Many kilometres apart, but on the same page in managing COPD: British Columbia & Ontario, a comparat

By: Leanne Mireault & Tara Thomas Tarcza

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that leads to non-reversible lung damage that is typically underdiagnosed and leads to significant costs to the individual and the health care system (Osman et al, 2017). People living with COPD experience frequent admissions to hospital due to exacerbations of their disease and require extensive follow up care in the community (Mittmann, 2008). COPD does not recognize any geographical boundaries and we see similar rates of the disease in Ontario and in British Columbia (BC) (Health Quality Ontario. 2018 Ministry of Health, 2017). Both provinces recognize the constraints with treatment and management due to low rates of confirmed diagnosis as in Ontario approximately only 45% of Ontarians with COPD have received spirometry testing to confirm diagnosis (Health Quality Ontario, 2018). In Ontario and BC guidelines recommend that anyone suspected of having COPD be referred by a physician for spirometry to confirm diagnosis (Health Quality Ontario, 2018., Ministry of Health, 2017).

Managing COPD has considerable implications for the individual in relation to quality of life and the province regarding utilization of health care spending (Popa-Velea & Purcarea, 2014, Chapman et al. 2003). Efforts to reduce risk and focus on lifestyle factors are common among the two provinces (Ministry of Health, 2017. Smoking is highly linked to COPD and thus the governments in both provinces have spent considerable time and money on finding ways to reduced smoking and smoking exposure.

Public Health Ontario, 2019). Back in 2006, Ontario legislated the Smoke-Free Ontario Act to protect Ontario residents from the harmful effects of smoking, by banning it in indoor public spaces. Over the years there have been changes to the act and it has been modified to meet the changing landscape as smoking has changed for many to include electronic-cigarettes (e-cigarettes) and cannabis legalization across the country (Ontario Government, 2018).

While Ontario has focused most of their lifestyle modification efforts on smoking cessation and prevention of exposure, BC has done the same, in addition to highlighting the important role that diet and nutrition can play in maintaining a healthy Body Mass Index (BMI) as a measure of a healthy weight (Ministry of Health, 2017). Likewise both provinces have made attempts to support residents with movement and physical activity through pulmonary rehabilitation programs (Ministry of Health, 2017. The Lung Association, 2015. Health Quality Ontario, 2015). To prevent complications and exacerbations of COPD both provinces recommend any person with COPD diagnosis receive annual influenza and pneumococcal pneumonia immunization per Ministry of Health guidelines (2017, (Health Quality Ontario, 2018). Each province covers the cost of these vaccines given the efficacy in prevention of acute illness (Ministry of Health, 2017. Health Quality Ontario, 2018).

Something of interest in Ontario, even before the medical world embraced virtual prior to the Covid-19 pandemic, the Ontario Telemedicine Network created a free 6 month home monitoring and management program for COPD patients. The program is often put in place after a hospitalization for COPD exacerbation and includes blood pressure and blood oxygen monitoring as well as weight monitoring and use of an ipad. Calls from a nurse to check on monitoring results and can offer suggestions to change to improve functioning (Ontario Telemedicine Network, 2021).

Both provinces invest a significant amount of funding to support smokers who would like to quit through counselling and providing free nicotine replacement therapy (NRT) and medications. BC provincial government however provides up to 12 weeks NRT free in comparison to Ontario which supports up to 6 weeks depending on the program (Ministry of Health, 2021. University of Ottawa Heart Institute, 2021. Centre for Addiction and Mental Health, 2019). Ontario has a drug benefit program (ODB) which also funds free medications to help people quit (Ontario, 2019).

Many people who live with COPD require supplemental oxygen therapy based on their blood gas analysis and tolerance to activity and rest for hypoxemia (Ontario, 2021). If a patient does not have extended health benefits the government in both provinces will assist with funding as part of their Home Oxygen programs (Sandberg & Fleetham, 2013. Ontario, 2021). In Ontario, patients must utilize their private benefits prior to utilization of the government funded program.

In both provinces there is financial support for payment of necessary medications. In BC this is the Fair Pharmacare program and in Ontario medications are covered as part of the ODB program (Government of British Columbia, nd. Ontario, 2019). The medications to manage COPD can be costly and without coverage would be out-of-pocket expenses if the person does not have additional private or extended health benefits through their employer (Tavakoli et al. 2019).

The social determinants of developing COPD are common among residents of either BC or Ontario. Smoking history is typically the most common cause of COPD, but what about the cause of smoking? Both provinces note geographic disparity, education, and income as predictors of smoking (Provincial Health Services Authority, 2012. Public Health Ontario, 2019. Statistics Canada, 2016. Making healthy choices might seem like an easy thing to do, but for many Canadians it is a challenge (Andermann et al. 2016). Perhaps if we put some attention toward managing and supporting Canadians with improving their daily situations we could see some change.

References:

Andermann, A., & CLEAR Collaboration (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Canadian Medical Association journal, 188 (17-18), E474–E483. https://doi.org/10.1503/cmaj.160177

Chapman, K., Bourbeau, J., Rance L. (2003). The burden of COPD in Canada: results from the Confronting COPD survey. Respirology Medicine,97 Suppl C:S23-31. doi: 10.1016/s0954-6111(03)80022-7.

Health Quality Ontario. (2018). Quality Standards – Chronic Obstructive Pulmonary Disease, care in the community for adults. https://www.hqontario.ca/Portals/0/documents/evidence/quality-standards/qs- chronic-obstructive-pulmonary-disease-quality-standard-en.pdf

Government of British Columbia (n.d.). Fair pharmacare plan. Government of British Columbia website. https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/who- we-cover/fair10.2147/COPD.S210897-pharmacare-plan

Health Quality Ontario. (2015, March). Pulmonary Rehabilitation in Ontario: A Cross-Sectional Survey. http://www.hqontario.ca/Portals/0/Documents/evidence/reports/full-report-pulmonary-rehab-ontario-1503-en.pdf

Ministry of Health (2017). Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management. BC Guidelines website. https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc- guidelines/copd_full_guideline.pdf

Ontario Government. (2019, October 2). Support to quit smoking. https://www.ontario.ca/page/support-quit-smoking

Popa-Velea, O., & Purcarea, V. L. (2014). Psychological factors mediating health-related quality of life in COPD. Journal of Medicine and Life, 7(1), 100-103.

Provincial Health Services Authority (2012). Priority health indicators for British Columbia: Selected indicators report. http://www.bcdc.ca/pop-public- health/Documents/Priority%20health%20equity%20indicators%20for%20BC_selected%20indicators%20report_2 016.pdf

Sandberg, D. & Fleetham, J. (2013). Home oxygen therapy in British Columbia. BC Medical Journal, 55(3), 149-152. Retrieved from https://bcmj.org/articles/home-oxygen-therapy-british-columbia

Tavakoli, H., Johnson, K. M., FitzGerald, J.M., Sin, D.D., Gershon, A.S., Kendzerska, T., Sadatsafavi, M. (2019). Trends in prescriptions and costs of inhaled medications in chronic obstructive pulmonary disease: A19-year population-based study from Canada. International Journal of Chronic Obstructive Pulmonary Disease, 14, 2003-2013. http://dx.doi.org/10.2147/COPD.S210897