Lee Lewis
Liverpool Digital Health Service Manager
Assisting the diagnosis and management hypertensive patients outside of the GP surgery
The Digital Health Service in Liverpool are currently managed by Person Shaped Support (PSS). The primary purpose of the service is to introduce people to technology, empower people to use Florence to self-care and take more of a leading role in managing their blood pressure. They also aim to educate members of the local community about issues surrounding blood pressure, predominantly in primary care settings.
What is Liverpool’s Digital Health Service?
The approach we take is similar to the one we originally took as Health Trainers, in that individuals are referred to us from their GP surgery. However, the focus now is on blood pressure, rather than lifestyle as a whole as it was previously. People often respond differently when being given lifestyle advice than when they are being told they have high blood pressure. With blood pressure, most people know something about it, know some of the risks it entails, and they respond better to this.
To support people with their knowledge of blood pressure we have developed our own service user booklet which provides key information around how to use Florence, and includes the patient’s management plan and some basic lifestyle advice.
How does Flo feature?
When a patient is referred to us, we are able to set them up on Flo to monitor their blood pressure. We frequently use the AIM 01 protocol designed to prompt patients to take their blood pressure twice a day, as per NICE guidance, to collect sufficient readings for a GP to diagnose or exclude hypertension. We can offer this to patients without a referral from their GP.The readings we receive are shared with the surgery, and then the GP is able to decide if further action is required to treat the patient’s blood pressure. They often refer the patient back to us so that we can enrol them on the AIM 02 protocol to measure their blood pressure over a longer period aiming to improve hypertension control.
You would assume that most people are having their blood pressure checked, but this isn’t always the case. Many people only have their blood pressure taken during a health check or if the clinician needs to investigate something further, but generally most people who present at their surgery don’t have it taken. At the moment in Liverpool there is quite a long waiting list for ambulatory blood pressure monitoring, so the GP surgeries really like the idea of referring patients to us, as an alternative.
What benefits have you seen so far since Flo’s introduction?
With the help of Flo, we are able to provide information that will help GPs to diagnose hypertension, which saves them time, as well as reducing the anxious wait that a patient may have if they are on the waiting list for blood pressure monitoring. Additionally, we can use Flo to help clinician’s determine what medication and the dosage a patient requires to bring their blood pressure under control.We have also found that a number of patients want to continue using Flo as it reduces their concerns about their blood pressure; they have increased knowledge and awareness of blood pressure and they therefore feel more in control of their own health.
What’s next for the Digital Health Service?
We have been working hard to make sure that The Digital Health Service becomes more visible. We have been engaging occupational workplaces, such as the police force, to support staff and pick up on issues surrounding blood pressure. We now feel that due to PSS’s work within primary care settings over the last few years, we have built a lot of trust with the primary care services in the city. The GPs and clinicians know that we are capable; we can support patients, we are professional and everything we do is done in the correct manner. Liverpool is lucky; there are a lot of great clinicians here, and they have opened doors to engaging with both the communities and services in the city. They recognise that a medical approach is not the only option available, and that holistic approaches offer something just as valuable too.
The key really is to talk to as many people as you can and promote what you do, be that at conferences, or just by attending meetings with different organisations. Flo is a great example to use for us, as we can engage patients with the benefits and how Flo has helped patients. We found that being able to talk about these real situations that relate to patients made a difference to how willing some GP practices were to be involved with us and engage with the service we can offer their patients.
Going forward, we would like to develop the use of hubs across the city. These will create access routes into the service for primary care. The aim is to reach out to as many people as we can; be that working with other services to improve care, or just making ourselves more visible to the local communities. We want to help as many people as we possibly can, and Flo is tremendously important to this.
CASE STUDY 1
We recently helped a young man reach a diagnosis of high blood pressure using Flo. The patient was suffering with ongoing headaches, however despite having quite a strong family history of high blood pressure, he hadn’t linked the two together. We enrolled him with Flo to monitor his blood pressure and discovered that it was quite high, especially given that he was only in his early 20’s. From that point, we were able to pass on the information to his GP, who referred him back to us to put him on to the AIM 02 protocol to continue to monitor his blood pressure. The patient has since been sent to a specialist hypertension clinic to help him further with his blood pressure.
This isn’t an uncommon example when it comes to younger patients; we find that a lot of younger people aren’t as engaged with their health, especially when its things like hypertension which are traditionally associated with older individuals. However, once we sat him down and gave the patient the necessary education about his situation, he took it up and started to follow the advice and guidance.
There are many scenarios like this where we, helping people to engage with their healthcare, and Flo is a really helpful tool for us. We don’t just engage people in primary care settings, but also work closely with community and occupational settings.
CASE STUDY 2
More recently we have just engaged with a patient who was a 50 year old male, who had suffered from a stroke within the past 18 months. The patient was found by the surgery using the EMIS Flo searches, which our service provides; these were developed for the surgery with the support of Informatics Merseyside and Liverpool CCG. The client had previously been diagnosed with hypertension in 2015 but his readings were still high, especially his diastolic, even with the patient being on medication.
The patient was put on AIM 01 for one week to monitor and get a more accurate measurement of his blood pressure at home. The patient was a bit apprehensive at first about coming in to see the Digital Health Advisor (DHA) as he was not 100% sure why he was there. The DHA explained the service, what Flo was and how it was being used to monitor the blood pressure of patients. After discussing this, the patient divulged that directly after his stroke he was regularly seeing his practice nurse, having a variety of checks including blood pressure, but after 6 months the visits ceased. He felt strongly these routine visits should have continued, particularly as his blood pressure was not being monitored by the practice, which really concerned him.
The DHA explained to the patient that by using Flo we were able to monitor his blood pressure at home without the need for him to physically come to see the nurse (unless needed), and his results/readings would be put on to his records for all clinicians to see. The DHA also gave lifestyle advice on how to help manage his blood pressure better. After using Flo for one week the patient improved his compliance with his medication; he had noticed that on days when he took his medication as he should, there was the desired effect on his blood pressure. Previously the patient hadn’t been taking his medication as instructed, but as he started to use Flo he could see that it was actually helping.
The patient’s initial blood pressure on AIM 01 was 127/91mmHg, and his blood pressure at the end of the week was 122/79mmHg; this was an average across the 7 days, taken twice a day. The client is now fully complying with taking his medication as instructed. The patient asked if he could continue to be further monitored, as he felt reassured that his blood pressure was constantly monitored and fed back to the surgery. We discussed this and put the patient on AIM 03; he is now sending in his blood pressure once a week for 13 weeks. Since using Flo the patient’s blood pressure has improved with once weekly readings showing 135/85mmHg, 133/85mmHg, 130/84mmHg, and 112/73mmHg respectively. The first three readings were all taken between 16:00 and 18:00, with the final reading being taken at 22:00.
If you would like more information about the Digital Health Service in Liverpool, or how Flo is being used to help people in the community engage with their health, please contact Lee Lewis at Lee.Lewis@pss.org.uk
2015
Liverpool CCG – Blood pressure service user booklet (Membership required)
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