The impact of telehealth in clinical practice unit c2
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The impact of telehealth in clinical practice: Unit C2. Dr Paul Rice David Barrett. The challenge of long-term conditions. Conditions most well-suited for telehealth are; Heart failure: 1M sufferers in the UK

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The impact of telehealth in clinical practice: Unit C2

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The impact of telehealth in clinical practice unit c2

The impact of telehealth in clinical practice: Unit C2

Dr Paul Rice

David Barrett


The challenge of long term conditions

The challenge of long-term conditions

  • Conditions most well-suited for telehealth are;

    • Heart failure: 1M sufferers in the UK

    • Chronic Obstructive Pulmonary Disease (COPD): 900k diagnosed, actual figure may be closer to 3M

  • Telehealth also used to support

    • Diabetes: 2.6M diagnosed in the UK, with figure likely to rise to 4M by 2025

    • Hypertension: most common LTC, present in 7.5M people in England

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The impact of telehealth in clinical practice unit c2

Levels of LTC management

DH, 2012

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The challenge of long term conditions1

The challenge of long-term conditions

  • Think of patients with long-term conditions that you have cared for;

    • What particular challenges do their LTCs cause them and their families?

    • What interventions do your and your team carry out to support people with LTCs

    • Are there any examples where technology helps patients live more independently or help you provide care more efficiently and effectively?

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The spectrum of remote care

The spectrum of remote care

Convergence

Telecare

Telehealth

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Telecoaching in ltcs

Telecoaching in LTCs

  • Remote provision of education, coaching, support and advice (usually via the telephone)

  • Can be large-scale, population-wide;

    • Met Office ‘Healthy Outlook’

    • NHSD Twitter Feed

  • Can be focused on specific individuals;

    • Pfizer OwnHealth

    • Barnsley telecoaching service

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Telecoaching barnsley model

Telecoaching – “Barnsley Model”

  • Explain programme & benefits

  • Review risk factors

  • Confirm medical conditions

  • Formulate goals and prioritise

Outbound First Call

  • Review progress towards goals

  • Set goals for next time

  • Check confidence level for achieving goals

  • Coach on barriers, triggers, learn from successes

  • Formulate relapse prevention strategy

  • Invite inbound calls if support needed between calls

Outbound

Follow Up Call

  • Patient/client in control of frequency of calls and level of support required

Inbound Call

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Teleconsultation

Teleconsultation

  • Represents the use of video conferencing to support delivery of care

  • Main applications are;

    • Overcoming geographical barriers

    • Overcoming logistical challenges

    • Overcoming lack of ‘on-site’ specialist support

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What else is out there

What else is out there?

  • Teletriage – remote assessment and triage (NHSD/NHS24 being the best example)

  • Telerehabilitation – remote support for rehabilitation and recovery (e.g. Cardiac rehabilitation)

  • Health kiosks – Open access, public health facilities, supporting lifestyle and behaviour change

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Telemonitoring models

Telemonitoring models

Not an emergency service

Output

Input

Process

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Different triage models

Different triage models

Centralised technical triage, localised clinical triage (below)

Centralised technical and clinical triage (above)

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Why telemonitoring should work

Why telemonitoring should work

  • Closer monitoring of vital signs and symptoms should allow for earlier detection of deterioration

  • Earlier detection of deterioration should allow for earlier intervention

  • Earlier intervention should improve outcomes and reduce reliance on secondary care

  • Self-monitoring should improve patients’ knowledge and ability to self-care

  • Provision of triage and feedback should reassure patients and their carers

  • Better information about patient status should allow practitioners to work more effectively

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Telemonitoring in heart failure

Telemonitoring in Heart Failure

  • Early signs of deterioration in HF include weight gain and increased breathlessness – these can be detected via telemonitoring

  • 2010 Cochrane review demonstrated telemonitoring in HF could reduce mortality by 34% and CHF-related hospitalisations by 21%

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Telemonitoring in copd

Telemonitoring in COPD

  • Deterioration may be detected early through a reported increase in symptoms, reduction in the amount of circulating oxygen or decrease in breathing function

  • Some positive research evidence exists: a recent Cochrane review reports lower rates of hospital admissions with telemonitoring, but suggests that more (and better) research is required

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The whole system demonstrator

The Whole System Demonstrator

  • £31M, Department of Health funded study into telehealth (and telecare) in people with LTCs

  • ≈3000 participants, with ≈1500 in telehealth (telemonitoring) arm

  • Telehealth associated with 45% lower mortality rates and 20% fewer admissions to hospital when compared to control arm (Steventon et al, 2012)

  • Moderate cost savings (£188/year), but that does not include cost of providing the telehealth service

  • Approx £90k per QALY gained

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