Camden Telehealth Jennie Symondson Long Term Conditions and Cancer Programme Jennie Symondson

Aims Telehealth Evidence Case studies Camden Pilot

Telehealth Telehealth is the monitoring of a patient’s vital signs and symptoms via technology in their home. Peripherals include, oximeter, BP, weighing scales, thermometer, glucometer Patients take their readings and answer a series of health questions Information is transmitted to a clinical triage centre (CNWL Milton Keynes) Nurses will verify the results, complete a phone assessment and only refer to Camden clinicians if required

Statistics 15million people LTC in England (total population 53m) Expected to rise to 18million by 2025 2010 est. the following 70% of the total health & social care budget spent patients with LTC’s 50% of all GP appointments 65% of all out patient appointments 70% of inpatient bed days Ref: DH 2012 Long Term Conditions Compendium of Information, 3rd ed. London:Available at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_134486.pdf

Camden data Table 11: Recorded and expected prevalence of selected conditions as of 2008/09 Disease Register Camden Recorded Prevalence 2008/09 (numbers) Camden Expected prevalence by 2020 CHD 1.85% (4,394) 4.80% (10806) Heart Failure 0.51 % (1,207) 0.85% (2648) Ref: http://www.camdenccg.nhs.uk/Downloads/ccg-public/about-us/board-meetings/Camden%20CCG%20Governing%20Body%20Agenda%20and%20Papers%20July%202013.pdf

Telehealth evidence The Whole System Demonstrator (WSD DH 2011) was the largest randomised control trial of telehealth & telecare in the world 6191 patients 238 GP practices Newham, Kent & Cornwall Heart failure, COPD, Diabetes Reference: https://www.gov.uk/government/news/whole-system-demonstrator-programme-headline-findings-december-2011

WSD outcomes 15% reduction in A&E 20% reduction in emergency admissions 14% reduction in elective admissions 14% reduction in bed days 45% reduction in mortality rates

CHF evidence Telemonitoring reduced all-cause mortality, hospitalisation, and increased adherence to treatment plans (Cochrane Nursing Care Field 2011, Nakamura et al 2014, Barrett 2012) Remote medication titration is feasible & safe (Steckler et al 2011) TH not only monitors but empowers & motivates individuals, giving them greater control over disease management (Barrett 2012)

Camden case study (JS of NW1) using telehealth since April 2011 COPD, glaucoma, and experiencing hypertension GP made referral to the district nurse team to monitor blood pressure once per week for 4 weeks. CNWL resp nurse informed GP that JS has TH & printed off BP report GP able to prescribe meds instantly

Pilot scope Commissioner led project Small scale - 25 units from 14th July 2014-July 2015 COPD & CHF Integrated working- CCG, CNWL & LA

Pilots aims Pre-telehealth user survey Patient/carer satisfaction: Self-management skills, mental state, function & personal goal Staff satisfaction

Year 3 (no additional units) Pilot aims Financial: Hospital admission, LOS, GP, A&E   Year 1 current (25 units)   Year 2 (additional 75 units) Year 2(200 units) Year 3 (no additional units) Comment Revenue / Savings Other revenue / saving CCG TOTAL REVENUE / SAVING £69,286 £277,968 £573,710 Costs / Investment Pay Non Pay TOTAL COSTS / Investment £51,402 £176,201 £352,414

Pathway Patient identified according this eligibility criteria One or more Long Term Condition/s. Known to CNWL Camden service (or eligible for) Patient/carer is: physically and cognitively able Interested, motivated. Capacity to understand TH not emergency service (mon-fri only)

Pathway continued……. Assessment, referral Patient consent & leaflet Set parameters for patient Send letter to GP & LAS informing of TH Patient data prev. year e.g. hospital admissions

MK Triage Missing data, no data Clinical assessment TECHNICAL TRIAGE- re-test, arrange repair CLINICAL TRIAGE Clinical assessment Advice Rescue pack (highlight ref form) Update GP Call ambulance Refer to Cam before 1pm via Rapids Reset parameters Training Discharge Missing data, no data Reading near to parameter limit Outside of parameters

Next steps Evaluation Set up hospital discharge pathway Upscale to 100 units 2015/16 Decide if GP surgery wants access to ICP Launch event 30.07.14 St Pancras 2-5pm

HF Case study Heart failure, NHS North Yorkshire & York http://www.youtube.com/watch?v=lWaa-o9rG5o

Questions

References Barrett A (2012) Benefits of Telemonitoring in the care of patients with heart failure. Nursing Standard Vol 27 no 4 DH (2012) Long Term Conditions Compendium of Information, 3rd ed. London: Available at: www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_134486.pdf DH (2011) Whole Systems Demonstrator. Available at: https://www.gov.uk/government/news/whole-system-demonstrator-programme-headline-findings-december-2011 Holly C (2011) Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Nursing Care Filed. International Journal of Evidence-Based Healthcare Vol 9 Nakamura N, Koga T, Iseki H (2014) A meta-analysis of remote patient monitoring for chronic heart failure patients. Journal of Telemedicine & Telecare Vol 20 p11-17 Steckler A E et al (2011) telephone Titration of Heart Failure Medications. Journal of Cardiovascular Nursing. Vol 26 No1 p29-36