CNWL Camden Telehealth and Managing Your M edicines at Home

1. CNWL Camden Telehealth and Managing Your Medicines at Home

2. Camden Telehealth

3. Telehealth is…… • Telehealth is the monitoring of a patient’s vital signs and symptoms via technology in their home. • Peripherals include, oximeter, BP, weighing scales, thermometer • Patients take their readings and answer a series of diagnosis specific questions • Information is transmitted to a triage centre • If required, a nurses will verify the results, complete a phone assessment, and if necessary, visit the patient at home

4. National Hospital Admissions • In England, those with COPD and HF have the highest rate of emergency admissions and re-admissions • 90% of all admissions treated as an emergency. • HF related hospital admissions are expected to rise by 50% over the next 25 years (Gnani & Ellis 2001).

5. Camden Telehealth • Initially a tool for CNWL respiratory & HF clinicians • Yet some patients suitable for TH are not necessarily under the care of CNWL Camden • Telehealth for observations, reablement, & admissions avoidance for COPD • Of the additional qualified nursing agency spend 27% of it is due to additional investments in Month 10. The majority of this investment is with in the Camden Community Team.

6. THORAAC outcomes • Dedicate clinician enabled us to manage patients: • CNWL respiratory team • GP high risk registers • Hospital discharges • 2 approaches • Clinical Monitoring –long or short term • Education –short term

7. THORAAC Outcomes

8. Heart Failure Successes • Service evaluation currently underway • However CCG data demonstrates:

9. ‘‘I think I tend to be kept longer in hospital than I would have thought. The most worrying thing is my oxygen levels so if someone is watching that then I would be happy to be discharged earlier. What happens in hospital my oxygen levels are fine because everyone is doing everything for me. I don’t have to make a cup of tea, I do nothing for myself.’ Comforting to know things are alright' ‘ When you’re on your own you can panic sometimes, I thought it was great.' THORAAC Patient Feedback

10. Continued…… • 'I wouldn’t know unless I had one of them machines, I wouldn’t know if I was getting ill. Would need to use it longer term but only 2-3 times per week.' • 'The questions after are programmed to also detect any problems. I would like to use it again and have the thermometer this time. Having a combination of a few readings is good as I don’t always get a temperature when ill. Also I don’t want to take antibiotics unnecessarily. I miss it as I don’t always like to call for help. I’m a carer for my wife as she has early stage Alzheimer’s so don’t want to be in hospital.'

11. Plans • Incorporate other patient groups that the CCG have stated are a priority for digital health: diabetes, chronic kidney disease, anticoagulation • Telehealth hub will manage on a needs basis: those that have been admitted to hospital & those that would benefit from learning self-care skills • Referral form will be added to CCG website

12. Managing Your Medicines at Home

13. 2015/16 Pilot Aims • Operational for 4 months form Dec 15 • Led by pharmacy technician • Aim to support Medicines Optimisation (MO); • reduce medication risks • support adherence • promote independence & self management of medicines

14. MYMAH Referrals • 60 referrals received • 50 patients assessed • 36% referrals from GP’s • Non-adherence, promoting independence & education most common reasons for referral

15. MYMAH Statistics

17. Outcomes • In 30 out of 50 patients had their risk of medication error reduced

18. Patient/Carer Feedback 'I had difficulty opening packets – could do it but it took some time to open. Technician provided a gadget to get tablets out of packets which is very useful. But it doesn’t work on the bigger tablets.' 'The guy that came was a darling, mum really took to him, he was really good at explaining to older people'. ‘Patient was discharged from hospital and whatever advice was provided at that time was not retained as there were too many things to remember. Daughter feels its a relief having someone visit the home to discuss when everything was topsy-turvy. More info is gathered at the home. It was a very helpful service. When someone is housebound every little helps' 'Patient said she is very thankful for all the help she receives. Technician was a very nice man, he even phoned afterwards to check we were ok, shows that he cares. People are really trying to help us, I would recommend' ‘Mum had a blister pack but I noticed some tablets kept being missed as she was forgetting.She was given a pivotell 3 months ago , I have to fill because the chemist wont do it. But its brilliant, she absolutely loves it, she calls it her little chemist. Now she talks meds independently.'

19. Next Steps • Recruit pharmacist initially & then pharmacy technician • Work across Camden • Re-launch service • Scope of service includes: • Support medicines adherence & understanding of their medicines • Targeted medicine reviews • Partnership working across agencies to support MO • Incorporate MYMAH service into IPC central referral pathway • Reduce medication risks & utilisation of emergency services due to avoidable medicines errors/ adverse reactions • Defined key outcome measures

20. Questions