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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. 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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  1. The impact of telehealth in clinical practice: Unit C2 Dr Paul Rice David Barrett

  2. 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

  3. Levels of LTC management DH, 2012 C2/2

  4. 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

  5. The spectrum of remote care Convergence Telecare Telehealth C2/4

  6. 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

  7. 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

  8. 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

  9. 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

  10. Telemonitoring models Not an emergency service Output Input Process C2/9

  11. Different triage models Centralised technical triage, localised clinical triage (below) Centralised technical and clinical triage (above) C2/10

  12. 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

  13. 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

  14. 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

  15. 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

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