By last fall, the 75-year-old Botwood woman spent much of her time gasping for breath. Her chronic obstructive pulmonary disease (COPD) had progressed to the point where just getting up to wash her face and brush her teeth in the morning made her turn blue around the lips.
Sleeping didn’t provide any rest or relief; lying flat would cause her to wake up unable to breathe.
“It was steady getting worse,” said Snow, who was diagnosed with COPD about a decade ago. “Months and months had gone by that I couldn’t shower.”
Results of a pulmonary function test indicated she would benefit from home oxygen, but her insurance didn’t cover it. Her family didn’t know what to do.
Then she signed up to be part of a pilot project that she credits with giving her back her life.
The 12-week INSPIRED program, initiated by the Canadian Foundation for Healthcare Improvement (CFHI) and Boehringer Ingelheim Canada Inc., started in October. It provided outreach care to patients with moderate to severe COPD through 19 teams across 78 organizations, including one based in Gander.
Snow was visited at home by health-care professionals who assessed her condition and living arrangements, and provided tools to help her better manage her symptoms. Her medication was changed, her home oxygen was covered and she was given a bronchodilator and a chair for sleeping in.
“I can’t tell you enough how it changed my life. It was like night and day,” said Snow.
“I never expected to have this much quality of life I’ve got now.”
Snow said she’s now able to visit her grandchildren, which she couldn’t do before because of the stairs at their house. She’s also been able to go back to church, and she can make it out to the mall without struggling as much as she used to.
“To be honest with you, I know that I would not be alive today” if not for the program, she said.
“I can’t go and run a marathon, I don’t mean that, but my life now as it was in November is like night and day. There’s no comparison. Actually, I think my family thought I would not be here this long, because there was no way I could live the way I was living.”
Snow’s daughter, Amanda Jennings, said she was “absolutely amazed” by the results of the care.
“It has meant so much to our family. I can’t even begin to tell you,” she said.
Jennings said her mother wasn’t able to talk on the phone before, but now she can have a conversation and be understood.
“I’m someone who calls my mom like four times a day to tell her, ‘Guess what the kids did,’ or, ‘How do you bake this?’ You know? And just to be able to call her and she can actually talk back to you is amazing. Truly.”
Gander’s pilot program
Snow was one of 20 patients in the service area of James Paton Memorial Regional Hospital to avail of the program. The local team — the only one in Newfoundland and Labrador — was led by co-ordinator Valerie Pritchett.
Pritchett said Central Health wanted in on the project as part of an ongoing effort to improve care for COPD patients in the province.
“In 2005 we received a failing grade for COPD care within Newfoundland and Labrador, and most of the provinces across Canada did the same thing — they did very poorly,” Pritchett said.
“I have to say, we do great care in Newfoundland and Labrador when it comes to medical management in our acute-care facilities. … Where we fail is that transition from home to community, and for people to try to help prevent them from having to come back into our system. We know with chronic disease that we don’t do a good job across the whole country in this respect.”
There are about 13,000 people in Newfoundland and Labrador living with COPD. According to CFHI, the disease is behind 1,777 inpatient hospitalizations a year in this province, with the average stay being 7.6 days.
Pritchett says COPD has the highest incidence of chronic disease hospital admissions, length of hospital stays and visits to the ER.
A $50,000 grant last year helped the team implement the INSPIRED program, which has yielded significant results for both the patients and Central Health’s bottom line.
“They’re having better control of their disease, they’re having less symptoms, they’re better self-managers of their disease, and that means if they’re not spending time in hospital or utilizing our health-care system, they’re spending time with their families, they’re spending time attending important life events, those type of things,” Pritchett said.
“From a health administration perspective, the return on investment is significant from a perspective of health-care dollars and what we can potentially save there. And then that also gives us the ability to reinvest money to be able to provide more programming for these types of diseases and other chronic diseases.”
Five of the participants, who had advanced COPD, died during the program. Pritchett said they and their families still saw results.
The results of the pilot project were put in numbers and released Tuesday as part of the organization’s push to “fix Canada’s failing approach to chronic disease.”
Central Health’s program resulted in a 63 per cent reduction in emergency visits by the participants, a 57 per cent reduction in participant hospital admissions and a 31 per cent reduction in their length of stay in hospital.
The CFHI estimates that if the INSPIRED program were offered across the province for five years, enrolling about 100 participants per year, it would prevent 1,100 emergency visits, 700 hospitalizations and 6,400 bed days. The organization says that translates into $1.3 million in emergency department costs and $10.3 million in hospital costs.
(These saving were identified in an independent analysis by RiskAnalytica, which accounts for population growth and an aging population, assumes gradual implementation of the program and patient enrolment, and adjusts for an expected decrease in smoking rates.)
The CFHI says INSPIRED programs cost about $1,000 for every COPD patient, and that every dollar spent will prevent $21 in health-care costs.
Funding ran out for the pilot project around Christmastime, and while new patients couldn’t be enrolled, the team continued to follow up with the original patients.
“However, within the last month or so, because we know that we made such a significant impact in the lives of these people, we were able to re-secure some internal funds to be able to continue the program for the next 10 months,” Pritchett said.
Three more have enrolled, and they’re hoping for more. The program has expanded to include all of Central Health. Patients with moderate to severe COPD who feel they could benefit are encouraged to check with Central Health to see if they meet the criteria.
Meanwhile, the team is trying to secure funding to keep the program up and running. Pritchett said she is hopeful, because she’d like to see Newfoundland and Labrador lead the way for COPD care.
Snow said the program has given her a new lease on life. She really wants to see it continue.
“I know there’s other people out there like I am, and just because we’re getting up in age, we don’t need to die yet, because those things are there for us. And I know it’s expensive, but with all the money that the government’s spending, certainly, goodness, they can give us this to save our life,” she said.
“Because this is a life-saving device, I can guarantee you, that I know I would not be talking to you today if I didn’t have this.”
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