Transcript Long Term Conditions Compendium of

Camden Telehealth
ons 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
CHD
Heart Failure
Camden
Recorded
Prevalence
2008/09
(numbers)
Camden
Expected
prevalence by
2020
1.85% (4,394) 4.80% (10806)
0.51 % (1,207)
0.85% (2648)
Ref: http://www.camdenccg.nhs.uk/Downloads/ccg-public/about-us/boardmeetings/Camden%20CCG%20Governing%20Body%20Agenda%20and%20Papers%20July%2
02013.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-demonstratorprogramme-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
Pilot aims
Financial:
Hospital admission, LOS, GP, A&E
Year 2(200
(25 units)
Year 2
(additional
75 units)
units)
Year 3 (no
additional
units)
£69,286
£277,968
£573,710
£573,710
£51,402
£176,201
£352,414
£352,414
Year 1
current
Revenue / Savings
Other revenue / saving CCG
TOTAL REVENUE / SAVING
Costs / Investment
Pay
Non Pay
TOTAL COSTS / Investment
Comment
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
• Reading near
to parameter
limit
• Outside of
parameters
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
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=l
Waa-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-systemdemonstrator-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 p2936