Ms. Lily Spanjevic, Joseph Brant Hospital, Burlington, ON
Ms. Melanie Potvin, Joseph Brant Hospital, Burlington, ON
Ms. Emily Kitts, Horizon Health Network, Fredericton, NB

INSPIRED is a successful hospital to home program that enables patients to manage their COPD at home or in the community. Patients are generally enrolled in this program after they have been hospitalized for an acute exacerbation of COPD. As part of CFHI’s INSPIRED scale collaborative, two teams are looking to identify and partner with patients before they begin the cycle of admission, discharge and re-admission. Joseph Brant Hospital in Burlington, Ontario and Horizon Health Network in New Brunswick have both introduced COPD education and outreach programs through primary care. These programs are designed to catch COPD patients early and provide them with education and support to enable them to remain at home or in the community with limited need for hospital utilization. This presentation will share details of these programs as well as lessons learned about implementing a comprehensive chronic disease management program in primary care.

Learning Objectives
At the end of this presentation, attendees will be able to:

  • describe the process of managing COPD education and outreach in primary care;
  • discuss the barriers and enablers for the primary care approach to managing patients living with COPD; and
  • assess opportunities for further integration of COPD education and outreach with local primary care teams.