Telehealth transforming care for CODP patients in rural areas
Argyll and Bute Telehealth Project, Scotland
This Telehealth project began in early 2009 and was specifically aimed at helping elderly people in remote and rural Scotland – in particular the Isles of Bite and Luing – manage their long term conditions better and stay well in their homes longer. For the health services the objective was to avoid unnecessary admissions which can often involve the use of a helicopter for those living on islands. The people who were targeted for the project lived were generally older (range 61-102 years). The mean age was 73 years in Bute and 71 years in Luing.
What is the technological intervention and how does the technology work?
The main solution chosen by Argyll and Bute CHP was Telehealth Solutions’ HomePod. This device enables remote monitoring of patients’ vital signs and answers to questionnaires, on a daily basis, via a secure link to a server accessible only by clinicians. As a result it enables patients to feel empowered to be part of their own condition management.
Depending on condition, the HomePod can be attached to a wide range of peripherals (such as pulse oximeter, scales, sphygmomanometer, glucometer, peak flow meter). This device uses a touchscreen with large white-on-dark-blue writing that prompts users to take vital signs readings, poses questions on their condition, and sends responses to a central server. This server raises alerts to the community nursing team if any combination of vital signs and/or responses is outside pre-set parameters, and provides a full set of data including historical trend analyses for triaging and assessing care plans for patients. These touch screen devices are designed to enable patients to measure and record a range of key variables, including their own weight, body mass index (BMI), oxygen saturation, pulse and blood pressure without on-site clinical supervision.
Information gathered from the patient HomePod is sent securely either wirelessly or via broadband to the Telehealth Solutions secure server that maintained by a third party and behind the NHS firewall. Nominated community nursing teams check this website daily and are alerted to any changes in the patient’s condition, to enable appropriate patient follow up where necessary. Texts and e-mail alerts can also be sent to the clinician to make them aware as soon as possible to any pending alerts.
The innovation of the HomePod
In contrast to many other telehealth implementations, this project combined a number of care methodologies. It completely redesigned the management of COPD patients in Bute by integrating remote monitoring and access to specialist COPD expertise, as well as pulmonary rehabilitation and medicine usage reviews. Tied in with the remote monitoring, the nursing staff has also introduced regular pulmonary rehabilitation classes with a particular focus on those that are being monitored remotely.
Another important innovation is that the use of remote monitoring has enabled the health practitioners to establish a review mechanism allowing nurses to oversee all the patients’ progress and be on hand to give advice when required. This was especially practical given that many patients were living in very rural areas and not in the vicinity of the nearest specialist and respiratory nurse in Oban, which is two hours away from Bute (including a ferry ride), and even further from the Isle of Luing. Nurses were able to provide for full medicine usage review which continues to deliver significant benefits as giving advice on medication has a direct effect on patient conditions.
Outcome of the Argyll and Bute Telehealth program
The Bute community nursing team has become far more skilled in COPD management, including the use of COPD modules at the local university and the introduction of nurse prescribing. As a result, there is now scope for the specialist nurse to begin a new project elsewhere, and to make the changes self-sustaining.
Capturing patient’s experience was also a very important exercise for the nursing staff. What telehealth had done for them and how they are affected by their condition were all comments that were collected by the patients. To capture this Argyll and Bute, together with an external evaluation, ran a digital voices workshop and have now published a selection of digital stories about telehealth that only the storyteller can tell.
Overall the feedback has been very positive, and only a very few amount of patients had difficulty in engaging with the technology. In these cases, this was resolved with further instruction and support. In all, the majority of patients felt consciously aware of a (positive) change in their condition, as well as an enhanced feeling of security about being monitored in this manner. In addition, statistical evidence has shown that admissions to hospital fell by 91%, Attendances at a General Practitioner fell by 41%, and Inpatient bed days fell by a total of 89%.