The NHS spends 70% of its budget on the 15 million people who have one or more long term conditions such as heart failure, chronic obstructive pulmonary disease and diabetes.
Evidence shows that appropriate diagnosis, treatment and ongoing support can improve a patient's quality of life, reduce morbidity and mortality, and reduce the length of hospital admissions.
Telehealth monitoring provides support and patient care 'at a distance' by regularly monitoring their health at home. The technique typically involves measuring factors specific to each person's condition e.g. blood pressure for a patient with a heart condition.
There are benefits to both the patient and the medical staff:
- The patient doesn't have to travel to their GP or hospital for routine readings
- The equipment accurately monitors the patient's condition without any staff intervention
- Medical staff can concentrate on those patients whose readings suggest there may be a problem
- Knowing that a medical professional is tracking their progress, allows patients to take control of their life
The following are two examples of monitoring – heart failure and Chronic Obstructive Pulmonary Disease - along with case studies from the patient's perspective.
1. Monitoring heart patients
Heart failure affects at least one in every hundred people in the UK and the number of patients with heart failure is set to rise in the next 20 years, due to improved survival rates in cardiovascular disease combined with an ageing population.
One example of health screening of heart patients is being used by the Community Heart Failure Team, where they have introduced a system to monitor a number of heart failure patients, initially in West Berkshire, with the aim to roll this out across the East of the county.
This particular system involves providing a patient with a small monitor, connected to one or more devices, in their home. On a daily basis, the patient is led through a simple procedure when a range of readings are recorded, such as blood pressure, oxygen levels, weight and pulse.
The system then automatically sends the information back to a monitoring hub, located at the Practice, where skilled clinicians will be alerted to any abnormal readings. They can then call the patient to assess their condition and decide if any further action is needed or provide advice on improvements to their lifestyle.
Case study - Marcus
In early 2013 I awoke in the middle of the night feeling pressure on my chest and it was difficult to breath. My wife called the emergency services and within 5 minutes a bike paramedic arrived and I was soon on my way to Hospital. I was diagnosed with a DVT (Deep vein thrombosis) and PE (Pulmonary embolism) and discharged from hospital.
A comprehensive support package was put in place and, over the following weeks, I was inundated with a series of friendly nurses, of one type or another, and my health continued to improve. One nurse has remained with me throughout, Kerry the Heart nurse, a lovelier individual you could not hope to meet!
Kerry suggested that I was a good candidate for remote telehealth, explaining that it was an internet-based system that allowed the nurses to monitor a patient remotely – I would supply an internet connection and the Health Authority would provide and install the necessary equipment, free of charge.
I was initially a little worried that a remote monitoring system at home would be too complicated, but how wrong I was. The system is very easy to use and potentially portable if I need to be away from home for more than twenty-four hours, but the nurses like to be advised if there will be any break in monitoring, such as taking a holiday.
I have used the system every day and continue to do so. It prompts me to take my vital readings and, once taken, they are automatically uploaded to a central location and reviewed. If any of the readings are abnormal, a nurse phones me, we discuss the reading and agree what action to take.
My telehealth system doesn't directly make any changes to my physical health - the changes it brings are more psychological rather than physical. I "know" when I am having a good day or a bad day because the system tells me.
I still continue to use the system and will probably have to do so for the rest of my life, but being monitored daily removes significant worry and provides me with peace of mind.
If someone is offered a place on the programme, I'd say 'Do it as soon as possible'. The telehealth system is very easy to use and provides peace of mind. Using the system also enables the nurses to monitor you daily without disturbing your life.
2. Monitoring of Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is the name for a collection of lung diseases including Chronic Bronchitis, Emphysema and Chronic Asthma.
Around 23,000 people die from COPD each year (Healthcare Commission 2006) and over 50% of people currently diagnosed with COPD are below retirement age (British Thoracic Society 2012).
The Berkshire West Community Respiratory Team has the primary focus of improving the care of patients with COPD and reducing the rates or admission and readmission to hospital with exacerbations (or flare ups) of COPD. The team consists of both nurses and physiotherapists, who are able to review patients at home, help and improve the patient's knowledge of the disease and promote independence through education and support.
Clinicians are able to refer a patient either for advice or for prevention of admission visits, while patients themselves are able to self-refer once they are known to the team. Patients are either referred to as "Urgent" – where they are contacted within two hours of referral, or "Routine" - where they are seen at home within 5 days of referral.
The patients are then visited at home for a number of sessions until the team member feels they are suitable for discharge and can manage their own symptoms.
Once the patient is due to be discharged by the Community Respiratory Team, their suitability for the IVR telecare model is assessed and, if they are suitable, the Team sets them up on a computer database which means the patient will be contacted by telephone, usually twice a week.
They are asked a set of questions from the computerised system, such as "Are you more breathless today than you were yesterday?" or "Are you coughing more today than you were yesterday?". If the patient answers "Yes" to any question, an alert is sent to the Team and the patient is contacted immediately.
The team currently manages 50 patients and, as the system aims to improve their self-management rather than be a replacement for health care services, they are usually kept on the system for a maximum of 6 months. The result is that monitoring can dramatically help to reduce the need for unnecessary hospital admissions and readmissions.
Case study – Graham
After coming out of hospital, I was referred to the community respiratory team, who were able to arrange an appointment for me to be visited at home. When we moved into our permanent address in West Berkshire, the Telehealth scheme was mentioned to me - I was set up later that day and received my first call almost immediately!
It's an automated system so it just asks me five questions on whether I rate my condition to be 'the same or better' or 'worse' – 'am I more wheezy than the last time?' for example. I then use the telephone keypad to enter, say '2', to tell them it's worse than last time and the system automatically records my details and will alert the staff of the change.
The system is set up to phone me twice a week - the call on Monday checks to see if I've been worse over the weekend, and the call on Thursday spots any problem before the next weekend.
The good thing is that, if you need to go out, the system will continue to call you up to five times throughout the day.
I don't get any feedback unless the nurse notices something that concerns them, in which case they will telephone or call in to see me.
The nurses also suggested changes to my lifestyle, such as attending a six-week pulmonary rehab class twice a week, where everyone can get advice and does moderate exercise at a level that suits them. This has helped me to feel fitter, while the monitoring cuts out the worry for both me and my wife.
If I hadn't had the monitoring, I would probably be up the doctors quite regularly. Instead, it has helped me manage my condition and lets me and my wife get on with our lives.
I've been on the scheme for nearly six months now and will be coming off it soon but, as I will still be registered with them, I am able to telephone them if I have any worries. I will also continue to go the monthly coffee mornings, where I can mention any concerns to the nurse running the session.