1. BART’S HEALTH CANCER CARE @ HOME ( BHCC@H )
Dr Mariya Rashid
Foundation Year One Doctor
Dr Samir Agrawal
Consultant Haemato-Oncologust

2. remote Patient Monitoring Programme (rPMP)
Initiated in 2015
Delivers specialised cancer care remotely

3. BACKGROUND
Poor performance of London cancer services in National Cancer Patient Experience Survey (NCPES)
Patient demand
Workload management

4. National Cancer Patient Experience Survey
Several factors had a negative impact on patient experience:
Overcrowded waiting rooms
Long clinic waiting times
Waiting for blood tests and pharmacy.
Commonest suggestion:“reduce waiting times”.
Survey showed positive response to the idea of remote monitoring.

5. BHCC@H - OBJECTIVES Primary objective: Secondary Outcomes:
Improve patients’ quality of life –
minimising visits – ongoing specialist care
Secondary Outcomes:
Minimise the stress of travel, costs and delays associated with hospital visits
Empower patients
direct access to blood results / letters
A major goal of government policy for health care is allowing patients a choice in the delivery of their care, with a focus on bringing care in to the community. 5

6. Eligible patients identified inclinic
PATIENT ENROLMENT
Pre enrolment
Eligible patients identified inclinic
“Blood pack” sent to patient, includes:
Questionnaire (pre-paid envelope)
OR, patients can input their data online
admin team collate results and book appointment
Post enrolment/ Pre appointment
ADD slide with the Royal Mail samples box to show alternative approach, where testing is done at the centre??
Remote consultation – telephone / video
Discuss responses and review blood test results
Agree Follow-up
Instant access to results and letters via the portal
Appointment 6

7. BART’S HEALTH CANCER CARE @ HOME
NOT easy to read of follow
Portal
Generates an ‘End of Treatment’ summary for every patient; a requirement of London Cancer which is currently unmet.
Allows high quality Audits to be carried out.
Amalgamates blood results and a consultation letter to generate regular patient reports which are available to GP’s and bridges gaps between primary and secondary care.
Allows direct interaction with patient’s through the ‘ask a question’ function reducing the number of non-urgent calls to CNS’s, the hotline and the day unit. 7

8. BART’S HEALTH CANCER CARE @ HOME
NOT easy to read of follow
Portal
Generates an ‘End of Treatment’ summary for every patient; a requirement of London Cancer which is currently unmet.
Allows high quality Audits to be carried out.
Amalgamates blood results and a consultation letter to generate regular patient reports which are available to GP’s and bridges gaps between primary and secondary care.
Allows direct interaction with patient’s through the ‘ask a question’ function reducing the number of non-urgent calls to CNS’s, the hotline and the day unit. 8

9. Patient Survey
50 patients were surveyed
64% response rate

10. Patient Survey For a single hospital clinic at Barts:
For a single hospital clinic at Barts:
Do you take time off work ?
Does this affect you financially ? Yes/No/How much ?
Travel - costs ? Time taken ?
Waiting time to see the doctor ?
Did someone come with you?
Did they take time off work ? what costs did they incur?

11. Patient Survey For rPMP appointments:
How many appointments have you had in 12 months?
Costs per rPMP appointment?
Was the service easy to use? Yes/No
How has rPMP helped you?
What are the drawbacks for you?
Rate the service?
Suggested Improvements?

12. PATIENT IMPACT Hospital Clinic rPMP Time off work (days)* 2 (1 – 3)
Loss of income
Up to £475
Travel costs#
£30 (0 – 79)
Travel times
60 – 240 min
Companion
34%
Travel costs
£40 (0 – 50)
Waiting times
60 (30 – 210) min
12.5% of patients reported stress and anxiety of coming to hospital /sitting next unwell patients
*: most patients retired
#: 53% had travel costs ; 15% used hospital transport 12

13. PATIENT IMPACT Hospital Clinic rPMP Time off work (days)* 2 (1 – 3)
Nil
Loss of income
Up to £475
Travel costs#
£30 (0 – 79)
Travel times
60 – 240 min
Companion
34% -
Travel costs
£40 (0 – 50)
Waiting times
60 (30 – 210) min
Nil**
Easy to use
Yes – 88%
Overall rating (1 – 10)
10 (1 – 10)
Hospital Clinic
rPMP
Time off work (days)*
2 (1 – 3)
Nil
Loss of income
Up to £475
Travel costs#
£30 (0 – 79) £5
Travel times
60 – 240 min
Companion
34% -
Travel costs
£40 (0 – 50)
Waiting times
60 (30 – 210) min
Nil**
Easy to use
Yes – 88%
Overall rating (1 – 10)
10 (1 – 10) 13

14. PATIENT BENEFITS OF BHCC@H
16% of patients were at work, in transit, shopping, abroad, waiting at another hospital appointment
Convenient “[Saved] arranging childcare”.
  “Very useful as I am a carer for my disabled wife”
Flexible
“Easier to fit into work, able to have blood tests done nearer to home, saves time”
Patient centred and Empowering
 “Makes me feel more involved in my illness”
Accessible
 “When I logged on to the system you could see all blood results from the last ten years”

15. PATIENT DRAWBACKS OF BHCC@H
Lack of face to face consultation and physician examination
 “I would like to retain the reassurance that can only come from personal consultation”
Admin and system errors
“It would help to receive blood forms a little earlier”
Not suitable for all patients
 “I do not hear so well so need someone with me for the telephone appointment”

16. Summary: BHCC@H vs Clinic
Decreases Travel – Time and Costs (patient / carer)
No loss of income (patient / carer)
No waiting time !
Ease to use – overwhelmingly positive experience
[advantages to the NHS - service delivery / resources]

17. What I Have I Learnt ? Patients are not dependent on the hospital
Patients are more accepting of change vs HCP
The current clinic model doesn’t make sense
Regular clinic visits for well patients ??
Workload vs Resource ?
Are patients able to report when they are unwell ?
Blood results are in our CRS, any issues (clinical or lab values) are highlighted before they get to clinic/Day Unit, reduces trips for patients and potential drug wastage, frees up Day unit and clinic space 17

18. FUTURE DIRECTION Patients on long-term oral chemotherapy
Ibrutinib, Idelalisib, Venetoclax…
Remote chemo pre-assessments
FCR + other chemo regimens
In fact, almost anything…
Chemo pre-assessments are essential, but currently inefficient, requiring an extra trip to Barts for many patients and/or chasing of bloods done elsewhere.
A suggestion: for certain diseases, patients who are well, have had TWO cycles and are responding, they could have their cycle 3 chemo pre-assessment remotely. 18