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East London patient's receiving "seamless service" to support self management with Flo

posted 28 Jun 2017, 01:13 by Hollie Stirman   [ updated 16 Oct 2017, 05:13 ]

East London 
NHS Foundation Trust 

Raguraman Padmanabhan 
PGDip (Lond), BPT (Ind), MCSP, MAACP - Clinical and Operational Lead 

29 June 2017 

As the Clinical and Operational Lead for Telehealth at East London NHS Foundation Trust (ELFT), I have been leading on the partnership between ELFT and Florence since 2013 to support people with chronic physical illness, improving their treatment adherence, engagement and self-management.  The number of pathways, innovation ELFT are developing is expanding, an increase in positive outcomes is being delivered and there is growing recognition for the teams involved.

ELFT is committed to facilitating integrated care and accessing best practice technology to support patients being managed in the community.  Examples of current pathways where Florence is supporting patients to self manage their condition include diabetes, chronic obstructive pulmonary disease and hypertension, to name a few.   From local evaluation of outcomes, Flo has proven to have a significant and positive effect on patients as they are provided the opportunity to experience the benefits of supported self-management and receive a seamless service.  Patients report back that they “ love Flo .

Overall Flo has also been used successfully in ELFT to monitor patients with long-term conditions and in mental health settings and plays an important role in facilitating and integrating care in the wider community.

HRH The Prince of Wales Award for Integrated Approaches to Care Award

At the end of 2016, we were honoured to be shortlisted for the HRH The Prince of Wales Award for Integrated Approaches to Care as part of the Nursing Times Awards.

The teams’ nomination was in recognition of ELFT’s innovative Telehealth Service including Flo helping patients manage their diabetes and other long term conditions better, maintain their health and live independently at home.

This prestigious award sought to reward nurses whose work is reducing the burden on the health service by preventing ill health and/or offering truly holistic care to patients who have long-term conditions or complex needs.

Created specifically to reflect HRH The Prince of Wales’s long commitment to holistic healthcare, the award identified those nurses from the community or hospital sector who have joined forces with other organisations, such as those from the voluntary and/or third sector, to help promote public health and prevent disease and/or manage long-term conditions in a holistic and integrated way that improves patients’ quality of life and independence.

From almost 200 applicants the team were shortlisted to only 8 and following an interview process were invited to Clarence House where HRH Prince Charles was keen to find out more around how digital empowerment via Flo worked in an integrated model.

What our patients are telling us - Diabetes Pathway

The Diabetic Specialist Nurse Team in East London have recruited Flo as part of their team for some time now to motivate their patients to better engage with their diabetes in between scheduled contacts.

Patients benefit from a daily message from Flo as a reminder to take their blood glucose measurement, with Flo sending advice back depending on the patient’s reading.  The team now has access to their patient’s daily readings which they would not have had otherwise offering not only the opportunity for earlier intervention should the patient’s diabetes exacerbate, but the additional patient reported measurements have proved to enable a more effective consultation either face to face or via Skype.

Evaluation with patients demonstrated that the appointment felt more focussed, took less time and the patient felt that they received more attention and had an increased feeling of control over their diabetes.

A short video of the team’s approach is available here and you can hear patient, Yvonne explain the difference that Flo has made to her 

I used to forget to take my blood glucose in the morning, now I have a reminder as soon as I get up and I can keep an eye and regulate what I’m doing.  Flo is definitely part of our family now

As an example, another one of our diabetes patients who has been using Flo for a while commented that he "prefers sending in the blood glucose readings via Flo".  The patient mentioned that it "gives him the confidence" knowing that someone is able to keep an eye on things.  The patient reported that he ‘loved’ the option of having a print out of readings from his Diabetic Specialist Nurse, if needed.

The patient also finds it reassuring to get a call from his Diabetic Specialist Team if they have identified up anything that requires early intervention from the readings that he has been reporting from home to Flo.  The patient also enjoys being able to speak to someone right away if Flo has advised him to contact the team due to his diabetes needing further review.

The patient’s GP is also happy that the team is provided with access to the patient’s readings in Flo as and when needed for review and initiation of further management.

The patient fed back that he would recommend this service to friends and family and is happy to be part of this service for the foreseeable future.

Another patient had a technical issue with one of the network providers and since it could not be solved despite several attempts, changed his phone so that his Flo connectivity remained intact.  The patient reported it was "the best thing ever for him to be in touch via Flo to self-manage his diabetes" and that didn’t want to lose Flo.

The service users also pointed out that Flo is well placed within a preventative and public health arena and is also accessible to patients.

Pressure ulcer prevention and management 

Another area that Florence is used to help support patients at ELFT is those patients are at risk of developing pressure sores or those who have a recently healed pressure area.   Patients identified by their District Nurse, Allied Health Professional or Tissue Viability Team; due to the volume of referrals the patent is referred to the Telehealth Team as a single point of access.  The Telehealth Team are co-located with the District Nurse Teams and will fast track a visit to address issues coming via Flo from the patient, providing a safe and coordinated pathway onwards.

Using a combination of targeted prompts, condition education and motivation; Flo interacts with patients around key areas such as positioning, equipment, nutrition, eating/drinking and the health of the patient’s skin and pressure area.  If a need is indicated, Flo will prompt the patient to make contact with the team as further intervention is required.

What has been the Impact?

The use of Flo to support patients in this cohort has proven to reduce the pressure on our community services with time being released to focus on patients with more acute and complex needs.

The teams have noticed how patients and carers have embraced this simple technology in shaping their care and also how Flo has improved compliance to agreed self-care arrangements.  In addition, with Flo providing remote support determined by their clinician, patients report feeling that they having access to a clinician when needed.  This gives patients the confidence to report to us any issues or concerns with their pressure area round the clock, knowing interactions with Flo will be reviewed and triaged accordingly, which also complements business continuity.

Supporting Service Users with Mental illness

The Mental Health team were selected by The Health Foundation to be part of its £1.5 million innovation programme, Innovating for Improvement supporting twenty health care projects in the UK with the aim of improving health care delivery and/or the way people manage their own health care by testing and developing innovative ideas and approaches and putting them into practice.

Flo is already used in Newham in supporting people with chronic physical illness to improve treatment adherence, patient engagement and self-management but this will be the first time it has been tested in a controlled trial for people with a severe mental health condition. 

Led by Professor Frank Röhricht ELFT’s REFRAME project is a feasibility randomised control trial using Flo to support service users with severe mental illness.  The research aims to understand if Flo’s interactive text messaging intervention can improve the care and self-management of patients with severe mental illness.  This is an ongoing project, we can’t say too much now, but watch this space!