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Nuffield Trust: “Flo has been formally evaluated, with positive results”

Phil O’Connell 

A few days ago, the Nuffield Trust published a Research Report; “The digital patient: transforming primary care?”.  

The report provides welcome and thoroughly researched analysis on the use of digital services in healthcare in the UK.
For this report, we conducted a literature review, interviewed 21 experts – including representatives from technology companies, policy, academia, patient organisations and health care providers – and held a workshop to test and refine four future scenarios. We also undertook four case studies comprising of desk research and one or more interviews with key people at the featured organisations.

“A professional monitoring system in action: Florence (Flo) – a case study”

We were delighted to find that Flo has been highlighted as one of the four case studies.  Drawing from multiple sources including the national AIM programme and Bay Medical Group’s CQC “Outstanding” citing for use of Flo, the case study discusses the merits and some of the earlier issues found and how they were addressed by those teams.  In particular it’s about getting the protocol right for the intended purpose and target cohort, and in the case of Bay Medical Group, they modified the protocol to fit their shared clinical management plan, whereas the earlier national AIM study (Cottrell et al) offered less flexibility and ability to change what in hindsight were quite verbose protocols for use over a 2-3 month cycle.   The learning from this earlier work now forms part of the established knowledge-base of 1,000+ applications of Flo, available to members of our Community of Practice. 

“To improve engagement, there are a number of things professionals can do: 

  • where patients are asked to send readings, send reminders at the time the readings are due and limit all other communication 

  • clearly communicate the commitment required from patients at the start of the intervention 
  • carefully select patients with the capacity for (and ideally interest in) self-management – particularly as monitoring can be costly (see Slomski, 2016). See Chapter 4 for broader considerations about engaging patients.

“The evidence base behind Flo”

Flo has been formally evaluated, with positive results. It is considered to be easy to use, convenient and reassuring for people across a wide age range (Cottrell and others, 2012; Cund and others, 2015). Both patients and professionals have found that Flo can help patients to develop a better understanding of their condition, medication and lifestyle and improve condition management (Cottrell and others, 2015a; Cund and others, 2015).

“A dystopian distraction”

The report goes on to echo our message on the the dangers posed by sales driven technology companies and the need for robust evidence and how these technologies should be evaluated, recognising that not many would actually reach the standards achieved with Simple Telehealth and Flo.  To become approved, the technology would have to go through a four stage process, culminating in “Independent impact evaluation by an NHS body“.
Strong marketing campaigns by the private sector may mean that the most fashionable or popular consumer technologies are used at scale, rather than those that have been proven to be effective.

Lead author Sophie Castle-Clarke, Fellow in Health Policy at the Nuffield Trust, said:

Technologies that patients can use offer some of the brightest hopes on the NHS horizon. Digital tools that help people stay healthy and manage their conditions at home will be critical to the future of the health service. The good news is that this is increasingly becoming a reality in the NHS.
But this technology could be a double edged sword, and there’s still a lot we don’t know. Without regulation and a careful look at the evidence – not all of which is compelling – these digital tools could compromise the quality of care and disrupt the way care is provided.

We are pleased that this timely Research Report highlights the huge potential for the NHS if genuine, evidence based technologies such as Florence are encouraged and adopted.

Read the report at the Nuffield Trust or members: click here.


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