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Simple Telehealth

8. Understanding the costs of Flo telehealth to the NHS; and potential savings in consultation times

 

8. Understanding the costs of Flo telehealth to the NHS; and potential savings in consultation times

Learning and service outcomes – you will be able to:

  1. Understand the costs of Flo telehealth: staff time, texts, associated equipment.
  2. Estimate cost savings by adoption of telehealth in your practice.

If the Flo telehealth service is utilised in the right clinical areas there should be obvious cost savings whilst providing at least as good quality general practice care. So these might include replacement of face to face consultations in general practice or other healthcare settings by interactive text messages or phone calls; enhancing accuracy and speed of collation of true bodily measures and readings – thus reducing wastage of inappropriate medication or other interventions and minimising deterioration or likelihood of acute exacerbations of long term conditions. In essence service users should illustrate or demonstrate avoidable healthcare usage in the short, medium and long term.

More evidence is needed about the effectiveness of the huge range of telehealth equipment, and the extent to which investment of money, workforce skills/time and effort is worthwhile. There are many individual studies worldwide that suggest that telehealth monitoring of patients helps to reduce hospital admissions, reduce cost and improve patient outcomes. But a systematic review of telemedicine interventions found no good evidence that telemedicine is a cost effective means of delivering health care.10 None of the studies used cost utility analysis and few compared telemedicine with traditionally organised health care. Another systematic review of economic evaluations of telemedicine where both costs (resource use) and outcomes (patient benefits, non-resource consequences) were measured was inconclusive – few published research papers were found to have trustworthy findings.11 Even if there is evidence for the clinical and cost effectiveness of a method of telehealth in future, you cannot presume that this is generalisable to other clinical conditions or other settings when there will be a different type and extent of healthcare support.

A review of trials of patient-centred, home based telehealth found that use of the equipment can enhance patient self-care (e.g. reduces sense of isolation, improves quality of life and psychological outcomes e.g. depression), and satisfaction amongst patients.12 Mobile phone based interventions for smoking cessation have been shown to have a benefit on long term quit rates.13

The current situation is that telehealth is now technically possible and seems to be a good idea for many patients to improve their clinical care and prevent deterioration of their long term condition; but how to use it effectively and how much impact it might have are still big unknowns. The eagerly awaited research reports of the Whole System Demonstrator sites found that complex telecare implemented in general practices did not always lead to significant reductions in service usage during the 12 months study.14,15,17 So far, simple telehealth appears to be a low cost alternative which requires minimal staff time and effort that is suitable for general practice settings.8,9

Table 3. Flo applications – maximum costings of different protocols (download)

(if each patient participates at 100% rate – and doesn’t need extra prompts. But please note that if patients submit readings prior to request on a specific day/time- they don’t receive request from Flo’. So expect to reduce the costs of texts for hypertension protocols by around 50% in reality.)

CPD Table 3

Example Costing of Case Study – Flo telehealth service compared with clinic measurement for e.g. 20 patients in one practice

Hypertension (initial high blood pressure – not yet confirmed, protocol 1 – see page 7 of Flo resource pack (click here))

Purpose: To establish whether a patient’s initial high blood pressure reading is confirmed hypertension, or merely an isolated incident.

Selection of 20 patients in 6 month period: Patients who have had an initial high blood pressure reading higher than 140/90mmHg when taken opportunistically in surgery or at an NHS Health Check (rechecked two times on that occasion and persistently > 140/90mmHg).

Method

Patients signed up to Flo by the 2 practice nurses and healthcare assistant (HCA) working in the practice. 20 of the 23 patients invited to participate agreed – to text in BP readings twice a day for a week. All patients loan one of the five sphygmomanometers that the practice had for this purpose, and returned it to the surgery the following week.

 

It took the nurse/HCA 5 minutes on average to explain the purpose of the intervention and gain informed consent and sign up each patient as part of their usual consultation (3 of the patients preferred that their husband/daughter was signed up on their behalf and texted in the readings as they were not confident about using text messaging) to register with Flo.)

 

All 20 patients texted in at least 10 BP readings; 2 had to be reinstated and repeat the exercise as they texted in too few readings in the following week. They received interactive automated messages: daily at 8.00am and 8.00pm; information messages: none.

Findings

6 of the 20 patients had BP readings consistently < 135/85mmHg (as home BP readings 5/5 deducted from equivalent 140/90mmHg clinic reading); 4 had BP readings just below the threshold for hypertension (in line with practice protocol taking into account other LTCs) and did not need treatment; and 10 were confirmed as having hypertension.

Guesstimate costs for 12 month period (if assume that subsequent clinic readings would have classed 18 of these patients as having hypertension, compared to the 10 patients confirmed by Flo telehealth service)

Table 4. Example costing of case study (n=20 patients) (download)

CPD Table 4

See: CHERP72_predicting_primary_health_care_costs.pdf This source is used here to justify estimated costings for GP and nurse consultations.

Question1The potential cost savings for specific applications of Flo simple telehealth service seem pretty obvious don’t they – from a practice team perspective? With at least as good if not better quality of care for your participating patients?

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