TELEHEALTH & WIRELESS COMMUNICATIONS
Physical and mental health outcomes This is how the CommonWell
project
described the results in Milton Keynes: “Service users were asked to rate their quality of life by fi lling in a standardised questionnaire called the Short Form Health Survey (also known as the SF-12). This questionnaire asks about physical and emotional health and well-being.
“In Milton Keynes, the project found overall improvement in the Mental Component Score of the SF-12. This means that people felt that their emotional well-being had improved over the course of the trial. There were important differences between men and women, however. Men reported higher levels of emotional well-being than women in the last three months of the project in Milton Keynes.
“On the other hand, the physical well-being of service users in Milton Keynes deteriorated over the course of the project. This might be explained by the nature of COPD as a progressive, life-limiting, chronic disease. A lot of the people who took part in the project in Milton Keynes had quite severe COPD when they started.
“Psychological factors were also examined in Milton Keynes. The psychological measure used was the BASDEC anxiety and depression scale. The results for the BASDEC showed a reduction in depression for service users in Milton Keynes. This is more signifi cant when considering that patients’ health had deteriorated at the same time.”
Baverstock said: “We know with COPD
anxiety is a huge component because of the breathlessness, so sometimes just the reassurance of having that button there is enough and certainly for the patient’s relatives as well who are holding down full-time jobs and have their own families, they’ve got that reassurance knowing there’s another rung of support.”
Early discharge
Referrals for the project came from GPs, practice nurses, the community matron service and the hospital, where monitoring on the ward could be continued at home to free up beds more quickly whilst promoting patient safety.
Hibble described how they set up an early discharge system to “get [patients] home earlier by putting the telehealth support in and knowing that they were safely going to be monitored.”
Evidence showed that the project prevented readmission, with 168 hospital admissions
and 85 GP visits avoided based on the use of telehealth.
“There have certainly been instances now where patients have started to develop a chest infection and the early intervention and prescription of antibiotics and steroids and the follow up after that to make sure they are recovering has defi nitely prevented hospital admissions,” Baverstock said.
Another benefi t of the project is that patients build up “a really clear record of their readings”, making it easier for consultants to see what has been happening with the patient on a day-by- day basis.
Self-management
In the past, telehealth projects have been criticised for creating dependency; once a regular link to clinicians is established, this can sometimes be diffi cult to break.
But Hibble said that the CommonWell project had been “a useful tool to support people with their self management.”
Being able to see the readings meant that patients could relate this to how they were feeling, making them more aware of their vital signs and what steps they could take to prevent an exacerbation of symptoms. This also meant that many people were not then readmitted to hospital, as treatment could be started earlier.
Some patients were at a stage in their disease at which they could self-mange without the use of telehealth. Additionally for certain patients it could inadvertently damage their wellbeing, Hibble explained.
“If they’re very anxious, and the readings are coming up constantly that their oxygen levels are a bit low, then that can actually make them more anxious and the benefi t is outweighed by the anxiety.”
i More stories like this at:
www.nationalhealthexecutive.com/ Care-Pathways
A step up
The hospital has continued to refer patients for telehealth, past the conclusion of the CommonWell project. This is often implemented as a temporary measure to smooth the transition between hospital care and being left to manage their symptoms independently.
“It’s a good ‘step up’ and none of our patients have wanted to get rid of the machine; most want to cling onto it,” Baverstock said.
Although the CommonWell project focused solely on patients with COPD, he stated: “I can see it being useful for lots of other long-term conditions.”
“We’ve realised that this is a useful tool and developed it with other long term conditions,” Hibble added, “for example heart failure and diabetes patients. We’re up to approximately 160 patients at the moment and looking to increase that. There’s evidence that a lot more people can benefi t from it so we’re looking at how we go about resourcing support.
“I think different councils will be looking at different areas; it’s about talking to our colleagues in different areas about the different incidences of the disease and how much we can do to support that.”
Concerning the future of telehealth, Baverstock considered that if used carefully, it could be of great benefi t both clinically and fi nancially.
He said: “I certainly think for COPD, just preventing one admission would probably pay for the unit and its upkeep for a while so just the economics of it are attractive. You’ve obviously got to pick your patients carefully but we can do that – it’s a long term condition that doesn’t just suddenly come out of nowhere. It’s all about preventing the exacerbations and reducing their number. It would pay for itself.”
FOR MORE INFORMATION
Visit
http://commonwell.eu/commonwell- home/
national health executive Jul/Aug 12 | 37
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