Technologies such as Telehealth have the potential to transform the way people engage in and control their own healthcare, empowering them to manage it in a way that is right for them.
The aim is for patients and carers to feel empowered in managing their long term health condition, safe in the knowledge that their Key Health Worker is on hand to remotely review their results and act promptly as required. Ultimately, patients are able to recognise any deterioration in their condition and access medical help at the right time without the requirement for Telehealth. The approach to Telehealth in Dorset has changed over the last 2 to 3 years of the pilot with the recognition that there is a risk it can create a different form of medical dependency and therefore is better positioned as part of the pathway to self-management/care.
Telehealth for Dorset was launched in February 2012 with the purchase of 500 pods; focusing primarily on patients who have COPD or CHF with some expansion to other areas including Oncology and Mental Health services. It is now time to conclude the pilot stage and move the service into core business as demonstrated by the Heart Failure service at Yeovil District Hospital NHS Foundation Trust.
In Dorset, 48% of patients state their primary reason for using the Telehealth system is for self–management and 15 % for prevention of deterioration/admission to hospital and 7% for reassurance.
The largest numbers of referrals are made by Community Matrons at 53%, Heart Failure Specialist Nurses and support workers at 20% and Practice Nurses at 11%.
Taking a conservative view there is scope to double the number of people on Telehealth who have COPD or CHF. The national contract requires the service development plan in each trust in relation to digital technology. The DAIRS services in the 3 acute trusts and DCH heart failure services should have targets set and monitored in relation to Telehealth uptake. DHUFT should develop locality COPD targets for their community nursing services based on individuals most supportive of the technology.
To help identify the benefit a cohort of 231 patients with COPD and/or CHF have been studied over a period of 12 months prior and 12 months’ post installation of Telehealth with the following outcomes.
Cost per Patient
231 patients @£700 per patient.
Excludes nursing and project management time.
Includes costs related to protocol development incurred.
Cost of Service
£162,000 for 231 patients.
For this group of 231 patients it is possible to quantify savings across the system of £472,000 which is approximately £2,044 per patient.
A small number of this cohort (11 patients) was audited in Primary Care at one Practice. Although the numbers are small, the following data was useful in building an understanding of the impact on Primary Care; 82% of the patients had no increase in GP or practice Nurse attendance and 64% of patients had no District Nurse visits.
On average, a caseload of 22 patients raised 12 alerts per day taking 30 minutes of key health workers time per day averaging 1.5 – 2 minutes of clinical input per patient per day. The Key Health Worker varies according to the patient’s condition i.e. Community Matron, Heart Failure Specialist Nurse or Practice Nurse.
From the evidence provided it can be seen that the provision of Telehealth for this cohort of patients is highly cost effective with a saving of £1,300 per patient.
View the full review here.
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