Enhanced Care and Improved Outcomes

Comprehensive Respiratory Care Program leveraging lessons learned to continue innovating and improving access to services for patients across NL

Last winter, Ashley Ryan and Dr. Gokul Vidyasankar had the opportunity to visit the isolated community of Nain, the northernmost community of Newfoundland and Labrador, located approximately 370 km from Happy Valley-Goose Bay.

As leaders of the Comprehensive Respiratory Care (CRC) program, they are committed to changing the future of respiratory disease in the province.  Ashley serves as division manager of innovation, and Dr. Vidyasankar is the program’s medical director, and division head of Respirology with Newfoundland and Labrador (NL) Health Services.

Their journey to Nain was fueled by the desire to better understand the realities of delivering health care in rural and remote communities, as they work towards expanding the reach of the CRC program.

L-R Ashley Ryan and Dr. Gokul Vidyasankar arriving in Nain

Bridging Acute and Community-Based Care

The CRC program takes an innovative, strategic approach to promoting lung health. The program is evidenced-based and aligns closely with several key principles of the Health Accord NL and was included in the blueprint as a recommendation for implementation.

Some of the key alignments with the Health Accord NL include:

• coordination of care across the healthcare system focusing on systems navigation for patients and their families.
• emphasis on health promotion and prevention, the social determinants of health and chronic disease management.
• promotion of high-quality, patient-centered and evidence-based care in most appropriate setting, utilizing technology and virtual care as needed.
• enabling providers to work to their highest scope of practice, promoting the role of allied health professionals. The registered respiratory therapists and physiotherapists who offer CRC are leaders in the community setting, and have furthered their training to be able to work to their highest scope of practice.

Since inception, over 1,500 patients have been assessed by this service, resulting in a large reduction in admissions and ER visits for chronic obstructive pulmonary disease (COPD) exacerbation.

“By bridging acute and community-based care, CRC provides patients with tools to better self-manage their disease, enhance their quality of life, and prevent hospital admissions and emergency room visits,” says Ashley.

The CRC team is made up of health-care professionals who work to their full scope of practice in the community setting, including respiratory therapists (RTs), a physiotherapist (PT) and clerical support.

L-R Amy Sweeney, RRT II; Ashley Ryan, manager; Dr. Gokul Vidyasankar, medical director; Corey Dickson, PT II; Christine King, RRT II; and Connie Best, clerk III

The program has now evolved into an effective strategic approach with multiple offerings for patients with respiratory disease. CRC has several key components:

• INSPIRED COPD Outreach Program ™ – Focuses on patients with Chronic Obstructive Pulmonary Disease (COPD) with a recent history of an emergency room visit or hospitalization for their respiratory disease. This strategy has demonstrated a marked reduction in hospital admissions and emergency room visits
• Comprehensive Respiratory Education Clinic – Offers respiratory assessments and diagnostic testing for those with asthma, COPD, Interstitial Lung Disease (ILD).
• Pulmonary Rehabilitation (PR) assists with improving physical activity and reducing shortness of breath for those with chronic respiratory disease. This approach is evidence-based, and has been shown to improve health outcomes for this population
• The CRC team has partnered with the Neurology division in the Eastern Urban Zone to provide home-based care for patients with Amyotrophic Lateral Sclerosis (ALS). Patients with chronic respiratory symptoms are supported with a variety of techniques and equipment to improve their quality of life at home.

“This program has been in operation since 2019, with significant growth over the past few years,” says Dr. Vidyasankar.  “It is now offered in the Eastern, Central, and Labrador-Grenfell Zones of NL Health Services.  By focusing on the fundamentals, the vision is to change the future of lung health in our province.”

Bringing the vision to life   

Fast forward from the trip to Nain last winter to June 12, 2024 where the CRC team proudly facilitated the first virtual visit at the Nain Community Clinic, with support from local health-care providers.

“Our dedicated team has adapted our approach through many key learnings, and we are now able to provide patients access to care regardless of their location,” says Ashley.  “We believe we can replicate this model of care across the entire province.”

Rural and Remote Health staff at the Nain Community Clinic with patients after the first successful virtual CRC visit. L-R:  Vanessa Webb registered nurse; Allan Murphy, client; Emily Williams registered nurse; Stephanie Angnatok, personal care attendant; Susie Maggo, client; and Susan Maggo, personal care attendant.

Dr. Vidyasankar says offering the CRC Program provincially is reliant on connecting and supporting other health-care providers across the province.  “We are very pleased to have developed this collaborative approach to improve access to care in rural and remote locations like the Nain Community Clinic.”

Sandy Penney, vice president and chief operations officer – Labrador-Grenfell Zone, echoes that the CRC Program has not only benefited clients in the zone, but has provided increased educational opportunities for staff to work with members of the CRC team.

“This collaboration has truly benefited our zone,” says Sandy. “The CRC team is doing great work, and we are pleased to be able to expand services to clients in the zone.”