TELEHEALTH TELEHEALTH IN PRACTICE


Highland population demographics, an increasing elderly population, geography, and sparse population density mean that the logistics of providing healthcare can be challenging, especially to those patients in remote and rural areas. This is further compounded by recruitment diffi culties of healthcare staff to these areas. Telehealth technologies have been shown to benefi t the care of remote and rural patients, therefore, in April 2015, NHS Highland, in conjunction with NHS 24, set up a remote, clinical pharmacy service to fi ve GP practices in Lochaber.


‘Lochaber was chosen as previous work carried out by Scottish Centre for Telehealth and Telecare and the NHS Highland dementia team, who had set up a remote dementia clinic for care home residents, meant that facilities were already in place,’ says Patricia Hannam, telehealth lead pharmacist for NHS Highlan. ‘And, with a lack of recruitment of a primary care pharmacist locally, it was the ideal place to test if a remote, primary care, clinical pharmacy service could be provided with a pharmacist recruited centrally.


be rolled out to 300,000 households. The £10 million NHS ‘telehealth’ scheme, which is mainly aimed at elderly patients with conditions such as diabetes or heart and lung complaints, has been given the go ahead following a successful trial in Ayrshire.


The use of the devices there saw a fall of up to 70 per cent in hospital admissions as doctors were alerted to any deterioration in patients’ conditions at an early stage avoiding the need for emergency treatment.


Established telecare services are in place throughout Scotland. In the NHS Highland Region there are more than 4,000 telecare service users. The Highland Hub provides the support for telecare in the Highland Region of Scotland. As well as being the call centre for telecare emergency alerts, the Highland Hub currently provides a co-ordination and management function for Primary Care Out of Hours (OOH) responses and NHS24 triage services across four Health Boards (NHS Highland, Shetland, Western Isles and Orkney).


‘My work is to perform medication reviews and provide prescribing support to fi ve GP practices and their four care homes. This is done from my offi ce base, Larachan House, Dingwall, 100km away from these GP practices.’


Patricia’s fi rst task was to create remote access with the GP computer systems. With the help of the NHS Highland eHealth team and the support from the Scottish Government, direct remote access was set up to three practices and shared desktop access to two practices. Ongoing work is looking at how to link with other GP practices remotely as the service develops.


‘The fi rst stage of the work is to perform medication reviews of care home patients,’ Patricia continues. ‘Future stages are to review Care at Home patients and other GP practice patients who would benefi t from a pharmaceutical review, eg, the frail and elderly, patients on multiple medications and, those at risk of falls. This supports the aims of promoting


self-care and helping patients to stay healthy and in their own homes for longer.


‘To perform a medication review, I access the patient’s records on the GP system to check their current medication, allergies and conditions, I check their blood and test results and review that each medication has a current and valid indication for that patient. Having access to the full patient record means that I am able to check their history to answer any queries which their treatment brings up.


‘I then arrange a pharmacy medication review clinic via video-conference with the patients. At the clinic I am able to assess the patient’s understanding of their medications, ask if they have any problems or questions and check for adverse drug reactions. We then discuss a plan for their medication and, if there are any changes agreed, this is then fed back to the GP in the form of a pharmaceutical care plan for the GP to agree and action. At present, prescribing remotely is not technically possible in Scotland however work is being done nationally to enable this. Being an independent prescriber, a future development would be to make changes to the patients’ medication on the GP system directly.


‘So far the service has been well received by patients and staff and I fi nd that telehealth is an enabler to collaborative working; clinicians can meet together virtually in a way that wouldn’t be possible physically. I regularly join multidisciplinary clinics and team meetings via video conferencing, for example, from Dingwall I regularly join clinics run by the Highland Hospice in Invergordon or New Craigs in Inverness to care homes in Lochaber.


‘All of this work is line with government vision and Prescription for Excellence which recommends greater involvement of pharmacists with GP practices and promotes telehealth technologies. Also, putting the patient at the heart of the medication review and decision making follows the principles of patient centred care.’


Over in NHS Shetland and Orkney (which has a population of around


23,000) , meanwhile, Anthony McDavitt, Primary Care Pharmacist at NHS Shetland, has established a telehealth initiative which he believes is necessary because pharmacy services in the area need to be planned and delivered differently in order to meet specifi c local need.


‘The population of NHS Shetland is very small,’ Tony told SP, ‘but it’s also widely dispersed and it faces its own individual issues. The island geography, for example, can prove challenging. Also, at the moment, about a quarter of the population is over 65, although it is estimated that this will grow by 40 per cent over the next 25 years. Similarly, around fi fteen per cent of the population is over 75 and this fi gure is expected to grow by an astounding 130 per cent over the same period of time. Population morbidity and polypharmacy are naturally going to increase, so it was obvious that what we needed was a community and managed pharmacy service that has the ability to deliver pharmaceutical care face to face and remotely across all care settings.


‘The obvious solution is telepharmacy/ telehealth, which is carried out through VC and which facilitates remote access to pharmacy services, so about two years ago we decided to trial the use of this technology across both the board and the local authority. Prescription for Excellence had led to the setting up of working groups and these groups began to trial using mobile technology in care homes to carry out polypharmacy reviews at regular intervals.


‘These monthly sessions involved myself as the NHS Shetland clinical pharmacist, the community pharmacist and the care centre and took part through VC facilities. As a result, patients in care centres are now regularly reviewed at half-hour ‘catch up’ meetings, where we can implement changes to prescriptions or answer patients’ queries. The pilot was carried out using the community pharmacy at Scalloway and the Island care centre at Whalsay and there’s no doubt that using this technology has improved access for patients.’ •


SCOTTISH PHARMACIST - 57


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