(CCSP061) BRINGING CARE CLOSE TO HOME: REMOTE MANAGEMENT OF HEART FAILURE IN PARTNERSHIP WITH INDIGENOUS COMMUNITIES IN NORTHERN ONTARIO

Background: The James and Hudson Bay (JHB) region of Northern Ontario encompasses diverse Indigenous communities served by Weeneebayko Area Health Authority (WAHA), a regional community-based Indigenous health authority. According to a March 2020 JHB report, at time of death, 31% of women and 24% of men had a history of heart failure. Remoteness of Indigenous communities necessitates long travel times for cardiology patients to receive care, often to urban centres ‘down south’.

Purpose: Collaboration to bring specialist cardiology care to the JHB region combining community-based cardiology clinics and improving local capacity and remote management via the digital therapeutic Medly. Medly includes a rules-based algorithm which tracks patients’ symptoms, weight, pulse and blood pressure, and provides feedback dependent on these values. It lives on patient’s phones, and requires a BP cuff, scale, and mobile device to use. The collaboration was guided by WAHA’s visions and values, including care close to home, culturally safe and appropriate care, and leveraging digital health interventions.

METHODS AND RESULTS: Patients were referred to WAHA/UHN regional cardiology clinics through various pathways: WAHA family physicians, nursing station staff, self-referrals and other visiting cardiologists. A WAHA-based clinical coordinator based in Moose Factory worked closely with the UHN team. The use of Medly was tracked through alert and patient self-reporting data. Distribution of equipment for Medly was recorded. A survey to assess patient and provider satisfaction was also administered. Lastly, integrating Medly into the WAHA system necessitated localization, such as the translation of Medly material into Cree.

33 patients in the JHB were enrolled and managed using Medly over a seven-month period. Medly alert distribution diminished over time through the seven-month period concluding at 76% normal, 23% caution, and 1% critical alerts. For Medly equipment, 46% of patients brought their own device, 40% brought their own everything, and 14% required a full kit. 100% of patients agreed or strongly agreed Medly brought care close to home, and 86% of providers agreed or strongly agreed Medly addresses a gap in available care in the region.

Conclusion: The implementation of Medly within the JHB in partnership with WAHA has demonstrated success in both volume of referrals and satisfaction with the program. Both patients and providers in the JHB agree that Medly has addressed a priority of WAHA’s – bringing specialist cardiology care close to home. Building capacity in the JHB via a partnered approach for cardiac care will help improve Indigenous health outcomes.