Telehealth Project The Orchard Medical Centre Kingswood Bristol

Telehealth Project The Orchard Medical Centre Kingswood, Bristol 19. 6. 11 Dr Richard Berkley GPw. SI Heart Failure NHS South Glos Clinical Lead for BNSSG PCTs Cardiac Services Development

Advances in Technology

Telehealth Project at TOMC started in 2007

Focus l Decision to focus on chronic heart failure as this is where the best evidence for intensive patient support lay at the time l Chronic Heart Failure is an increasing burden in an population that is aging and surviving longer following myocardial damage l Significant data exists for intervention in patients with heart failure to l Improve quality of life l Reduce Hospital Admissions l Prolong life

Patients l Initially we had planned to pick those patients discharged from hospital, as a way of identifying the more sick ones l The patients were actually identified ad hoc from personal knowledge, trying to pick those with more severe symptoms

Progress l. Tricky beginning, slow uptake and some teething issues l. 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 l This is an interesting development, that appears to be acceptable to patients l Initial learning curve was steep, but the workload has not been as onerous as it was feared to be l There have been some specific incidents which have been captured and changed the management of patients l Uptitration of medication has been conducted with ease, and in safety with home monitoring

Impact on Doctors Time

Clinical Examples of Potential Benefit l LG 60 yrs, Multiple admissions, Severe LVSD, end stage IHD plus PEs l Class III-IV l Poor compliance with medication (would stop warfarin intermittently and not turn up for INR checks) l Dramatic change in Emergency Care following introduction of telehealth l ? improved compliance l ? more clinical contact due to scheme l ? reassurance of self monitoring

Telehealth commenced

Clinical Examples of Potential Benefit l LG, 60 yrs l Severe LVSD, end stage IHD plus PEs l Class III-IV l April 08, Increasing weight and decreasing 02 saturation alerted l Diuretics doubled, inched forward with Bblockers once stabilised as well (patient reluctant to take them) l Situation resolved with symptomatic improvement and improvement in O 2 sats and weight reduced again l 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 62 yrs

Clinical Examples of Potential Benefit l ED 82 yr old, Mod severe LVSD class III l Sept 08, Self presented, Increase SOB with leg swelling l Monitor actually had picked up the trend in increase in weight, but not yet acted l Clear response to diuretic increase, gave confidence to Doctor treating that was the correct course of action as using very high dose diuretics (Furosemide 80 mg bd and bendroflumethiazide)

Clinical Examples of Potential Benefit l GB, 85 yrs, COPD, mod/severe LVSD, class IV l 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 l Management by phone eased with data, symptomatic improvement for patient l Possible Hospital admission saved l Patient Died the following month

Clinical Examples of Potential Benefit l AO, 31 GUCH, Awaiting Pulmonary valve replacement l Poor compliance, tends to forget medication at weekend l Little peripheral oedema but notices that gets RUQ pain when forgets to take diuretics (liver engorgement? ) l 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 67 yrs