'Telehealth is patient empowerment in action'
Cathy Gillespie leads a telehealth service that has helped thousands of patients manage heart failure, diabetes and COPD in their own homes.
Cathy Gillespie leads a telehealth service that has helped thousands of patients manage heart failure, diabetes and COPD in their own home
As a senior nurse with many years of experience, mostly in general practice, Cathy Gillespie admits to having been a bit sceptical about telehealth at first.
Surely the essence of nursing is being face-to-face with your patient, not sitting in an office perhaps many miles away? And how would patients – many of them elderly and vulnerable – cope with the demands of new technology? ‘I didn’t really see how it could work,’ she says. ‘I didn’t learn that until I came into the job.’
Now, as the team leader in telehealth at Liverpool Community Health, Ms Gillespie is an enthusiastic convert. ‘People talk a lot about patient empowerment,’ she says. ‘But for me, telehealth is patient empowerment in action. It helps people understand their condition and how to manage it. Nurses frequently get feedback that patients feel much more confident in managing their own condition.’
Visible to nurses
The city's supported self-care programme was implemented by Liverpool Clinical Commissioning Group (CCG) in partnership with Liverpool Community Health and electronics company Philips. Initially run on a small scale in 2012 and using community matrons, the idea was to support patients to manage chronic conditions at home.
The programme was expanded in 2014, and in the last two and a half years has supported about 3,500 patients, covering chronic obstructive pulmonary disease (COPD), heart failure and type 2 diabetes.
Nurses visit patients and assess them for suitability, then technicians sub-contracted by Philips fit equipment in the patient’s home and the patient, and carers where relevant, are taught to use it. Once the system is up and running, the patient’s oxygen, blood pressure and sometimes weight readings will be visible to nurses in a clinical hub.
If readings fall outside the individual parameters set for each patient, a clinical hub nurse may contact the patient to check if they need further help, either from their GP or community nursing or multidisciplinary teams.
Simple to use
The equipment is simple and straightforward to use, says Ms Gillespie, who adds that she is far from a ‘techie’ person herself.
Depending on their circumstances, patients have the equipment for four to six months, during which time they learn what is ‘normal’ for them, and what they can do to monitor and manage their condition. ‘Sometimes patients are not keen – they’ll say things like “I don’t do figures”. But then they’ll get curious and become interested.’
The clinical hub team follow up with phone calls to reassure patients as they begin using the equipment and make sure they are happy and know what they are doing.
Sometimes patients will buy their own monitoring equipment at the end of their four or six months, because they like the level of control it gives them, says Ms Gillespie.
Prevention is key
As someone who entered practice nursing because she cared about public health, Ms Gillespie finds this relatively new role a very good fit.
‘It’s all about prevention,’ she explains. ‘As a practice nurse I had lots of experience of patients at high risk. Practice nurses do their best, but we know that patients actually forget a lot of what you tell them – in hospital, they forget 70% and in the GP surgery it’s 50%. But the good thing is that in their own homes that doesn’t seem to happen.’
For NHS managers too – whether in CCGs or trusts – telehealth initiatives like this are good news. An evaluation of the programme, covering 1,801 patients and published at an event at the King’s Fund early last year, found a 22% reduction in hospital admissions for patients with above-average risk, and 90% of patients reported feeling more in control of their condition.
The initiative is attracting interest from other healthcare providers across the UK who want to replicate its success. ‘We’re becoming a bit of a go-to place,’ says Ms Gillespie.
For the nurses working in the clinical hub – Ms Gillespie manages a team of 15, including administrative staff – it means learning a new set of communication skills, so that they can build relationships with patients over the phone, rather than just face-to-face. But there is continuity and a chance to get to know the patient and what’s important to them, because of the relatively intense support offered over this period.
It’s also winning new supporters as the word gets out among the local healthcare community. ‘We’ve got a practice nurse who came onto the team in August because of what her patients had been telling her about telehealth,’ says Ms Gillespie. ‘She could see the value in the programme.’
GPs who were initially unsure about the initiative, thinking it would increase their workload, are now largely supportive, she adds, because they can see that in practice they aren’t being called up every time someone’s readings are a bit out of line with what’s expected.
Patients, who so far range in age range from 40 to 98, are also delighted, as are local NHS managers. ‘It’s core business now, so we’re able to advertise permanent jobs,’ says Ms Gillespie, adding that the calibre of applicants for each post has risen as a result – as has morale in the team.
Much as she is an advocate for telehealth, she does not see it as a substitute for nursing care. ‘The technology is getting simpler and simpler, which is great, but there’s still a long way to go,’ she says. ‘And you should never rely on machines on their own for reassurance. It’s not black and white, and you should look at the patient, not just the machine. But it’s a useful aid, and we should be embracing it.’
How to set up a telehealth service
Cathy Gillespie's advice for creating a successful service:
- Project support is key – lots of great ideas falter because people don’t have administrative support.
- Work in partnership and build relationships – in Liverpool, for example, the relationship with community respiratory nurses is important, because liaising with them (if patients’ readings are a cause for concern) can help avoid hospital admissions and ensure that people are safe and looked after in their own homes.
- Don’t wait for people to come to you – the team in Liverpool spoke to GP practices to spread the word about what they were doing and encourage referrals.
- Senior management buy-in is vital, but a strong business case will help, especially as so many hospitals are facing a reduction in beds and looking for ways to cut admissions and length of stay.
- Provide ongoing support for patients using the service, to make sure they are happy with it and understand what they are doing.
- Don’t think of telehealth as an answer in itself – it’s part of the wider package of nursing care that helps empower people to live as independently as possible for as long as possible.
Jennifer Trueland is a freelance health journalist