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COPD TELEHEALTH/CARE PROJECT NATIONAL TELECARE LEARNING FORUM Monday 8 th March 2010. Project Objectives:. Promote Supported Self-care Interactive Voice Response (IVR) System to provide early indication of COPD exacerbation
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COPD TELEHEALTH/CARE PROJECT NATIONAL TELECARE LEARNING FORUM Monday 8th March 2010
Project Objectives: • Promote Supported Self-care • Interactive Voice Response (IVR) System to provide early indication of COPD exacerbation • Develop the role of Care Managers to provide early intervention of a COPD exacerbation • Electronic COPD Patient Record to track & record information across the integrated pathway
ACTIVITY TRENDS FOR DOUGLASDALE INITIATION DATE: 15th September 2008
ACTIVITY TRENDS FOR MOTHERWELL (1) INITIATION DATE: 27th October 2008
ACTIVITY TRENDS FOR MOTHERWELL (2) INITIATION DATE: 24th November 2008
ACTIVITY TRENDS FOR LARKHALL INITIATION DATE: 5th March 2008
Initial Outcomes: • Electronic COPD Patient Record • System integration still barrier • Interactive Voice Response (IVR) System • Working well • Patient responding to system • Supporting self-care • Develop the role of Care Managers • Training achieved • Increased knowledge & skills • Increased disease management • Increased confidence • Promote Supported Self-care • Patients initiating self-care • Early initiation of medications • Increased self-management & control • Reduction in admissions
LESSONS LEARNED • Clinical Emphasis • Patient Criteria • Identification & Engagement of LTC Team • Importance of Patient Pathway within Model Development • Training Needs Assessment of LTC Team • Robust Admin & PM • Wording of Question • Continuity of Alert System • Recording Outcomes • Patient Recruitment & Retention • Patient Compliance • System Integration • Patient Discharge Process: Independence -v- Dependence • Effectiveness of Service Delivery & Cost Efficiency of Model
WITHDRAWN PATIENTS • Of the ten patients withdrawn: • one patient died • one patient now being supported through palliative care • two patients requested to be removed from the service (no reason given) • two patients removed due to lack of understanding or ability to engage appropriately with the service • one patient withdrew due to other medical issues • one patient after being registered on the system declined to be involved • one patient wished to have more face-to-face contact with staff. • one patient abusing medication regime
EXIT STRATEGY • Pilot project ending 31st March 2010
EVALUATION • Interrogate data in more detail • Comparison analysis • Admissions • GP contacts • Patient Experience • Patient Stories • Patient Questionnaires • Exit Questionnaires • Staff Experience • Staff Questionnaires • Staff Interviews
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