the whole system demonstrator - adaptation & integration of telecare & telehealth into whole systems...
TRANSCRIPT
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Adaptation & integration of telecare &telehealth into whole systems care:
the experiences of frontline community
health & social care professionals
DR VIRGINIA MACNEILLSenior Research OfficerDepartment of Public HealthUniversity of Oxford
[email protected] 2010
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OutlinePart 1DefinitionsBackgroundPolicy context
Part 2The research study
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Terminology
Assistive technology Assistive technologyTelecareTelecareTelehealthTelehealth
TelemonitoringTelemonitoringTelemedicineTelemedicineSmart homesSmart homesEE--healthhealth
Remote careRemote care
All are used interchangeably to describe the All are used interchangeably to describe theremote delivery of health and social careremote delivery of health and social care
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Ass is tive TechnologyTELEC AR E An emergency service
Aim: to keep people safeat home
Electronic sensors and aids
that make the homeenvironment safer so thatpeople can live at home,independently, for longer.The sensors automaticallyraise the alarm bycontacting control centre and then afamily member,friend, neighbour, or warden (in sheltered housing) or emergency service eg ambulance
TELEHE A LTH A monitoring service
Aim: to keep people well at home
Patients record their vital signs and
transmit the data to aresponse centre or clinicianscomputer, where it ismonitored againstparameters set by the
individuals clinician.Evidence that vital signsare outside of normalparameters triggers aresponse.
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M aking a ca s e for telehealth and telecare
Throughout most of the world birth rates aredeclining, life expectancies are increasing
populations are ageing and the prevalence of
chronic conditions is growing. Almost 1 in 3 of the population, in England suffer from a long-term condition (LTC)
People less likely to have the support of anextended family
= a growing need for health and social care
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Increasing focus on a whole system approachto care, integrating health and social services
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The need for remote care
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H owever, the concept of remote health care is not new.H owever, the concept of remote health care is not new.
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UK Government Policy Context
Lot s of official report s and recommendation s over the la s t few year s eg:
Assistive Technology Assistive Technology Independence and WellIndependence and Well- -BeingBeing Audit Commission 2004 Audit Commission 2004
Building Telecare in EnglandBuilding Telecare in England J uly 2005 J uly 2005
D H White Paper, Whole System Long Term ConditionsDemonstrators (2006)
Putting People First ConcordatPutting People First Concordat D ec 2007 D ec 2007
Transforming Social Independent Living StrategyTransforming Social Independent Living Strategy F eb 2008 F eb 2008
Building Britains Future /Building a Society for all AgesBuilding Britains Future /Building a Society for all Ages/ Working Together for Older People in Rural Areas/ Working Together for Older People in Rural Areas J une/ J uly 09J une/ J uly 09
Shaping the Future of Care Together (Green Paper July 2009)Shaping the Future of Care Together (Green Paper July 2009)
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Part 2
The Research Study
(Whole Systems Demonstrator)
DH White Paper, Wh ole System Long Term ConditionsD emonstrators (2006)
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The Whole Sy s tem D emon s trator Programme
Led by the UK Department of H ealth
Aims to demonstrate whether the use of telecare and/or telehealth technologies allows:
1. individuals to manage their condition better and improvetheir quality of life
2. Deliver gains in the integration of service delivery andcost effectiveness of care
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Whole Sy s tem D emon s trator
Randomised control trial of 6000 patients in three sites inEngland with embedded qualitative studieswith embedded qualitative studies
RCTComparison 1: comparing telehealth technology with usual health
care in 1000 patients with long term conditions *Comparison 2: Compare telecare technology with usual social carein 1000 patients with social care needs.
Complex LTC
Chronic heart disease,Chronic obstructive pulmonary disease [COPD]Diabetes 1&2Social care needs
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WS D Goal sTo what extent the WSD model of care:
promotes individuals long term well-being andindependence
improves individuals and their carers quality of life
improve s the working live s of s taff
is more cost effective
is more clinically effective
Provide an evidence base for future care and technologymodels
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Co-ordinator role
Quantitative Qualitative
Service utili s ation
Impact on co s ts
Clinical mea s ure s and patientreported quality of life
M echani s m s of impact ons ervice u s er outcome s &variation s between s ubgroup s
Patient, carer & profe ss ionalexperience
Organi s ational context &implemation proce ss
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The Oxford team i s part of a con s ortium in charge of the programme evaluation.
Funding bodyDepartment of H ealth
R e s earch partner sImperial College LondonKing's FundLSEOxfordManchester
UCL
Oxford teamThe experience s of front line profe ss ional s
delivering telehealth & telecare
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The WSD interventions
TelehealthTelehealth
TelecareTelecare
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TELEHE A LTH agenda: remote monitoring toprovide appropriate intervention when nece ss ary
The interventionTelehealth equipment installed in patients homestores the patients clinical information -
peripherals (eg blood pressure cuff) arephysically connected to it or Bluetooth enabledPatient records vital signs daily using equipmentCommunity nurse monitors patients informationremotely and dailyCommunity nurse acts if patient vital signs areoutside agreed parameters
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Spirometer measuresvolume of air inhaled &exhaled
Blood pre ss uremonitor checks bloodpressure.
Pul s e oximeter measures bloodoxygen levels and/or heart rate.
Blood glucometer measures bloodsugar level
Weighing s cale smonitors weight
Telehealth monitoringequipmentu s ed by patient s
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Telehealth s ervice delivery arrangement sTelehealth s ervice delivery arrangement s
The three sites have adoptedThe three sites have adoptedsimilar service models:similar service models:
Community matron s erviceCommunity matron s ervicecommunity matrons deliver carecommunity matrons deliver careto the T H patients withto the T H patients withmost complex needsmost complex needsbut still keep a caseload of non telehealth patientsbut still keep a caseload of non telehealth patients
M onitoring s erviceM onitoring s ervice
telehealth nurses monitor patients whose conditions is less well advanced.telehealth nurses monitor patients whose conditions is less well advanced.The monitoring service varies from site to site but typically a team of nursesThe monitoring service varies from site to site but typically a team of nurseshave telephone contact with the patients; if they observe an exacerbation or have telephone contact with the patients; if they observe an exacerbation or
A set of unusual reading on the computer screen, they will alert the community A set of unusual reading on the computer screen, they will alert the communitymatron or GP. Thus the patient continues to be managed by the clinicianmatron or GP. Thus the patient continues to be managed by the clinicianresponsible for their care, who also benefits from the T Hresponsible for their care, who also benefits from the T H monitoring tool.monitoring tool.
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TELEC AR E - agenda: to help people live s afely at home
The interventionLifelines and movements sensors installed in
service users homeConnected to a call centre manned by telecare
operatorsOnce a sensor is triggered, an alert is receivedby the call centreThis generates a response by operator to checkstatus of alert by contacting service user telecare operator then arranges appropriateresponse eg emergency call out
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Examples of telecare equipment anduses around the home
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Part 3
Our Qualitative Study
(Whole Systems Demonstrator)
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Our research question(Oxford)
What are the experiences of health and social
care professionals and key workers usingtelehealth or telecare and their attitudes towardssustained use?
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Why qualitative?Why qualitative? A better understanding of provider experiences leads to: A better understanding of provider experiences leads to:more effective interventions that meets patients needsmore effective interventions that meets patients needs
AN D AN D work processes that are acceptable to the providerswork processes that are acceptable to the providers
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Some methodological challenge s
Understanding service delivery arrangements in the 3 sitesUnderstanding service delivery arrangements in the 3 sitesIdentifying key interview participantsIdentifying key interview participantsChanges in delivery structuresChanges in delivery structures
-- within and between siteswithin and between sites-- and over timeand over time
Time management and travelTime management and travel
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Preliminary Finding s
to follow
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Adaptation & integration of telecare & Adaptation & integration of telecare &telehealth into whole systems care:telehealth into whole systems care:
the experiences of frontline communitythe experiences of frontline communityhealth & social care professionalshealth & social care professionals
DR VIRGINIA MACNEILLDR VIRGINIA MACNEILL
Senior Research OfficerSenior Research OfficerDepartment of Public HealthDepartment of Public HealthUniversity of OxfordUniversity of Oxford