Joanne McGuigan Home and Mobile Health Monitoring Nurse
At East Renfrewshire Health & Social Care Partnership we first introduced Flo in September 2017. We are using Flo to assist in the management of hypertension – including diagnosis, titration of medication, and long-term management of the condition. We have also started to implement Flo to assist in the management of COPD.
The decision to introduce Telehealth in East Renfrewshire was made several years ago when East Renfrewshire had a small part to play in the United4Health European project. The United4Health Project was set up to assist European countries to meet the growing demands for healthcare services, and ran from January 2012 to December 2015. It focused on finding ways to maximise new technology, such as telehealth solutions, to help improve healthcare, access to care, self-management and resource utilisation. Following on from U4H, when Flo’s success was evidenced in other areas, such as Lanarkshire and Lothian, it was decided Flo would be used by East Renfrewshire as part of the National TEC Programme.
East Renfrewshire got off to a slow start in its implementation of Home and Mobile Health Monitoring (HMHM). Several different models were looked at. One suggested model was to have the Advanced Nurse Practitioners lead on HMHM, however, their already heavy workload prevented this model from going forward. Our HMHM journey finally got underway when a designated clinical lead was recruited. We created a new Flo hypertension pathway which was easy for our primary care partners to adopt, and developed a simple protocol which is user friendly for practitioners. We are now proud to be able to share that 87% of East Renfrewshire’s GP practices have signed up and are trained to recruit patients to Flo, and 100% of GP practices have agreed to use Flo to assist in the management of hypertension.
We have recently carried out an evaluation of Flo’s impact when used to assist in the management of hypertension. This was done as part of the national evaluation undertaken by Dr Helen Alexander, the purpose of which was to assess the outcomes achieved by Years 1-3 of Scotland’s Home and Mobile Health Monitoring Programme, and its success with scale-up, spread and sustainability.
The findings of our contribution to the national evaluation have shown some fantastic benefits for both patients and staff following the implementation of Flo, and the feedback from both groups has also been great. For example, we have found that:
- 42% of patients were able to stabilise their hypertension with Flo’s help.
- Monitoring and titration with Flo has saved around 1400 face-to-face appointments as of the end of November 2018. This means that our clinicians are able to ease some of the pressure on their caseload, and see more patients during their working hours.
A random selection of patients were surveyed about their experience using Flo, and we found that:
- 100% of patients felt that Flo helped them to understand their health condition.
- 100% of patients felt that Flo helped them to comply with health advice.
- 93% of patients felt that Flo helped them to control their symptoms.
- 73% of patients felt that Flo helped them to make lifestyle changes.
- 80% of patients felt that Flo helped them to recognise when their condition was getting worse and when they needed to take action.
- 86% of patients felt that Flo reduced the need for them to attend clinic appointments.
- 100% of patients felt that Flo had been a positive experience for them.
As well as receiving such fantastic feedback, patient comments also gave us a further insight into the impact that Flo had for them:
“ It was excellent not having to miss work to attend the nurse to have my blood pressure checked. ”
“ It was fantastic. It really reassured me because of my family history of high blood pressure. ”
Alongside patients, a smaller number of health professionals were also surveyed; again, the results were fantastic, with 100% of those asked responding positively to the questions asked, including:
- Flo aided better conversations with patients.
- Flo aided better clinical decision making.
- Flo aided patients to avoid unrequired/unwanted appointments.
The evaluation also includes two case studies of patients who used Flo to monitor their blood pressure at home, and in both cases the outcomes for the patient was significantly improved. Both patients replied to Flo registering high blood pressure readings, upon which Flo advised them to seek out of hours help. Had the patients not sought further appropriate medical support on Flo’s advice, then the consequences may have been considerably worse, including the potential risk of stroke. If you would like to read about these case studies in more depth, then please take a look at the full evaluation below (membership required).
Due to the benefits to patients, practitioners and the HSCP, we are looking at ways to increase the uptake of patients to our current pathways with Flo. We are liaising with our community pharmacists around the possibility of Flo being implemented into their pathway for hypertension, and we are hopeful that the results of our COPD test of change will highlight the benefits of Flo in the management of COPD in such a way that the protocol can be implemented for long term use. We are also keen to identify new ways Flo can help the people of East Renfrewshire; the Technology Enabled Care Team is working in conjunction with our Clinical Director, our Lead Nurse, and other members of the HSCP team to identify ways which Flo can assist people to live longer healthier lives at home, or in a homely setting, as set out by the Scottish Government’s 2020 Vision.
For more information, please contact Joanne.McGuigan@eastrenfrewshire.gov.uk
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