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

将医疗服务送到家门口:与加拿大安大略省北部原住民社区合作开展心力衰竭远程管理

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Abstract

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.

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