GPwSI Heart Failure and Clinical Lead for BNSSG

Report
Telehealth Project
The Orchard Medical Centre
Kingswood, Bristol
19.6.11
Dr Richard Berkley
GPwSI 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 life
 Reduce Hospital Admissions
 Prolong 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
Impact on Doctors Time
Doctor Use
6.00
4.00
Doctor Tel Calls
Doctor visits
Doctor in surgery
total doctor demand
3.00
2.00
1.00
Month
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0.00
M
contacts per user
5.00
Clinical Examples of Potential Benefit
 LG 60yrs, Multiple admissions, Severe LVSD,
end stage IHD plus PEs
 Class III-IV
 Poor 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
2.5
Telehealth
commenced
2
Admission
1.5
A&E
Frendoc
1
Total
0.5
0
05 05 06 06 06 06 07 07 07 07 08 08 08 08
Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q4 Q4 Q1 Q2 Q3 Q4
Clinical Examples of Potential Benefit
 LG, 60yrs
 Severe LVSD, end stage IHD plus PEs
 Class III-IV
 April 08, Increasing weight and decreasing 02
saturation alerted
 Diuretics doubled, inched forward with Bblockers 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 III
 Sept 08, Self presented, Increase SOB with leg
swelling
 Monitor actually had picked up the trend in
increase in weight, but not yet acted
 Clear 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 IV
 April 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 saved
 Patient 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

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