The Whole System Demonstrator - adaptation & integration of telecare & telehealth into whole systems...

8/8/2019 The Whole System Demonstrator - adaptation & integration of telecare & telehealth into whole systems care

1/30

11

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


2/30

OutlinePart 1DefinitionsBackgroundPolicy context

Part 2The research study


3/30

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


4/30

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.


5/30

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


6/30

Increasing focus on a whole system approachto care, integrating health and social services


7/30


8/30

The need for remote care


9/30

H owever, the concept of remote health care is not new.H owever, the concept of remote health care is not new.


10/30


11/30

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)


12/30

Part 2

The Research Study

(Whole Systems Demonstrator)

DH White Paper, Wh ole System Long Term ConditionsD emonstrators (2006)


13/30

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


14/30

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


15/30

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


16/30

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


17/30

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


18/30

The WSD interventions

TelehealthTelehealth

TelecareTelecare


19/30

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


20/30

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


21/30

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.


22/30

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


23/30

Examples of telecare equipment anduses around the home


24/30


25/30

Part 3

Our Qualitative Study

(Whole Systems Demonstrator)


26/30

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?


27/30

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


28/30

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


29/30

Preliminary Finding s

to follow


30/30

3030

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

The Whole System Demonstrator - adaptation & integration of telecare & telehealth into whole systems...

Documents

Transcript of The Whole System Demonstrator - adaptation & integration of telecare & telehealth into whole systems...