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

2. 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

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

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

5. 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

6. 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

7. 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

8. 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

9. “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

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

11. Performance feedback for the patient

12. 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

13. 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!
Theheartmanual.com

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

15. Have a look www.sct.scot.nhs.uk www.nhs24.com and www.nhsinform.co.uk
dementia.stir.ac.uk/

16. Telehealth and Telecare Learning Network
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