BY NORM TOLLINSKY

Residents of smaller communities in northwestern Ontario who return home following a heart attack are more able to participate in a cardiac rehabilitation program thanks to telemedicine technology.

The Multi Site Telemedicine Cardiac Rehabilitation Program for Residents of Northwestern Ontario had its origins in a cardiac rehab program established in 2001 for patients in Thunder Bay.

The program was very successful and soon had a waiting list, but Dr. Stephen Arif, a physician in Atikokan, saw the need for an extension of the program to other communities in the region and challenged the Thunder Bay cardiac rehab team to take the next step.

“He said ‘That’s great for Thunder Bay, but what about the rest of northwestern Ontario?’ recalled Gwen Third, manager of cardiac services at Thunder Bay Regional Health Sciences Centre.

The multi-site rehab program kicked off in 2003 with the delivery of education workshops to nine communities via videoconferencing technology and expanded again in 2006 with an exercise program linking Thunder Bay with Marathon, Manitouwadge, Nipigon and Atikokan. Several other communities, including Dryden, Kenora, Sioux Lookout and Terrace Bay will join the exercise program via videoconference as soon as they are able to acquire mobile Tandberg Intern videoconferencing units. Red Lake and Geraldton have also expressed interest.

The program won the coveted Ted Freedman Award for Innovation in Education at the Ontario Hospital Association’s Health Achieve conference in November. It also won the Canadian Society of Telehealth Clinidata Award in 2005 and the Minister’s Innovation Award at the 2007 Innovations in Healthcare Expo.

As part of the program, health-care staff from the regional partner sites participated in an educational program to bring everyone up to the standards of the Canadian Association of Cardiac Rehabilitation.

Education program

The six-session education program for cardiac patients covers heart anatomy, diet and nutrition, the benefits of exercise and heart medications, as well as stress and anger management. Nurses, dietitians, pharmacists and social workers from Thunder Bay deliver the education programs to the partner sites and to other Ontario locations interested in participating.

Rolling out the exercise program posed more of a challenge because of the requirement for a large enough space and the availability of mobile videoconferencing equipment.

People participating in an exercise group via videoconferencing are more likely to adhere to the twice-weekly routine over the six month rehab period, said Third.

“You can have one person in a small community and still have connectivity with the whole group,” she said. “We know that people respond much better in group sessions.”

Health-care staff at the partner sites can also consult with their colleagues in Thunder Bay during the exercise sessions.

“If you’re a professional staff member in Marathon and you have a question regarding Mrs. Smith, you can approach the Tandberg, ask your question, get an answer in real time and modify Mrs. Smith’s exercise prescription right there and then,” said Third. “
There’s no delay as there would be if you were sending letters back and forth.”

Research conducted by Dr. Darlene Steven of Lakehead University’s School of Nursing concluded that the outcomes for patients at partner sites participating via videoconference were similar to the outcomes for patients in Thunder Bay.

The program is open to patients who have had a cardiac event, including myocardial infarction, chest pain, an angioplasty or congestive heart failure. Prior to joining in the program, patients participate in an intake clinic for assessment by the hospital’s medical director of cardiac rehabilitation, who provides an exercise prescription tailored to the individual’s capacity. Intake sessions are done via videoconference or in Thunder Bay, depending on the availability of stress testing in the patient’s community.
What would these patients do in the absence of such a program?

“Absolutely nothing,” said Lori Marshall, Thunder Bay Regional’s vice-president, Medicine, Cardiology, Mental Health and Maternal/Child. Some patients from Nipigon and Atikokan commuted to Thunder Bay prior to the establishment of the multi-site program because they believed rehab was important to their recovery, but the long distances and inconvenience meant that most patients were on their own.

“When we set this up, we rejected the notion that just because you’re a regional client, you should have substandard care. The literature is very clear that rehabilitation is a benefit to (patients recovering from a cardiac event),” said Marshall. “They need to deal with behaviour modification and make the lifestyle changes necessary to prevent another event.”

The program was launched with a grant of $39,000 from the Change Foundation. Thunder Bay Regional provided matching funds, while contributions from Fednor and the Ontario Telemedicine Network made it possible for Nipigon, Atikokan and Manitouwadge to purchase Tandberg Interns.