telehealth project the orchard medical centre kingswood, bristol 19.6.11 dr richard berkley gpwsi...
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Telehealth Project
The Orchard Medical CentreKingswood, Bristol
19.6.11
Dr Richard BerkleyGPwSI Heart Failure NHS South Glos
Clinical Lead for BNSSG PCTs Cardiac Services Development
Advances in Technology
Advances in Technology
Telehealth Project at TOMC started in 2007
Focus
Decision to focus on chronic heart failure as this is where the best evidence for intensive patient support lay at the time
Chronic Heart Failure is an increasing burden in an population that is aging and surviving longer following myocardial damage
Significant data exists for intervention in patients with heart failure to
Improve quality of lifeReduce Hospital AdmissionsProlong life
Patients
Initially we had planned to pick those patients discharged from hospital, as a way of identifying the more sick ones
The patients were actually identified ad hoc from personal knowledge, trying to pick those with more severe symptoms
Progress
Tricky beginning, slow uptake and some teething issues
Early doors report highlighted some technical concerns and frustrations but ongoing enthusiasm
Progress
Flow Charts Introduced during the project to try and improve handling of alerts and the hassle of sorting out what to do, including the urgency of action
Early Conclusions
This is an interesting development, that appears to be acceptable to patients
Initial learning curve was steep, but the workload has not been as onerous as it was feared to be
There have been some specific incidents which have been captured and changed the management of patients
Uptitration of medication has been conducted with ease, and in safety with home monitoring
Doctor Use
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Doctor Tel Calls
Doctor visits
Doctor in surgery
total doctor demand
Impact on Doctors Time
Clinical Examples of Potential Benefit
LG 60yrs, Multiple admissions, Severe LVSD, end stage IHD plus PEs
Class III-IVPoor compliance with medication (would stop
warfarin intermittently and not turn up for INR checks)
Dramatic change in Emergency Care following introduction of telehealth
?improved compliance?more clinical contact due to scheme?reassurance of self monitoring
Emergency Profile Pt LG 7062
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Telehealth commenced
Clinical Examples of Potential Benefit
LG, 60yrsSevere LVSD, end stage IHD plus PEsClass III-IVApril 08, Increasing weight and decreasing 02
saturation alertedDiuretics doubled, inched forward with B-
blockers once stabilised as well (patient reluctant to take them)
Situation resolved with symptomatic improvement and improvement in O2 sats and weight reduced again
Suspected Admission saved
“I would have given up work by now. I would have given in. It gave me confidence. Reassurance that the readings were stable. I knew you would get in touch if anything was wrong so I didn’t bother you and kept at work and paid my taxes!”
LG aged 62yrs
Clinical Examples of Potential Benefit
ED 82yr old, Mod severe LVSD class IIISept 08, Self presented, Increase SOB with leg
swellingMonitor actually had picked up the trend in
increase in weight, but not yet actedClear response to diuretic increase, gave
confidence to Doctor treating that was the correct course of action as using very high dose diuretics (Furosemide 80mg bd and bendroflumethiazide)
Clinical Examples of Potential Benefit
GB, 85yrs, COPD, mod/severe LVSD, class IVApril 08 increasing weight and alerted. Doctor
visited, doubled diuretics and gave a/b. resultant signficant wt loss and improvement in symptoms but started to become symptomatic again soon after
Management by phone eased with data, symptomatic improvement for patient
Possible Hospital admission savedPatient Died the following month
Clinical Examples of Potential Benefit
AO, 31 GUCH, Awaiting Pulmonary valve replacement
Poor compliance, tends to forget medication at weekend
Little peripheral oedema but notices that gets RUQ pain when forgets to take diuretics (liver engorgement?)
I used the following graphs to help her see the benefit of taking her diuretics, direct link to her taking the tablets, her weight reduction and the improvement in oxygen saturation
?The Future of Telehealth?
Scale Deployment
The Future of Telehealth?
“Telehealth has made a huge difference to me. A great benefit of the service is the peace of mind it brings - not just to me, but to my family too, as they know that if my condition should deteriorate in any way medical help will be on hand as soon as I need it. The equipment, which is very easy to use, has had a great positive impact on my day-to-day life; I am very happy with the service.”
Bill, age 67yrs