Features: February 6th, 2009

By Helen Rollings

Treating patients in hospital is expensive and hospital is not the place where patients want to be. Patients prefer to remain in their own homes where their quality of life is greater and support costs are much less. The author describes how Swindon Primary Care Trust installed monitoring systems in homes so that nurses could manage their patients remotely. Success in Swindon has prompted a new look at the extension of telehealth.

Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory diseases in the UK and its fifth biggest killer, causing 30,000 deaths a year in England and Wales alone. (1)

Today the annual cost to the NHS of treating COPD is around £818m (2) and if we do not address the issue, the burden on the NHS will continue to rise.

To ensure healthcare resources are used effectively, NHS Trusts across the UK are looking at alternative models of care to treat and manage cases of COPD in a more timely manner.

COPD: An occupational hazard

COPD is often linked to industrial exposure, and in Swindon’s case this can be attributed to the town’s tradition of manufacturing, the railways and mining. As a result, COPD represents the single largest cause of emergency admissions to hospital for Swindon PCT.

Quality Outcome Figures from 2006-2007 show 1.5% of the population suffer from COPD, putting the PCT above both the National and Strategic Health Authority ratings. This translates into over 300 emergency admissions to secondary care for patients per annum, and with the cost of a hospital bed at £17,500 per week the condition places a heavy burden on healthcare resources in Swindon.

In order to reduce the number of avoidable COPD-related emergency hospital admissions and ensure the most effective use of healthcare resources, we decided to look at alternative approaches to tackling COPD in order to provide a more responsive community-based model of care.

Deploying telehealth for community-based care

To improve healthcare outcomes and reduce dependency upon secondary care, a telehealth pilot was commissioned using technology to remotely monitor patients with COPD in their own homes, partnering with leading telehealth and telecare provider Tunstall.

In addition to reducing hospital admissions for patients with COPD, our aim was to improve patients’ quality of life and increase their ability to self-manage their condition – a key factor in raising healthcare outcomes.

A proactive pilot

Telehealth monitors from Tunstall were rolled-out to 11 high-risk patients who were shown how to use the monitor to measure their own vital signs including heart rate, weight, blood pressure and oxygen levels; the monitor would ask a series of specific clinical questions to further determine their condition and the results sent to the Single Point of Access at our Primary Care Centre. A nurse analysed the data and for those patients who had readings outside the pre-set parameters, appropriate action was taken to address the issue.

This process allows the patient to be monitored in their own home and for nurses to manage their patients remotely. By detecting changes in a patient’s health at an early stage, proactive action can be taken which reduces the number of unscheduled hospital visits.

Rewards: win-win for PCT and carers

Following the success of the pilot the PCT took the decision to mainstream its use of telehealth. A further 50 monitors will be distributed and telehealth monitoring is already making significant improvements to the clinical care of COPD patients in Swindon.

Clinical staff now have accurate information about the patients’ condition over time. Being able to detect charges at an early stage has enabled to PCT to significantly reduce the average number of acute admissions to hospital in Swindon, improving care outcomes and ensuring best use of healthcare resources. The telehealth pilot reduced the number of hospital visits by an average of one visit per patient. An average stay in hospital for a COPD patient is typically 11 days meaning that the PCT has already saved approximately £300,000 from 11 patients.

Remotely triaging patients helps staff prioritise visits, meaning those COPD patients experiencing a critical change in their health receive more timely, proactive medical intervention. Patients have also expressed feeling more engaged with clinical staff as a result of telehealth monitoring.

The scheme has also had a positive effect on carers within the PCT by providing a support network that promotes health, independence and well-being within the home. It offers carers peace of mind and reassurance that when they are not there, support is available 24 hours a day.

Empowering the patient

Continuous monitoring using telehealth benefits COPD patients as they are reassured that their health is being monitored on a daily basis. This reduces anxiety, maintains privacy and promotes independence, improving overall quality of life.

Telehealth also educates patients to be more aware of their own symptoms and to proactively manage them, helping to reduce part of the burden on healthcare providers. It also encourages patients to feel more in control of their condition, which is a key factor in helping to improve healthcare outcomes.

A healthy outlook for Swindon

Deploying telehealth on a widespread scale throughout the PCT has made a real difference to the healthcare provision and outcomes. To see patients taking more responsibility for managing their condition has been immensely encouraging, and represents a crucial step in the effective management of long-term conditions.

Swindon PCT is now looking at a number of different options regarding how to take telehealth monitoring forward in the region. One possibility is to use telehealth monitoring as an educational tool for patients to give them a greater knowledge of their condition. The goal is to help patients better understand their symptoms and which physical activities can make a difference to their condition.

The clinical staff are also keen to explore using telehealth monitoring for patients with other chronic conditions such as diabetes. According to the British Diabetic Association and the King’s Fund health charity, the annual NHS cost of caring for people with type II diabetes is £2 billion, or 4.7% of total health service expenditure but by using telehealth to detect changes at an early stage, it will be possible to prevent the need for hospital admission.

Swindon is continuing to develop the service and early indications demonstrate the clear benefits telehealth delivers to patient and PCT. We look forward to further extending the use of telehealth to address other long-term conditions and to making it an integral part of our overall model of care.

Helen Rollings is Community Matron at Swindon Primary Care Trust.

(1) http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=540
(2) National COPD audit (2004)