Emma-Jane Roberts, Managing Director of Spirit Digital explains the many ways in which remote monitoring could improve patient health and save the NHS money
Multimorbidity is a growing problem within the NHS and the current model for long-term condition (LTC) care could be viewed as unsustainable. More than 15 million people in England have at least one LTC, while the number with three or more is forecast to reach 2.9 million this year. LTC patients already account for 50 per cent of all GP appointments, 70 per cent of all bed days and around 70 per cent of acute and primary care budgets in England. As the population ages, those numbers are only going to increase. Recent research predicts that, by 2035, 2.5 million (17 per cent) people over the age of 65 will have four or more chronic illnesses. And, around two thirds of over 65s – a massive 9.7 million – will have at least two.
While the need to establish new models of care as laid out in NHS England’s ‘House of Care’ framework is widely understood, unlocking a solution at the local level remains a huge challenge. The number of people with LTCs and multi-morbidity continues to grow, placing intolerable pressure on services and pathways. The implications are significant. Our ability to establish effective models of LTC care is vital to the sustainable delivery of safe, timely and high-quality care. So how do we do it?
The single biggest priority in the NHS is patient safety. Five years ago, in the wake of the Francis Report and the Berwick Review, a range of policies and measures were put in place to help clinicians recognise and respond to patient deterioration in acute settings. However, these same policies haven’t been extended into the community. As a result, clinicians in primary and community care are often unable to recognise deteriorating patients before they suffer an emergency exacerbation. The impact is felt on the front line of care in the form of increased demand for services, greater costs and poor health outcomes. The scenario is particularly common in patients with multi-morbidity. The system is not set up to support them.
The problems with current approaches to multi-morbidity are manifold. Primarily, chronic diseases are typically managed in isolation via services that are set up to focus on single conditions. Well-coordinated care is the exception, not the rule, with pathways often fragmented and thwarted by a lack of informational connectivity.
In this digital age, there is an extended network of knowledge available online for patients. Theoretically, this extensive and easily accessible information should be empowering patients to better self-manage their condition. However, LTC patients often receive limited support beyond the clinic, thus leaving the vast amount of information on their condition and care online, unacknowledged and wasted. It’s clear that services don’t always do enough to educate patients around their disease to recognise deterioration or self-manage deterioration.
Wide variability in online health information, health literacy levels and the understanding of disease invariably leads to poor self-management and, at times, patient deterioration. The latter manifests itself in patients returning to the GP surgery for urgent treatment or presenting at A & E. Many of these emergency exacerbations are entirely avoidable. However, since clinicians have no advance visibility of patient deterioration, they cannot proactively intervene.
Current pathways are routinely configured to deliver expensive, reactive models of care. The solution? We have to reengineer them and regain control through remote monitoring.
The challenges of multi-morbidity are familiar to every practice, community trust and acute hospital – many have limited control over the flow of patients entering into their services. But familiar challenges can have familiar solutions. This is certainly the case with LTC care.
The simple use of the right mobile technology can, at the touch of a button, empower patients and clinicians with tools to support the safe, proactive and efficient management of LTCs. Remote monitoring solutions, delivered over intuitive tablet devices, provide a powerful platform for intensive monitoring, education and empowerment of at-risk patients. These solutions are custom-designed to help patients engage with their health and self-manage their conditions through the daily capture of physiological data and self-reported information about their wellbeing.
That data is linked to dynamic care plans and evidence-based algorithms that enable automated triage for healthcare teams when an escalation of care is required. Crucially, this gives clinicians real-time visibility of physiological trends to help them recognise and respond to deterioration.
Moreover, it provides them with an evidence-base that gifts them ‘remote control’ of vulnerable patients, allowing them to intervene proactively rather than wait for a costly emergency exacerbation. This is hugely reassuring for patients and carers, who also feel in greater control of their care.
Adoption of remote monitoring solutions is growing across all settings within the NHS. Evidence shows it’s helping to facilitate earlier discharge, prevent readmission and reduce the risk of future exacerbations through better self-management. In chronic diseases like COPD, diabetes, heart failure and frailty, CCGs and community trusts are leveraging remote monitoring solutions to engineer more efficient pathways – with improved patient engagement and better self-management helping to alleviate the burden on services and lower the cost of care.
Key components of the House of Care model strongly align with the principles of remote monitoring for person-centred, co-ordinated care. The framework highlights the need for services that ‘engage and inform individuals and carers to self-manage’. It also calls for ‘organisational and clinical processes that structure around the needs of patients using the best evidence available’. Moreover, House of Care underlines the importance of ‘informational continuity’: if HCPs are to provide the right care at the right time, they ultimately need access to the right information. This is undoubtedly true. And it’s why remote monitoring solutions, which give clinicians unprecedented real-time visibility of their most at-risk patients, must play a key role in future models of LTC care.
Technology is an essential component in addressing the challenges facing today’s healthcare environment. Remote monitoring solutions present a simple way of utilising technology to drive timely, proactive interventions, minimising the potential need for more acute costly care and enabling sustainable long-term success.
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