The UK population is increasingly diverse. Language, age and other factors mean that traditional methods of communication between clinician and patient are changing. Technology Enabled Care Services (TECS), such as telehealth, telecare, telemedicine, telecoaching and self-care apps, have the potential to transform the way people engage in and control their own healthcare, allowing citizens to monitor their health and activity levels by themselves, so the need to take up valuable clinician time to take basic health readings is no longer necessary.
WMAHSN is investing in a service to show how technology can be utilised in the delivery of person-centred care in the context of patient convenience, patient understanding of condition(s), patient experience, clinical benefits and associated cost benefits (including avoided health/care usage) from the applications of TECS. One method is Florence Simple Telehealth (Flo), which makes use of a mobile phone text service to communicate with the patient. It involves provision of an interactive mobile phone texting service, free to patients, and is used across the UK in general practice, community and hospital healthcare settings. Flo is a particularly popular method, being a very easy to use service, designed by professionals inside the NHS to provide support and advice for patients to manage their own health conditions. Flo combines the expertise of the patient’s healthcare team and the convenience of their own mobile phone, giving prompts and advice to act upon. If the patient needs a little more assistance, Flo helps them to monitor their vital signs such as blood pressure, pulse, oxygen levels and many others.
In 2015/16, the service is being promoted to the whole population of West Midlands via all 22 CCGs and some acute and community trusts, alongside other forms of TECS:
- CCG intelligence packs
- Staying Independent online checklist
- apps (COPD, asthma and diabetes type 2)
- Skype and social media online toolkits (with some direct expert support)
- general awareness of Flo telehealth with some direct support and resources focused in North Staffordshire, Stoke-on-Trent, Stafford and Surrounds and Cannock Chase CCGs related to COPD and asthma.
- Integrated care development continues across participating organisations and now with other interested organisations e.g. interest from community pharmacies in Flo protocols to support the delivery of their New Medicines Service and Medication Use Reviews to support patients, better medicines optimisation and improved patient experience, and avoided healthcare usage
- A vision of how TECS underpins integrated care has been published (Tackling Telehealth 2) which describes different definitions of integrated care and how Flo and other TECS fit in. The draft paper received broad acknowledgment from clinicians around the country and key TECS leads at NHS England. This paper covers the transformative role that TECS can play in creating integrated health and social care systems based around the patient
- Since organisations (CCGs/trusts) took out WMAHSN-related project licences - between April 2014 and March 2015 - 2,489 patients had signed up to Flo, with some CCGs and trusts initially piloting Flo on Stoke-on-Trent CCG’s overall Flo licence prior to their own project licence being funded
- The service hosted events across the West Midlands region - Stafford, West Bromwich, Coventry, Shrewsbury and Worcester - to raise awareness of the range of technology that can support common long term conditions, including COPD, asthma and diabetes, and redress adverse lifestyle habits, using social media, apps, Skype and telehealth. The events were aimed at general practice teams (practice managers, practice nurses and GPs), CCGs and acute and community trust staff. The events covered creating TECS in the NHS and digital delivery in workplace. The events were attended by more than 200 delegates from a wide range of health professionals, GPs, practice nurses, CCG managers and trust representatives. The project team was also pleased to have received the support from the Managing Director of the WMAHSN, who attended the Shrewsbury event
- Heart failure (HF), diabetes and community pharmacy Flo protocols are ready for use. The HF protocols are related to an integrated care project between acute and primary care to upskill GPs in the titration of HF medication. Flo protocols have also been developed with a mental health trust and are now being deployed for pre-vascular dementia, mood management and depression. Pilot protocols being evolved or used are pre-bariatric surgery weight loss, multiple sclerosis, community and secondary care pharmacies– new medicine and medication review services, wound fluid discharge, enuresis and informal carers’ stress.
- There is a wealth of additional interest and further innovations:
- primary care interest in proactive/preventative monitoring of acute HF patients through monitoring of patient submitted data, blood pressure, weight etc.
- wound fluid discharge monitoring in a community setting, alleviating time for clinician to attend patient home purely for this purpose
- acute pharmacy interest in stratifying patients through A&E attendance due to medication issues and using Flo to support the patients with their medicines regime for a period of time post discharge
- anxiety/stress management for carers to support their wellbeing, therefore reducing the chance of failure of care
- Matched funds from Stoke-on-Trent CCG has supported the evolution of the TECS Staying Independent Checklist, a resource to allow health and social care and other professionals, during assessment of an individual’s support needs, identify what TECS are available and suitable for them
- Organisations are keen to learn about broader work around TECS and the programme provides a good opportunity to share, promote and relate learning including Skype, child and adult asthma avatar apps, the TECS referral pathway and other WMAHSN projects including STarT Back, the Manage Your Health app and COPD primary care training, so the Flo programme has developed a wider TECS scope
- The extensive networking undertaken created further interest, links and opportunities in the Flo exemplar project and related TECS
- The capture of patient outcomes has been included in the evaluation with standard feedback captured at point of patient sign up to Flo and at termination and determined points in the Flo protocols.
- The team is also working with each participating organisation to capture and evaluate their patient case studies to build a body of qualitative evidence to share and use to promote further the benefits of Flo
- The Flo data will be used to review patient adherence to protocol/pathway and, dependent upon the LTC, determine any sustained patient outcomes e.g. blood pressure, improved inhaler
- There is a focused evaluation underway.
Dr Ruth Chambers
t: 0121 371 8061