1. CNWL Camden
Telehealth and
Managing Your Medicines at Home

2. Camden Telehealth

3. Telehealth is……
Telehealth is the monitoring of a patient’s vital signs and symptoms via technology in their home.
Peripherals include, oximeter, BP, weighing scales, thermometer
Patients take their readings and answer a series of diagnosis specific questions
Information is transmitted to a triage centre
If required, a nurses will verify the results, complete a phone assessment, and if necessary, visit the patient at home

4. National Hospital Admissions
In England, those with COPD and HF have the highest rate of emergency admissions and re-admissions
90% of all admissions treated as an emergency.
HF related hospital admissions are expected to rise by 50% over the next 25 years (Gnani & Ellis 2001).

5. Initially a tool for CNWL respiratory & HF clinicians
Camden Telehealth
Initially a tool for CNWL respiratory & HF clinicians
Yet some patients suitable for TH are not necessarily under the care of CNWL Camden
Telehealth for observations, reablement, & admissions avoidance for COPD
Of the additional qualified nursing agency spend 27% of it is due to additional investments in Month 10. The majority of this investment is with in the Camden Community Team.

6. THORAAC outcomes Dedicate clinician enabled us to manage patients:
CNWL respiratory team
GP high risk registers
Hospital discharges
2 approaches
Clinical Monitoring –long or short term
Education –short term

7. THORAAC Outcomes Pathway Total no patients GP appts saved
Av. per patient
Hosp. admissions saved
Av. Per patient
Hospital discharges 5 42
8.4 12
2.4
GP risk Reg. 1
Post PR 13

8. Heart Failure Successes
Service evaluation currently underway
However CCG data demonstrates:

9. THORAAC Patient Feedback
‘‘I think I tend to be kept longer in hospital than I would have thought. The most worrying thing is my oxygen levels so if someone is watching that then I would be happy to be discharged earlier. What happens in hospital my oxygen levels are fine because everyone is doing everything for me. I don’t have to make a cup of tea, I do nothing for myself.’
Comforting to know things are alright' ‘
When you’re on your own you can panic sometimes, I thought it was great.'

10. Continued……
'I wouldn’t know unless I had one of them machines, I wouldn’t know if I was getting ill. Would need to use it longer term but only 2-3 times per week.'
'The questions after are programmed to also detect any problems. I would like to use it again and have the thermometer this time. Having a combination of a few readings is good as I don’t always get a temperature when ill. Also I don’t want to take antibiotics unnecessarily. I miss it as I don’t always like to call for help. I’m a carer for my wife as she has early stage Alzheimer’s so don’t want to be in hospital.'

11. Plans
Incorporate other patient groups that the CCG have stated are a priority for digital health: diabetes, chronic kidney disease, anticoagulation
Telehealth hub will manage on a needs basis: those that have been admitted to hospital & those that would benefit from learning self-care skills
Referral form will be added to CCG website

12. Managing Your Medicines at Home

13. 2015/16 Pilot Aims Operational for 4 months form Dec 15
Led by pharmacy technician
Aim to support Medicines Optimisation (MO);
reduce medication risks
support adherence
promote independence & self management of medicines

14. MYMAH Referrals 60 referrals received 50 patients assessed
36% referrals from GP’s
Non-adherence, promoting independence & education most common reasons for referral

15. MYMAH Statistics

17. Outcomes
In 30 out of 50 patients had their risk of medication error reduced

18. Patient/Carer Feedback
'I had difficulty opening packets – could do it but it took some time to open. Technician provided a gadget to get tablets out of packets which is very useful. But it doesn’t work on the bigger tablets.'
'The guy that came was a darling, mum really took to him, he was really good at explaining to older people'.
‘Patient was discharged from hospital and whatever advice was provided at that time was not retained as there were too many things to remember. Daughter feels its a relief having someone visit the home to discuss when everything was topsy-turvy. More info is gathered at the home. It was a very helpful service. When someone is housebound every little helps'
'Patient said she is very thankful for all the help she receives. Technician was a very nice man, he even phoned afterwards to check we were ok, shows that he cares. People are really trying to help us, I would recommend'
‘Mum had a blister pack but I noticed some tablets kept being missed as she was forgetting. She was given a pivotell 3 months ago , I have to fill because the chemist wont do it. But its brilliant, she absolutely loves it, she calls it her little chemist. Now she talks meds independently.'

19. Next Steps Recruit pharmacist initially & then pharmacy technician
Work across Camden
Re-launch service
Scope of service includes:
Support medicines adherence & understanding of their medicines
Targeted medicine reviews
Partnership working across agencies to support MO
Incorporate MYMAH service into IPC central referral pathway
Reduce medication risks & utilisation of emergency services due to avoidable medicines errors/ adverse reactions
Defined key outcome measures

20. Questions