Monitoring for people with COPD, heart failure or type 2 diabetes

Telehealth is a service for people living with chronic obstructive pulmonary disease (COPD), heart failure or type 2 diabetes.

According to Carol Hughes, Mersey Care’s health technology and access services manager: “Its nursing done in a different way.” Telehealth enables the patient or carer to take vital signs such as blood pressure, pulse, body weight, oxygen levels at home. Through the use of technology, patients also answer simple questions about their health. Answers to the questions are linked to an algorithm which can flag any issues that may need further attention.

The information is monitored remotely by healthcare professionals enabling them to provide support if required.

There are different options for the technology used in the patient’s home. The service can be delivered through a TV or tablet. If the patient does not own a tablet, the service will loan them a tablet-style device designed to meet the needs of elderly patients. The device is 4G enabled so an internet connection is not vital. All the peripheral devices, such as the weighing scales, use Bluetooth to connect.

The system triages patients and puts them in order of priority for nurses to review and follow up as necessary. This includes providing advice over the phone, continuing to monitor or referring the patient to another service, such as the GP.

Carol Hughes says the service “is about more than monitoring - coaching and education are important elements of the service”. The system sends structured videos and information to patients helping them to understand and better manage their conditions.

Liverpool GP, Dr Tristan Elkin, said: “A key benefit is that Telehealth allows people to stay well at home and encourages independence and confidence in their condition”.

How was it developed?

Work began with a small pilot service with 50 patients in 2011/12. Over the next three years, supported by Innovate UK, the service expanded to more than 1,600 patients and is now a commissioned service. Some 8,000 people have accessed the service to date.

During the development phases, insight work led to the creation of patient profiles which were then used to inform the engagement with patients and potential users of the service. Patient feedback is used to continuously improve the service.

Who is using it?

The service is offered to people with COPD, heart failure or type 2 diabetes who are referred by a Liverpool GP or who are referred on discharge from hospital. Patients can choose to not use the service.

On referral, patients are visited by a nurse who assesses their ability to use the equipment. For example, if they can manage the technology and equipment, talk on the phone and read messages on a screen.

On average, the service has 160 new patients each month. The intention is that people use the service for as long as they need it - usually a few months or until they are ready and more confident to manage their health conditions. Plans are being developed for a step-down and light-touch service for people who need to keep a degree of support while they transition to independence.

Lily Jones, who has a number of health conditions including COPD and angina, said: “Telehealth has been a great support and helped me stay at home. It has given me more confidence because I know somebody is there if I need them. It has stopped me going back into hospital because it’s told me things I didn’t know I had, and I’ve been able to get them sorted.”

Outcomes

A survey found that 30 percent of people who had used the service made lifestyle changes, such as taking more exercise or changing their diet, and 39 percent said that they felt their health had improved through engagement with the telehealth service. 2,006 people completed the survey between November 2017 and May 2019.

Patient Reported Outcome Measures (PROMs) data shows a reduction of 37 percent in GP visits and a reduction of 39 per-cent in hospital visits; quantitative data shows a reduction of 25.3 per cent in hospital admissions in the last 12 months (May 2018 to June 2019).