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Telemetric Supported Self-Monitoring of Long-Term Conditions Brian McKinstry

Telemetric Supported Self-Monitoring of Long-Term Conditions Brian McKinstry. Background How telemetry can help manage illness Overview of the planned programme Challenges of the research. Background. Rapidly Aging Population. Expected growth in elderly population. Increasingly Unhealthy.

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Telemetric Supported Self-Monitoring of Long-Term Conditions Brian McKinstry

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  1. Telemetric Supported Self-Monitoring of Long-Term ConditionsBrian McKinstry

  2. Background • How telemetry can help manage illness • Overview of the planned programme • Challenges of the research

  3. Background

  4. Rapidly Aging Population • Expected growth in elderly population

  5. Increasingly Unhealthy

  6. Rise in Vascular and Metabolic Disease • Source ISD Scotland: Predicted increase vascular disease and diabetes 1998-2023

  7. Audit Scotland. Managing long-term conditions. 2007 Expected Increase in COPD

  8. Long Term Conditions • 17.5 million adults may be living with a chronic disease • 75% of people over 75yrs have a chronic disease • 45% will suffer from more than one condition • By 2030 the incidence of chronic disease will double The care of people with chronic conditions consumes a large proportion of health and social care resources.

  9. Increasingly Challenging Targets • QOF

  10. Management Challenge • Current clinician-centred models of care will struggle to cope • Policy drive towards self-monitoring and self-care

  11. Self-monitoring • Self-monitoring alone is often not effective • Evidence of effectiveness in asthma • Conflicting evidence in COPD and HBP • Little evidence in diabetes

  12. Possible Reasons for Failureof Self-monitoring • Difficulty in maintaining motivation • Infrequent feedback from clinical staff • Heightened anxiety at failure to control

  13. Supervised self-monitoring • Availability of reliable low-cost devices • Sending data by broadband or mobile phone links • Allowing remote supervision at distance and prompting action by clinicians based on multiple inputs

  14. Call centre Call to check situation Constant monitoring of potentially unstable conditions (e.g. COPD) Urgent referral if required Reminders to self monitor Automated feedback Links to online information Relatively stable conditions (e.g. diabetes, BP) checked intermittently (normally by practice nurse Internet or SMS Home GP practice Patient takes readings and enters symptom score Remote server Telephone or videolink Consultation arranged as appropriate Record of readings and symptom scores Models of telemetric supported self monitoring

  15. Patient View

  16. Clinician View

  17. Streaming Data

  18. Why here? Why now? • The strength of telecare and telehealth in Lothian • A large investment in telemetric devices by NHS Lothian (backed by Scottish Government) sourced from leading manufacturers. • Rare for there to be good quality quantitative evaluation of such interventions • Majority of RCTs have taken place in other countries and health services • There is a real need for robust trials

  19. Exemplar conditions • Hypertension • A common largely asymptomatic condition • Stroke/HBP • Affecting older frailer group with challenging targets • Diabetes • A condition requiring multiple measurements, blood pressure, blood glucose and weight • COPD • A symptomatic potentially unstable progressive condition

  20. Programme aim • To establish the clinical, social and service impact of introducing telemetry-aided, supervised, self-monitoring for the management of long-term conditions in primary care

  21. Methods Design 4 linked randomised controlled trials • BP: principal outcome daytime ABP n=400 • BP in Stroke: outcome daytime ABP n=400 • Diabetes: HbA1c (daytime ABP) n=340 • COPD: outcome number of days to readmission n=300

  22. Methods Qualitative component • will explore the participants’ perceptions and experiences of telemetric home monitoring. • will illuminate and explain the results of the trials (what components work and which don’t) • identify issues which may be facilitators or barriers for long term implementation Economic analysis • To determine the resource use and impact on patient utility of the intervention

  23. Related work • A study of time to BP control of Lothian GPs showed 40% remain uncontrolled at 6 months • A pilot study of 100 patients of BP self-monitoring (NHS Lothian) demonstrated accurate self monitoring and powered the BP studies • Two mixed methods studies of patient preferences for telemetric BP, asthma and ongoing study of COPD (RCGP/Asthma UK/Intel) telemetry has derived management protocols, fine-tuned the interventions established the reliability of the systems • We are currently conducting a RCT in telemetry in asthma for Asthma UK • A pilot study on the use of tablet internet connected devices in heart failure • Demonstrated patient enthusiasm for these interventions

  24. The team • A multi-disciplinary research team with expertise in remote consulting and telemetry, world class collaborators • Strong clinical and research background in HBP, COPD Diabetes and Stroke • Managed by Edinburgh Clinical Trials • Nursing lead from Napier University • Health economic support from HERU

  25. Brian McKinstry (lead) David Kelly (NHS Lothian) Janet Hanley (Qualitative) Paul Padfield (HBP) Hilary Pinnock (COPD) John McKnight (diabetes) Cathie Sudlow (stroke) Sarah Wild (epidemiology) Steff Lewis (statistics) Marjon van der Pol (economics) Anne Langston (trials manager) Claudia Pagliari (e-health) Aziz Sheikh (primary care) Bill MacNee (respiratory) Sandra Auld (telecare) Collaborators Wisia Wedzicha (COPD) J Roca (telemetry) Martin Dennis (stroke) Martin Denvir (CCF) Simon Maxwell (pharma) Colin Fischbacher (ISD) John Steyn (GP IT) Joyce Barr (resp. nurse) The team

  26. Funding sources • CSO £990k BUPA Foundation £235k Scottish Centre for Telehealth £50k • NHS Lothian (equipment) £700k Edinburgh Council (equipment) £30k • Edinburgh Community Health Partnership £35k

  27. Industry Partners

  28. Challenges • Managing a complex suite of trials • Recruitment • Minimising research impact on NHS

  29. Managing the trials • Three trials closely related • Same technology, data management, recruitment, practices, researchers • Running sequentially • Wellcome Clinical Research Facility research nurses provide increased resource as required

  30. Recruitment • Strong local network and connections • Enthusiasm among patients in pilots • Strong professional interest • Tapping into new resources to minimise GP workload • No expectation of increased impact on day-to-day workload

  31. Outcomes for Public and NHS • Rigorous evaluation of telemetric methods in a generalisable way If shown to be effective may • Improve integration between self-management and professional support • Encourage self-care • Reduce readmissions • Reduce the frequency of serious complication stroke, IHD, blindness and amputation

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