Since NHS Gloucestershire's telehealth service started in 2011, it has become a highly successful GP-led programme with 80 out of a total 85 practices referring patients to it.
Gloucestershire's population is over 600,000, of whom 60,000 are currently living with a long-term condition such as COPD, diabetes or CHD.
In 2010/11, these conditions accounted for over 4,300 emergency admissions, at a cost of approximately £13.7m.
Help with LTCs
So how can we effectively cope with these pressures while ensuring the best possible care provision and management for patients living with long-term conditions?
For me the answer lies partly in telehealth.
I am an advocate of self-care: the more a patient understands about their condition, and the situations that can arise, the better. The ability to access patients' readings on a regular basis and to identify trends over time, allows me to monitor their wellbeing.
Telecare provides insight into the patient’s overall condition, improving their care by treating the person rather than just the symptoms.
Regular reports on the condition's trend are most important. As GPs, if we see a downward spiral and act on it as quickly, we can reduce the risk of long-term effects.
My practice has fully embraced the technology:
- Each morning we collect telehealth users’ readings
- Users carry out routine checks, such as BP, blood sugar level and answer questions about their general health.
- The system then alerts the clinician to any readings outside the normal range.
Although some of our most vulnerable patients are also monitored by specialist teams in secondary care, we identified those who would benefit from telehealth as determined by set criteria.
While we aim to reduce admissions for patients with long-term conditions, 50% of emergency admissions are handled by Gloucestershire’s out-of-hours service, over which we have little direct control.
With appropriate use of telehealth, I believe patients are less likely to call out-of-hours and emergency services because we can identify any potential problems earlier and provide reassurance.
Of course there are patients who fall desperately ill when there is no alternative to hospital admission.
However, it is important to try to reduce to emergency admissions although, at this stage in the scheme, it is difficult to quantify how many are being prevented.
Partnering with other services
During implementation of the scheme we found that by partnering with primary, secondary and acute care services we could improve the overall level of care for the individuals concerned.
Historically, the patient was simply referred to as the ‘service user’ was left out of the care loop when really they are an active and integral part of the care pathway. Telehealth goes some way to redress this.
Telehealth gives patients the confidence to manage their own condition at home. It has certainly made an impact on those with heart failure and COPD who can often become breathless – something that is exacerbated by stressful situations.
Often their readings lie just outside the normal range, but with telehealth they have the understanding and knowledge that tells them they are okay. They can then relax and avoid seeking emergency advice.
We have a number of heart failure patients who are doing extremely well, especially with keeping their weight down, which I think is potentially keeping them out of hospital. It is telehealth’s self-management aspects that make people more interested and actively involved in understanding their condition.
However, it can sometimes be difficult to get the self-care message across, particularly with diabetes patients.
Telehealth in diabetes
As we become more aware of telehealth’s benefits, I want to see it applied more often in diabetes management.
This may not necessarily keep people out of hospital in the short term, but it will help them gain control and a better understanding of their condition.
People with diabetes who have all the recommended NHS-regulated care will only see a healthcare professional for 3.5 hours a year.
So for nearly 100% of the time they have to look after themselves. GPs have little influence on what these patients do as we see them so infrequently.
An increasing number of diabetes patients are ‘lost’ in terms of how they should be eating, managing their weight and exercising.
For the longer term we should be looking at a more comprehensive level of care for diabetes that includes the use of pedometers and regular weighing so we can record a person’s activity.
This may not need to be provided by existing services and may have no place in the NHS. But telehealth is an opportunity to engage patients with what really matters. After all, the most important thing for most people with diabetes is not their medication, but diet and lifestyle.
Getting the balance right
Telehealth is not a one-stop solution and requires the clinician and patient to cooperate to be successful.
As a practice within a highly successful GP referring programme, I am proud of our progress with telehealth and the ongoing encouragement for our patients to manage their own conditions more effectively.
|Telehealth in Gloucestershire|
- Dr Ian Lake is a GP in Gloucestershire.