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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

C2/1

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?

C2/3

the spectrum of remote care
The spectrum of remote care

Convergence

Telecare

Telehealth

C2/4

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

C2/5

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

C2/6

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

C2/7

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

C2/8

telemonitoring models
Telemonitoring models

Not an emergency service

Output

Input

Process

C2/9

different triage models
Different triage models

Centralised technical triage, localised clinical triage (below)

Centralised technical and clinical triage (above)

C2/10

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

C2/11

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%

C2/12

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

C2/13

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

C2/14