanitaire autochtone communautaire régionale située dans le nord de l’Ontario, au Canada. De septembre 2022 à mars 2023, la WAHA et le Réseau universitaire de santé ont conclu un partenariat visant à concevoir un modèle de soins collaboratif pour s’attaquer aux iniquités en ce qui concerne l’accès aux spécialistes en cardiologie dans le nord de l’Ontario. Ce modèle a permis l’instauration d’une solution thérapeutique numérique pour l’insuffisance cardiaque (le programme Medly) et de cliniques de cardiologie en personne dans la région.

Méthodologie: Un coordonnateur clinique du programme Medly faisant partie de la WAHA a travaillé en étroite collaboration avec l’équipe du Réseau universitaire de santé pour dispenser des soins et apporter du soutien aux patients dans l’autoprise en charge de leur insuffisance cardiaque. L’utilisation et l’efficacité du programme Medly ont fait l’objet d’un suivi au moyen d’une application et d’alertes par un algorithme reposant sur des règles ainsi que sur des données rapportées par les patients. La distribution du matériel pertinent (un pèse-personne, un brassard de tensiomètre et un appareil mobile) pour le programme Medly a été consignée. Des sondages visant à évaluer la satisfaction des patients et des prestataires de soins ont été réalisés. Une vérification rétrospective de dossiers médicaux électroniques et de bases de données administratives a été menée.

Résultats: Un total de 33 patients dans la WAHA ont été recrutés dans le cadre du programme Medly durant une période de 7 mois, ce qui était supérieur à l’objectif de 25 patients. Au total, 93 % des patients admissibles suivaient un traitement médical optimisé axé sur les lignes directrices ou y étaient préparés. Parmi 15 patients interrogés, 100 % étaient d’accord ou fortement d’accord que le programme facilitait la prestation des soins près de leur domicile et 86 % des cliniciens interrogés (n = 7) étaient d’accord ou fortement d’accord que le programme Medly comblait une lacune dans la prestation des soins dans la région.

Conclusions: L’instauration du programme Medly en partenariat avec la WAHA a été une réussite quant au nombre de patients orientés, à la qualité des soins, à l’adhésion aux lignes directrices des pratiques exemplaires fondées sur des données probantes et à la satisfaction à l’égard du programme.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Map of Ontario, Canada, showing the Weeneebayko Area Health Authority communities included in the Medly program pilot project, and several communities visited by the University Health Network (based in Toronto, about 850 km south of Moose Factory, and 1326 km south of Peawanuck) cardiology team. Figure courtesy of Google Maps 2023, accessed June 2023.
Figure 2
Figure 2
Distribution of Medly program alerts, from November 2022 to March 2023. The increase in the proportion of normal alerts and the decrease in the proportions of caution alerts and critical alerts could indicate better heart failure management.
Figure 3
Figure 3
Patient question: Would you recommend the Medly program to others? A total of 87% of respondents indicated they would recommend the Medly program to others. X-axis indicates number of responses.
Figure 4
Figure 4
Patient question: I found the program easy to participate in. A total of 80% of respondents agreed or strongly agreed that the Medly program was easy to participate in. X-axis indicates number of responses.
Figure 5
Figure 5
Patient question: I felt more confident in the management of my heart condition on Medly. A total of 87% of respondents felt more confident in the management of their heart failure through enrollment in the Medly program. X-axis indicates number of responses.
Figure 6
Figure 6
Patient question: Medly addresses a gap in available care within my community. A total of 80% of respondents agreed or strongly agreed that Medly addresses a gap in available care within the James and Hudson Bays region. X-axis indicates number of responses.
Figure 7
Figure 7
Patient question: The Medly program allows me to access care close to home. A total of 86% of respondents agreed or strongly agreed that the Medly program allowed them to access care close to home, a key objective of the Weeneebayko Area Health Authority. X-axis indicates number of responses.
Figure 8
Figure 8
Provider question: This program enhanced my ability to coordinate the continuity of care. A total of 58% of respondents were neutral in their sentiment or disagreed that the Medly program enhanced their ability to coordinate continuity of care. X-axis indicates number of responses.
Figure 9
Figure 9
Provider question: Offering the Medly program to the Weeneebayko Area Health Authority communities addresses a gap in available care in the James and Hudson Bays region. A total of 86% of providers felt that the Medly program addressed a gap in available care in the James and Hudson Bays region. X-axis indicates number of responses.
Figure 10
Figure 10
Provider question: The program is integrated into my workflow and practice. A total of 43% of providers agreed or strongly agreed that the Medly program was integrated into their workflow and practice. X-axis indicates number of responses.
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