Telehealth pilot in Northern Ireland for COPD

Many patients using telehealth as a means of delivering care and monitoring at home link this to an improvement in their quality of life and independence.

One such project was led by The South Eastern Health and Social Care Trust in Northern Ireland in partnership with Home Telehealth, using equipment manufactured by Honeywell HomMed. The pilot programme was conducted among patients with chronic obstructive pulmonary disease (COPD), which includes the conditions chronic bronchitis and emphysema, and was led by a specialist community respiratory team based at Lagan Valley Hospital in Lisburn. At the time of the project the number of patients with COPD was growing in the region, putting additional strain on the medical teams at a time when there were fewer beds available in hospitals.

All of the patients appeared to grasp how to the use of the equipment very quickly thanks to the text and audio instructions provided within the monitor

The primary aims of the programme were, therefore, to identify the impact of using telehealth to support better quality of life and improved disease management for patients with COPD, support the reduction in avoidable hospital admissions, and help ease the financial costs of patient care.

Installing the technology

The initial project was conducted among 22 COPD patients living at home using telehealth technology. Each was provided with a monitoring device for a period of 12 weeks. Before this was installed, the Eastern Health and Social Care Trust community respiratory teams provided Home Telehealth with a list of the patients' diagnoses, past medical history and current medication. Along with personal information gathered at the assessment process, this was logged onto Home Telehealth's call handling system.

A Honeywell HomMed Genesis monitor was then allocated to the patient and their personal monitoring information was downloaded onto it, including their name, the monitoring start time, the vital signs that should be recorded and any personal reminders. This process was followed by a quick question-and-answer session.

Genesis measures heart rate, blood pressure, weight and asks subjective disease-related questions to provide a more complete picture of the individual's health. It automatically prompts users when it is time to take their vital signs through voice or text communication, and can accommodate multiple medical peripherals such as a glucose meter or PT/INR device.

"The monitors were installed in the patients' homes, normally in the presence of a relative or friend," says Barbara Hanna, a respiratory nurse specialist at South Eastern Health and Social Care Trust.

When asked if they would prefer to be cared for in a hospital setting or their own domestic environment, the patients on our project reported that they would rather receive care at home with telehealth as a support

"Patients were given a full demonstration of the equipment and then asked to carry out a minimum of two sessions on their own to assess their skill. All of the patients appeared to grasp how to the use of the equipment very quickly thanks to the text and audio instructions provided within the monitor."

Monitoring patients

Once vital signs and answers had been inputted, the data was transmitted down the patient’s phone line to a secure server. Telehealth nurses at Home Telehealth's care centre reviewed the data within 10 minutes of transmission and compared it with the limits set by the community respiratory team.

"If the data received was within the patient's normal limits then no action would be taken, apart from a regular courtesy call to the patient that occurred every few days," says Hanna. "These calls were very useful as they helped the patient to build up a relationship with the telehealth nurse. If any of the data gathered - including vitals or questions - fell outside of the agreed limits, the telehealth nurse would phone the patients to discuss the readings and ask further questions which had also been agreed by the medical team. In most cases, patients were asked to rest and then retest to see if their vitals fell back to within the agreed limits. If the second set of results were still outside the normal limits then an escalation was made to the community respiratory team on their mobile phones."

The results

The majority of patients involved in the project felt empowered and did see an overall improvement in their quality of life

The outcome of the initial 22-patient pilot programme showed a number of significant reductions for the heathcare provider, including an 11.7% reduction in hospital admissions, a 40% reduction in bed days caused by unavoidable admissions and a 24.5% reduction in face-to-face visits with patients. A 22.4% reduction in GP visits and 36 prevented hospital admissions was also achieved, while the average length of hospital stays was reduced by 2.26 days. In total, the biggest cost savings were derived through prevented hospital admissions ,which totalled an estimated £82,980.

Significantly, quality-of-life questionnaires revealed a 25% patient improvement.

"When asked if they would prefer to be cared for in a hospital setting or their own domestic environment, the patients on our project reported that they would rather receive care at home with telehealth as a support," says Hanna.

During the project it was found that the use of the Honeywell HomMed home monitoring systems improved patient knowledge about their condition

"The majority of patients involved in the project felt empowered and did see an overall improvement in their quality of life. One man said that the experience was like having your GP in your room all the time and a lady who had been reluctant to go out of her house reported that she had become much more confident and felt more able to do so.

"During the project it was also found that the use of the Honeywell HomMed home monitoring systems improved patient knowledge about their condition. This resulted in fewer unnecessary appointments with their GP. In essence, the patients themselves became better self-managers."

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