Dan Chen RRT, BSc (Hons), RTSO; Refik Saskin MSc, Principal Investigator, ICES; Jodi Gatley, MPH, Epidemiologist, ICES; Priscila Pequeno MSc, Analyst, ICES; Nancy Garvey RRT, MAppSc (Hons), RTSO

The COVID-19 pandemic has upended many priorities in the Respiratory Therapy Society of Ontario’s (RTSO) advocacy efforts. A key initiative is focused on Workforce Planning intending to:

  • help non-Registered Respiratory Therapists (RRTs) (meaning those outside of our profession) and RRT Managers alike realize and utilize RRTs to their full potential, and
  • identify gaps in access to RRTs in various practice settings across Ontario.

One key element of this initiative, the RRT Integrated Role Profile in Ontario, presents comprehensive descriptions of RRT roles and includes an extensive bibliography. It is available on the RTSO website https://www.rtso.ca/registered-respiratory-therapist-role-profile-across-multiple-practice-setting-in-ontario/.

The second part of the initiative is an Applied Health Research Question (AHRQ) study currently being conducted at ICES. ICES is an independent, non-profit corporation that applies the study of health informatics for health services research and population-wide health outcomes research in Ontario, Canada, using data collected through the routine administration of Ontario’s system of publicly funded health care. ICES is funded by the Government of Ontario.

The RTSO submitted an AHRQ proposal to ICES in 2018 that was accepted in August of that year. The intent of this research study is to examine the health equity and healthcare utilization characteristics for adults over the age of 35 years with chronic obstructive pulmonary disease (COPD) in various regions of Ontario with respect to access to RRT clinical services.

Background

As we well know, RRTs have unique knowledge, skills, and abilities relative to cardiorespiratory care of patients. Access to RRT services improves health outcomes related to the prevention, management, and treatment of cardiorespiratory conditions (Bennion, Daniel, White & Stucki, 2018; Ferrone et al., 2019; Slack, Hayward & Markham, 2018). COPD is a common, serious public health problem, which will become the fourth leading cause of mortality worldwide by 2030 (Health Quality Ontario, 2012). This disease imparts a substantial burden on affected patients, the health care system and collective society (Mathioudakis et al., 2020).

Data

The use of the data in this project is authorized under section 45 of Ontario’s Personal Health Information Protection Act (PHIPA) and does not require review by a Research Ethics Board. The data used in this study is based on data and information compiled and provided by: the College of Respiratory Therapists of Ontario (CRTO), the Canadian Institute for Health Information (CIHI), the Ministry of Health (MOH), and Health Shared Services Ontario (HSSO). These datasets were linked using unique encoded identifiers and analyzed at ICES.

Using the data provided by the CRTO, anonymized RRT employer and practice data for October 2019 was obtained for all RRTs licensed to practice in Ontario at that time. Each RRT reported up to six different work positions, or roles. We examined the distribution of the role characteristics in the five Ontario Health Interim and Transitional Regions as well as the 14 Local Health Integration Networks (LHINs), based on the city where the employer was identified. The Interim and Transitional Regions are new, broad regional groupings of LHINs being adopted by the Ministry of Health (MOH).

RRT Inclusion Criteria

We are aiming to present a descriptive breakdown of the included RRT roles. Employers were categorized into:

  • community respiratory clinic,
  • continuing care (i.e., long-term care, rehabilitation, and other continuing care facilities),
  • hospital,
  • home care, and
  • primary care.

Position types were categorized, relative to clinical care provided to COPD patients, into:

  • home care,
  • patient education/rehabilitation,
  • pulmonary diagnostics, and
  • staff therapist.

For each role we also report the role ‘status’, which describes whether it was full-time, part-time, or casual work. We used this information to estimate the full-time equivalents (FTEs) associated with each role using the following scheme, based on personal communication with the RTSO Executive and Research Interest Group: full-time = 1.0 FTE, part-time = 0.45 FTE, and casual = 0.25 FTE.

RRT Exclusion Criteria

The study excluded RRTs with inactive CRTO status and RRT roles in the following employer name categories:

  • academic institutions,
  • children’s hospitals,
  • other clinics,
  • consulting company,
  • government,
  • medical devices supplier/company,
  • patient transport,
  • working outside of Ontario,
  • professional association,
  • regulatory body,
  • non-profit organization, or
  • research.

We also excluded RRT roles where the practice area was:

  • administration/management,
  • anaesthesia,
  • CPAP care coordinator,
  • consultant,
  • education (didactic, post-secondary),
  • health informatics,
  • hyperbarics,
  • infection control,
  • other,
  • patient transport (i.e., air/land),
  • polysomnography,
  • public health,
  • quality management,
  • research,
  • sales,
  • simulation,
  • telemedicine, or
  • the Ventilator Equipment Pool.

ICES Administrative Data for COPD Patients

The study also incorporates administrative health data obtained from ICES to outline descriptive characteristics of adults aged 35 years and older with COPD in Ontario as of April 1, 2019. These characteristics include sociodemographic characteristics such as:

  • age,
  • income quintile,
  • rurality,
  • LHIN location
  • Ontario Marginalization (ON-MARG) index scores (i.e., instability quintile, deprivation quintile, dependency quintile, and ethnic concentration quintile) and
  • comorbidity burden characteristics such as years since COPD diagnosis,
  • long-term care use in the past year,
  • home care use in past year, and
  • several comorbidities from ICES derived cohorts, and from the ICES COPD research group lead by Dr. Andrea Gershon.

This population of COPD patients was used as the denominator to calculate crude rates of RRT FTEs available per 1,000 COPD patient population.

We further describe health outcomes among the COPD patient population over 1 year (April 1, 2019 to March 31, 2020). The following outcomes were included:

  • all-cause hospitalizations,
  • COPD-specific hospitalizations,
  • COPD-related hospitalizations,
  • cardiovascular-related hospitalizations,
  • all-cause emergency department (ED) visits,
  • COPD-specific ED visits,
  • COPD-related ED visits,
  • cardiovascular-related ED visits,
  • primary care visits,
  • specialist visits to any specialist serving the COPD patient population (geriatricians, internal medicine specialists, and respirologists), and
  • all-cause mortality

We anticipate the study will provide a ‘picture’ of COPD patient access, or lack thereof, to RRTs across the province that can guide staffing projections for the future, thus improving outcomes for patients with respiratory conditions overall. Considering implications of COVID-19 on ICES scientists’ availability, it is anticipated that the study may be completed by Fall/Winter 2021. Stay tuned for more.

Acknowledgements

This study was supported by ICES (https://www.ices.on.ca) which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and information compiled and provided by: the CRTO, CIHI, the MOH, and HSSO (formerly OACCAC). We thank IQVIA Solutions Canada Inc. for use of their Drug Information File. The analyses, conclusions, opinions and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

References

Bennion, K.J., Daniel, S., White, K. & Stucki, T. (2018). Outcomes from the implementation of a pulmonary disease navigator for higher risk patients: In-hospital mortality and 30-day readmission rates.  Resp Care Oct 2018, 63 (Suppl 10) 3008824.

Ferrone, M., Masciantonio, M.G., Malus, N., Stitt, L., O’Callahan, T., Roberts, Z., Johnson, L., Samson, J., Durocher, L., Ferrari, M., Reilly, M., Griffiths, K. & Licskai, C.J., Primary Care Innovation Collaborative. (2019).  The impact of integrated disease management in high-risk COPD patients in primary care. NPJ Prim Care Respir Med. 2019; 29: 8. Published online 2019 Mar 28. doi: 10.1038/s41533-019-0119-9. PMID: 30923313. PMCID: PMC6438975.

Health Quality Ontario (HQO) (2012). OHTAC Recommendation: Chronic Obstructive Pulmonary Disease (COPD) Ontario Health Technology Advisory Committee. Retrieved 25 May 2021 from https://www.hqontario.ca/evidence-to-improve-care/health-technology-assessment/reviews-and-recommendations/chronic-obstructive-pulmonary-disease-copd

Mathioudakis, A., Vanfleteren, L., Lahousse, L., Higham, A., Allinson, J., & Gotera, C. et al. (2020). Current developments and future directions in COPD. European Respiratory Review, 29(158), 200289. doi: 10.1183/16000617.0289-2020

Slack C.L., Hayward, K. & Markham, A.W. (2018). The Calgary COPD & Asthma Program: The role of the respiratory therapy profession in primary care. Can J Respir Ther. 2018 Winter; 54(4): 10.29390/cjrt-2018-018. Published online 2018 Feb 1. doi: 10.29390/cjrt-2018-018 PMCID: PMID: 31164787. PMC6516137.

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