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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 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


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?


the spectrum of remote care
The spectrum of remote care





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


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


Follow Up Call

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

Inbound Call


  • 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


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


telemonitoring models
Telemonitoring models

Not an emergency service





different triage models
Different triage models

Centralised technical triage, localised clinical triage (below)

Centralised technical and clinical triage (above)


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


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%


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


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