Technology enabled care is a must for delivery of care for long term conditions- now!

Transcription

1 Technology enabled care is a must for delivery of care for long term conditions- now! Professor Ruth Chambers OBE WMAHSN Clinical lead for LTC priority

2 The challenges Number of Conditions 1 % self reporting 1 30% 2 13% 3+ 10% The 15 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorbs 70% of NHS and social care budgets in England 1. The percentage of people aged 18 and over self-reporting experiencing long-term conditions in the GP Patient Survey

3 People with multimorbidity do not feel enabled by healthcare encounters In a study of over 3,000 GP consultations, patients with multimorbidity (compared to those without) had : More problems to discuss, which were more often complex (a mix of physical, psychological, and social); Yet Consultations were not longer for people with multimorbidity; and Patient enablement was lower; These findings were worse in deprived areas, and GPs in deprived areas reported more stress in and after the consultations

4 Implementing technology enabled care in any health/social care setting skype encrypted video consultation apps telehealth social media 4

5 Organisational challenges

6 Affording & organising types of technology enabled care: right treatment for LTC, right delivery, right time, right team, right intensity, match to person. Personal responsibility & self care eg apps

7 How NHS and social care professionals can provide LTC care Patient focused: TECS Integrative and innovative Pharmacies apotek Community Trusts Home visits Skill mix Acute care Incentive schemes PV-områden Practices(6) Trusts acute/mental health Other service providers Social care teams People with LTCs LTC reviews Reminders for interventions Clinical pathways/ protocols Patient groups Patient empowerment/ Better clinical outcomes

8 Local authority Public Health England Local Area Team/NHS England CCG Commissioning Support Unit Public Health Patient GP practices + other independent contractor practices (including dentistry, pharmacy, optometry) Social Care Emergency services End of life care Direct Ambulance service Out of Hours services (SDUC/ NHS111) Community services Mental Health Emergency portal Secondary care Elective referral Other initiative Home Discharge GP Partnership Trust Community District Nurse team Social care Community services

9 Extent of responsibility for delivery of integrated & connected care via TECS 1.Shared real time responsibility by 2 clinicians/ social workers, in different organisations/settings share TECS directly (same mode of technology or connected if different) for delivery of an agreed shared care plan of same patient/ same condition at same treatment phase (clinicians/ social workers have agreed responsibility via shared care plan agreed by patient, that optimises patient responsibility for their own care) 2. Shared sequential responsibility: 2 clinicians/ social workers, in different organisations/settings interface; so one hands over responsibility to the other for providing TECS directly (same mode of technology or different) for continuing care of same patient/same condition via agreed care plan.(this might be by the most senior/expert defining the patient pathway and endorsing the TECS protocol for others to provide with real time support eg advice in person/by ; with shared care plan agreed by patient, that optimises patient responsibility for their own care.) 3. Shared multidisciplinary protocol with one TECS operator: 2 clinicians/ social workers, of different disciplines, in same organisation or setting; sharing (delegated) responsibility for providing TECS directly ( 1 mode of technology) for continuing care of same patient/ 1 conditions via agreed care plan. (This might be by the most senior/expert defining patient pathway and endorsing TECS protocol(s) for others to provide with real time support eg advice in person/by ; with shared care plan agreed by patient, that optimises patient responsibility for their own care.) 4. Shared delivery by individual professional with patient/carer: TECS initiated & delivered by health /social care professional who updates other health/social care professional(s) or teams involved in the patient s care (ie giving information rather than interactive decision making between professionals). It might be that a patient requested the inclusion of their personal technology such as an app in their health or social care, that the initiating health/social care professional has adopted; with shared care plan agreed by patient, that optimises patient responsibility for their own care. 5. Person selects and purchases own technology to support or improve their own health and/or social care and/or lifestyle habits: they may include goal setting, reminders, records of feelings/bodily measurements etc, action plans, information about best practice. They may or may not share their personal information/record keeping generated by the technology (eg health app) with a health/social care professional.

10 Organisation s vision What we mean by quality Organisation;s strategic goals What care will look like for service users Alignment with national strategic direction I will know when my needs change Improve experien ce & outcome s My care & treatment will be coordinated Effective Work with service users & carers Personali sed Care of the Highest Quality Positive experien ce Innovativ e services supportin g independ ence I will get the best possible treatment & I will feel in support to to suit me control of recover managing my health & Care Safe Empowe red & supporte d workforc e I will always be treated with compassion, dignity & respect Improve efficienc y & producti vity I will feel safe but if things go wrong I will be told The feedback I provide will be acted upon Remote consultations Tele-diagnostics Telehealth (home monitoring) Telecare (Supporting independence) Online digital support & Mobile Apps Unanswered Questions How do we identify the needs of our service users with regard to technology? How do we determine what type of technology meets the needs of our service users? How do we evaluate what works well? How do we know what represents good value for money? How do we know we are making a difference? How do we ensure workforce have skills & competencies to embed technology? What interdependencies are there with health economy infrastructure plans? How do we prioritise where to start? How do we ensure engagement & Buy-in to work in new ways?

11 Tele care & promoting independence Tele video consultations & remote diagnostics Online self management & Mobile Apps Telehealth & Home Monitoring Risk stratification must be used to determine what fits where Level 3 5% High level of professi onal support Video consultation s & video therapy Telediagnostics E- consultatio ns & messaging Palliative care Level 2 15% medium level of professional support. Need to identify those that can use technology to support self management Home monitoring with professional support Self care websites Wound & management online solutions Self monitoring, using advice Medicines management Wound management Support for families & carers Level 1 80% self management support support for whole population to remain independent and informed with aim of identifying when needs increase Mobile Apps Text based support Telecoaching

12 How Flo Simple Telehealth can support the whole patient pathway Supporting people at home Enhanced support at home Manage Crisis Effectively Specialist acute input Manage step down from acute effectively Enhanced support at home Supporting People at Home Home Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management Worried Well INR Weight loss motivational messages Health self assessment Unstable Hypertension Support* Newly diagnosed hypertension Medication Reminders for: - Hypertension / Ashma inhaler / pain management Paediatric ashma COPD Diabetes (type1& 2) Heart Failure Palliative care carer support/wellbeing Falls prevention Crisis Acute Trf of care EMAS unstable vital signs monitoring Oncology Neurology Speech therapy Alcohol support Learning disabilities Mental health behaviour Mental Health appt & medication reminders/ supportive messages Daily living/ medication reminders for people with Aspergers/autism Pregnancy induced hypertension Gestational diabetes COPD CHD Diabetes physiotherapy Monitoring of pre op patients to reduce cancelled operations Out patient acute specialist follow up DNA management Support early discharge Virtual Wards Intermediate care Step down facilities Unstable vital signs monitoring Medication management Support As * Home Long term hypertension Smoking Cessation Long term vital signs monitoring Care Homes Pain Mment Medicines Management Worried Well INR Weight loss motivational messages Health self assessment Sexual health Sexual health

13 1 Hypertension prevalence Simple Telehealth Flo Driver for TECS via CCG intelligence pack Stoke-on-Trent CCG Similar CCGs 10+1* (range) NHS England average TECS exemplar you can try 2 Stroke & BP not <150/90mmHg % 8.5%-10.7% 9.7% Simple Telehealth Flo 3 Asthma prevalence (all ages) 3 6.3% 6.0%-6.8% 5.9% Simple Telehealth Flo 4 Emergency children asthma admissions 3 (per 100,000 resident population) Simple Telehealth Flo, App, Social Media e.g. Facebook group 5 Emergency adult asthma admissions 3 (per 1,000 practice population) Skype, Simple Telehealth Flo, App 6 Inpatient spend (respiratory over 75+) 2 (per 1,000 population) 221, , , ,739 Simple Telehealth Flo, Skype, App 7 Inpatient spend (respiratory under 5s) 2 (per 1,000 population) 85,910 53,065-85,910 49,680 Simple Telehealth Flo, Skype 8 COPD QOF prevalence (all ages) 3 2.4% 2.1%-3.2% 1.8% Simple Telehealth Flo 9 Emergency COPD admissions 3 (per 1,000 practice population) Simple Telehealth Flo, Skype, App 10 Excess weight (overweight or obese) in adults 1 11 Diabetes control (<HbA1c 59) % 60.2%-69.6% 63.8% Social media e.g. Facebook group, Simple Telehealth Flo 61.8% 57.6%-64.5% 59.6% App, Simple Telehealth Flo

14 TECS commissioning cycle 14

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16 And how do we show impact? Difficult! Enhanced clinical outcomes Great patient experience improved concordance/ compliance Minimise / prevent deterioration of LTC Improved lifestyle habits /prevent LTC Avoided healthcare use / at least as good clinical outcomes Patient greater understanding / more responsibility for health Integrated care all adhere to same clinical protocols/management

17 Frontline perspectives

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19 General practice focus on LTCs: practice nurses, HCAs, GPs Level 3: High Complexity Case Management Level 2: High risk Disease/Care Management Low cost, large-scale: simple telehealth Level 1: 70-80% of LTC population Self care support/management

20 Technology enabled care services - meaning and scope Focusing technology enabled care along pathways Preventing ill health Prolonging life and quality of care Poor life chances Unhealthy lifestyles Early onset of disease Severe disease End of life Unemployment Poor housing Education Smoking Obesity Diabetes Hypertension CHD COPD Heart Failure Frailty

21 The importance of self care Enriching self care as agreed shared management Helping people to help themselves as agreed with their clinicians/social care workers

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23 Your blood pressure is under control when the top (systolic) measurement is less than 135mmHg and the bottom (diastolic) measurement is less than 85mmHg. We hope your blood pressure readings will be below 135/85mmHg when you take them at home. Sometimes your blood pressure may be raised, and your reading may be as high as 175/105mmHg. Although this is a high reading, it might settle without any further change to your medication if this is an unusual reading. If your BP reading rises further: above 175/105mmHg (that is above either 175mmHg and / or 105mmHg) Very high blood pressure could trigger a stroke, so it s important for a doctor to adjust your tablets as soon as possible to lower your blood pressure.... Please note that if you send in a reading that is lower than an acceptable range, (eg. you text 70/50 or lower), Flo will ask you to take your BP again. Follow a healthy lifestyle. Take plenty of exercise half an hour walking each day, if you can. Eat sensibly 5 portions of fruit and vegetables every day, and cut down on fat, sugar and salt. Keep your weight down, and aim for a body mass index of less than 25. If you smoke, stop now. Keep taking the tablets every day as your doctor has prescribed. Think if there is anything which has made your blood pressure worse, and if you can identify it, take action to alter what has taken place. Were you angry or stressed? If your blood pressure remains as high as 175/105mmHg, make an appointment with your GP or practice nurse in the next few days. If it is only just above 135/85mmHg, wait and see if it settles and go for your next usual blood pressure review. Stay calm, and continue with your present tablets; try some relaxation techniques. Just sitting still and thinking about your breathing can help to calm you down. Or think about a relaxing holiday you ve had in the past. If you repeat your blood pressure reading an hour later, and it s still as high, make an appointment to see your doctor or practice nurse within the next couple of days if it is just above 175/105mmHg. If your blood pressure reaches 200/105mmHg,or even higher, this is very high, and you should contact a doctor urgently today. Phone the surgery or, if it s at night or the weekend, phone the Out of Hours / 111 service who can agree with you when you should be reviewed.....if it is still as low as this an hour later you should call a doctor urgently today and they can talk through any other symptoms you have and agree if you should be seen urgently.

24 Social media technology for primary care?. People communicate quickly & with fewer boundaries.

25 Discussion points: 1. Why do practitioners blank opportunities to adopt technology enabled care? 2.Why do commissioners & providers ignore digital healthcare at scale; prefer ad hoc pilots? 3. Why are the NHS/LAs wary of the commercial market of technology? 4. Is there enough evidence of invest to save benefits?

26 Person-centred care is our future it is the: right care for the person s (or carer s) needs and preferences, delivered with dignity, compassion, sensitivity and respect, at the right time and place, with due regard to the person s age and any cognitive impairment. (WMAHSN Person centred Care manifesto, 2015)