1. Clinical issues in telehealth: Unit M2 Dr Paul Rice David Barrett

2. M2/1 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 conditions

3. M2/2 Levels of LTC management DH, 2012

4. The spectrum of remote care TelecareTelehealth Convergence M2/3

5. 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 M2/4

6. 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 M2/5 Teleconsultation

7. 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 M2/6

8. Telemonitoring models InputProcess Output Not an emergency service M2/7

9. Different triage models M2/8 Centralised technical triage, localised clinical triage (below) Centralised technical and clinical triage (above)

10. 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 M2/9

11. 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% M2/10

12. 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 M2/11

13. 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 M2/12