Telehealth for COPD in Stoke NHS commissioner perspective

By Adem Lewis / in , , , , , /

Well, our local hospital’s got a vision for
over the next ten years and they are aiming for fifteen percent of their care to be delivered
remotely. So I would have thought that’s a really good sort of percentage and challenge
and instead of saying ten years sort of bringing it forward to two or three years. It would
be good to see if we could do that safely. I’m the Clinical Lead at the moment for the
role out of where we’ve used Flo Telehealth across the Country and we are just looking
at the results now really. The first 3000 patients that we’ve looked
at, for instance, with hypertension one of the very popular protocols was whether or
not we had helped people, who appeared to have high blood pressure in our practice but
we weren’t quite sure whether or not they really had hypertension and NICE guidance
says that you can use home blood pressure monitoring or ABPM machines if you are going
to diagnose them with hypertension and that particular one, we found about forty percent
of the patients across England, in the practices that have used it and we’re talking about
thousands of patients had not got hypertension so that was quite easy then for the practice
nurse just to text them or phone them and tell them they’d not got hypertension, please
drop in your machine and um, in that way we saved about forty percent of the consultations
as an example. So that was great and also with COPD in my practice, we’ve been showing
how we’ve managed to trigger rescue medication at just the right time which has really prevented
patients deteriorating and obviously then avoiding, hopefully, an admission to hospital.
So we’ve got practice nurses that lead on particular areas like diabetes, hyper-tension,
respiratory and are tending to work with the nurses and health care assistants over specific
protocols like COPD, asthma, smoking cessation and that way we make sure that they’ve got
time booked out to sign the patients up and look at regular reviews over the, um, server
and then sort of contact the patient remotely and that’s worked out very well in our practice.
Um, on the whole because I’m a busy GP, in a deprived area, um, if it can be devolved
to the nursing team then that’s what I find the most easiest and I think that most GP’s
do that. Uh, I think the main challenge is getting
organisations to work together, so at the moment with our West Midlands Academic Health
Science Network funded projects, we’ve got locally the acute trust to work with the community
trust , mental health trust and three CCG’s and now we are bringing in the two City Council
and County Councils as well and that’s quite difficult because everyone’s got different
computer systems and they’ve also got different targets, um and you’ve also got to be showing
it’s efficient, effective, productive and cost effective but the other main, um, challenge
is getting people to embrace innovation as part of their everyday delivery and that’s
with keen and not so keen practitioners as well as practices and units within the hospital
and so on. Um, well starting off, um, it was part actually
with a practice based commissioning and we were looking really as a local area to commission,
uh, the, uh, help and resources that we needed but as time’s gone on then I became a lot
more interested in a whole range of different kinds of Telehealth and that ranges from an
avatar that we’ve recently commissioned help with from Keele University which is helping
children with asthma understand their conditions more and it’s all very focused on what that
patients age groups perspectives are and their needs are to Flo Telehealth which is more
about mobile phone health texting and the interactivity that you can set up between
patient and clinician and then also trying to set up video consultations in a safe way
that, um, includes all the information governance, um, for patient’s confidentiality and security.
The whole system demonstrated was evidence and it’s the biggest evidence base that we
have so far on telehealth. It was looked at on technology that was, um, slightly older
than we have now and the doctors and the GP’s are still looking at that evidence base as
the staple that it is. What we have to do is we have to explain to them that, that was
some time ago, things have moved on. Patients tell us that telehealth is a really
good thing to do and the challenge, mainly, is to get over that telehealth is simply an
I.T. thing, that it’s just a computer solution. It’s so much more than that and when you link
it in to the care pathways, it is a strategic enabler that will allow patients to have control
and understand their health condition and help the doctors to manage it and the nurses
to manage it as opposed you do this, yes doctor we’ll do this.
In the NHS, currently, resource is very scarce. On the commissioning side we are forty percent
less staff then we were but there isn’t any less work but the clinicians and the doctors,
the GP’s there seeing more patients than ever before, up to sixty patients a day for GPs.
As we knock on the door of 2015, where everything is web based, online and I.T. solutions have
moved on, um, anything that assists clinicians and patients to utilise something different,
we can’t keep carrying on the way things were done before, it’s got to be done differently
and telehealth gives us, the telehealth assisted technology gives us an extra resource that
we didn’t have before that we can utilise, as long as it’s utilised correctly and obviously
safety wise.

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