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

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Presentation on theme: "The impact of telehealth in clinical practice: Unit C2 Dr Paul Rice David Barrett."— Presentation transcript:

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

2 Learning outcomes By the end of this session, you will be able to; – Analyse the evidence base for telemonitoring in long-term conditions – Describe the clinical applications of telemonitoring, telecoaching and teleconsultation in the care of patients with long-term conditions

3 C2/1 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

4 C2/2 Levels of LTC management DH, 2012

5 C2/3 Think of patients with long-term conditions that you have cared for; – What particular challenges do their LTCs cause them and their families? What characteristics do you see (or would you expect to see) in a high quality LTC care system? The challenge of long-term conditions

6 Ten characteristics of a high performing chronic care system Chris Ham (2010). The ten characteristics of the high performing chronic care system. Health, Economics, Policy and Law, 5, pp 7190 doi:10.1017/S1744133109990120 1.Universal healthcare coverage 2.Care free at the point of delivery 3.Focus on the prevention of ill-health 4.Priority is given to supporting self-management 5.Priority is given to primary care 6.Population management is emphasised 7.Care should be integrated 8.The potential benefits of IT should be exploited 9.Care is co-ordinated effectively 10.Characteristics 1-9 linked as part of a coherent strategy C2/4

7 The spectrum of remote care TelecareTelehealth Convergence C2/5

8 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 Pfizer OwnHealth – Barnsley telecoaching service C2/6

9 Telecoaching – “Barnsley Model” Explain programme & benefits Review risk factors Confirm medical conditions Formulate goals and prioritise 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 Patient/client in control of frequency of calls and level of support required C2/7

10 Represents the use of video conferencing to support delivery of care Main applications are; – Overcoming geographical barriers – Overcoming logistical – Overcoming lack of ‘on-site’ specialist support Which of your care interventions would suit teleconsultation? C2/8 Teleconsultation

11 Why teleconsultation works in stroke assessment The expertise to provide acute stroke care is not available everywhere 24/7 Telephone consultation isn’t good enough – 38% of patients treated in a community hospital with phone consultation support had deviations from treatment protocol (Uchino, 2010) Video consultation is good enough to safely prescribe treatment Uchino K, et al (2010) Protocol Adherence and Safety of Intravenous Thrombolysis After Telephone Consultation With a Stroke Center. Journal of Stroke and Cerebrovascular Diseases 16:6; 417-423Journal of Stroke and Cerebrovascular Diseases C2/9

12 The use of teleconsultation in stroke care C2/10

13 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 C2/11

14 Telemonitoring models InputProcess Output Not an emergency service C2/12

15 Different triage models C2/13 Centralised technical triage, localised clinical triage (below) Centralised technical and clinical triage (above)

16 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 C2/14

17 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% C2/15

18 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 C2/16

19 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 C2/17

20 What we still don’t know… Even if we assume broad benefits of telemonitoring in LTCs, we still don’t really know; – Which groups benefit the most – How long remote monitoring should remain in situ for – The best clinical model for implementation – What we should be measuring – Why it works! – Whether it is more effective than other areas for investment Goodlin, S. J. J Am Coll Cardiol 2009;54:386-396 C2/18

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