1. Camden Telehealth Jennie Symondson
Long Term Conditions and Cancer Programme
Jennie Symondson

2. Aims
Telehealth
Evidence
Case studies
Camden Pilot

3. Telehealth
Telehealth is the monitoring of a patient’s vital signs and symptoms via technology in their home.
Peripherals include, oximeter, BP, weighing scales, thermometer, glucometer
Patients take their readings and answer a series of health questions
Information is transmitted to a clinical triage centre (CNWL Milton Keynes)
Nurses will verify the results, complete a phone assessment and only refer to Camden clinicians if required

4. Statistics 15million people LTC in England (total population 53m)
Expected to rise to 18million by 2025
2010 est. the following
70% of the total health & social care budget spent patients with LTC’s
50% of all GP appointments
65% of all out patient appointments
70% of inpatient bed days
Ref: DH 2012 Long Term Conditions Compendium of Information, 3rd ed. London:Available at:

5. Camden data
Table 11: Recorded and expected prevalence of selected conditions as of 2008/09 Disease Register
Camden Recorded Prevalence 2008/09 (numbers)
Camden Expected prevalence by 2020
CHD
1.85% (4,394)
4.80% (10806)
Heart Failure
0.51 % (1,207)
0.85% (2648)
Ref:

6. Telehealth evidence
The Whole System Demonstrator (WSD DH 2011) was the largest randomised control trial of telehealth & telecare in the world
6191 patients
238 GP practices
Newham, Kent & Cornwall
Heart failure, COPD, Diabetes
Reference:

7. WSD outcomes 15% reduction in A&E
20% reduction in emergency admissions
14% reduction in elective admissions
14% reduction in bed days
45% reduction in mortality rates

8. CHF evidence
Telemonitoring reduced all-cause mortality, hospitalisation, and increased adherence to treatment plans (Cochrane Nursing Care Field 2011, Nakamura et al 2014, Barrett 2012)
Remote medication titration is feasible & safe (Steckler et al 2011)
TH not only monitors but empowers & motivates individuals, giving them greater control over disease management (Barrett 2012)

9. Camden case study (JS of NW1) using telehealth since April 2011
COPD, glaucoma, and experiencing hypertension
GP made referral to the district nurse team to monitor blood pressure once per week for 4 weeks.
CNWL resp nurse informed GP that JS has TH & printed off BP report
GP able to prescribe meds instantly

10. Pilot scope Commissioner led project
Small scale - 25 units from 14th July 2014-July 2015
COPD & CHF
Integrated working- CCG, CNWL & LA

11. Pilots aims Pre-telehealth user survey Patient/carer satisfaction:
Self-management skills, mental state, function & personal goal
Staff satisfaction

12. Year 3 (no additional units)
Pilot aims
Financial:
Hospital admission, LOS, GP, A&E
Year 1 current
(25 units)  
Year 2
(additional 75 units)
Year 2(200 units)
Year 3 (no additional units)
Comment
Revenue / Savings
Other revenue / saving CCG
TOTAL REVENUE / SAVING
£69,286
£277,968
£573,710
Costs / Investment
Pay
Non Pay
TOTAL COSTS / Investment
£51,402
£176,201
£352,414

13. Pathway Patient identified according this eligibility criteria
One or more Long Term Condition/s.
Known to CNWL Camden service (or eligible for)
Patient/carer is:
physically and cognitively able
Interested, motivated.
Capacity to understand TH not emergency service (mon-fri only)

14. Pathway continued……. Assessment, referral Patient consent & leaflet
Set parameters for patient
Send letter to GP & LAS informing of TH
Patient data prev. year e.g. hospital admissions

15. MK Triage Missing data, no data Clinical assessment
TECHNICAL TRIAGE- re-test, arrange repair
CLINICAL TRIAGE
Clinical assessment
Advice
Rescue pack (highlight ref form)
Update GP
Call ambulance
Refer to Cam before 1pm via Rapids
Reset parameters
Training
Discharge
Missing data, no data
Reading near to parameter limit
Outside of parameters

16. Next steps Evaluation Set up hospital discharge pathway
Upscale to 100 units 2015/16
Decide if GP surgery wants access to ICP
Launch event St Pancras 2-5pm

17. HF Case study Heart failure, NHS North Yorkshire & York

18. Questions

19. References
Barrett A (2012) Benefits of Telemonitoring in the care of patients with heart failure. Nursing Standard Vol 27 no 4
DH (2012) Long Term Conditions Compendium of Information, 3rd ed. London: Available at:
DH (2011) Whole Systems Demonstrator. Available at:
Holly C (2011) Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Nursing Care Filed. International Journal of Evidence-Based Healthcare Vol 9
Nakamura N, Koga T, Iseki H (2014) A meta-analysis of remote patient monitoring for chronic heart failure patients. Journal of Telemedicine & Telecare Vol 20 p11-17
Steckler A E et al (2011) telephone Titration of Heart Failure Medications. Journal of Cardiovascular Nursing. Vol 26 No1 p29-36