Telehealth & Telecare Learning Network 2013 Dr Carolyn Deighan, NHS Lothian Dr Lorna Paul, Glasgow University Nessa Barry, SCTT

Telehealth & Telecare Learning Network Health, housing, social care, academia, policy, research, user and carer organisations Support knowledge transfer and sharing good practice Feb-November 2013 monthly webcasts – access anytime 1 Network Event on 29th May, 1 Conference – 29 October 2013 Different perspectives using technology to enable care www.knowledge.scot.nhs.uk/telehealthcare www.video3uk.com/sctt

A presentation to highlight how technologies are being developed and utilised to support self management.

A tailored self management programme for people with Heart Failure Dr Carolyn Deighan Theheartmanual.com

The original Heart Manual Programme Sits within the rehabilitation directorate of NHS Lothian UK’s leading home based cardiac rehabilitation programme Clinically effective Specified by NICE & SIGN Adopts a cognitive behavioural approach Individualised education and support It provides a standardised approach for more than Clinically effective in repeated studies, and cited in a number of national and government reports as an example of good practice Adopts a cognitive behavioural approach addressing the patient’s beliefs about the illness Anxiety Depression QoL Health perception Exercise knowledge Smoking Exercise levels Cost effectiveness BP Cholesterol Cardiac symptoms Programme Adherence Self-reported behaviour GP visits Hospital re-admissions Dalal H, Zawada A, Jolly K, Moxham T, Taylor R. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis BMJ.2010;340:5631 Clark M, Kelly T, Deighan, C. A systematic review of the Heart Manual Literature. Eur J Cardiovascular Nurs. 2011: 3 -13

The Heart Manual Approach Understanding & Acceptance Prioritise & Planning Goal Setting Manage Psychological Responses Realistic physical activity Self Monitor Progress & Change Initiate & Maintain HBC Dealing with setbacks SELF MANAGEMENT 6

Navigated solely by the remote which only has arrows and numbers so this has been an enormous challenge but if this works on a simple system then other things will be a luxury. Phase A: Ability of the system to support medication titration safely and effectively to target doses; Phase B: Ability of the system to reduce diuretic doses safely in patients whose symptoms are well controlled and increase them appropriately in patients whose symptoms are not; Phase C: How challenges of everyday life (such as variations in salt intake, exercise and stress) alter vital signs; Phase D: Proportion of time that the system can keep patients in the ideal range for weight, blood pressure, and

What we added: ‘tailored education & coaching’ Purpose: to increase level of self management for HF patients Wendy Armitage 1 , Michelle Clark1 Louise Taylor1 Dr Wim Stut 2 Prof Tiny Jaarsma3 Heart Manual UK 1 Philips Research Netherlands 2 Linkoping University Sweden3

“actively engage the largest health-care workforce in the world; that is the patients and their carers” [Prof. John Cleland] self-care behaviours medication, symptom monitoring, exercise (physical activity), low-salt diet, fluid

Tailoring for the characteristics of the individual Knowledge & Behaviour Readiness to change –importance & confidence

Performance feedback for the patient

Observational study (1 year) 3 sites – Hull, Barcelona, Heidelburg N=150 Study the system usage by inspecting de-identified database copies Knowledge & behaviour assessed at baseline, 3 & 12 months (paper) Clinical indices also assessed including anxiety and depression Usability also assess via paper questionnaires

A coherent self management programme for people with heart failure Based on the Heart Manual approach Tailored to the individual Offered via system and HF nurse To support motivation and self efficacy for optimal self management Thank you! carolyn.deighan@nhslothian.scot.nhs.uk Theheartmanual.com

Web-based physio Dr Lorna Paul Reader in Rehabilitation Nursing & Health Care School University of Glasgow

Have a look www.sct.scot.nhs.uk www.nhs24.com and www.nhsinform.co.uk www.jitscotland.org.uk/action-areas/telecare-in-scotland/ www.carersscotland.org dementia.stir.ac.uk/ www.telescot.org/copd.html www.patientvoices.org.uk/telehealth.htm www.patientvoices.org.uk/sth.htm

Telehealth and Telecare Learning Network To find out more go to our portal site: www.knowledge.scot.nhs.uk/telehealthcare.aspx & use your Athens password to join the community. By doing this you will receive updates about the Learning Network. You can contact us with ideas for the Network events: Nessa.Barry@nhs.net donna@antaraconsulting.co.uk