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Sharing Experiences and Knowledge: Supporting Asthma Care with Flo in a Rural setting

posted 19 Aug 2019, 02:35 by Hollie O'Connell

Hannah Mountford 
Assistant to Director of Services and Community SSHC 


19 August 2019 

Our Member’s “Network Calls” enable peer to peer sharing across a single area of clinical interest, providing clinicians working within specialist fields the opportunity to hear from their peers to discuss their own experiences and learning with Flo.  The third “Respiratory” Member’s Network Call took place in July featuring Corinne Clark, Respiratory Specialist Nurse from NHS Highland.

What attracted you to integrating Flo into your service?

Corinne gave us an inspirational overview of how she has firmly integrated Flo into her service, helping her to care for patients on the team’s caseload who have been diagnosed with asthma.  Corrine specifically supports patients with Flo whose asthma is poorly controlled which can lead to acute exacerbations, and for some potentially near-fatal asthma attacks.  Corinne explained that there was also a specific group of patients who were not engaged with their healthcare, which puts them at further risk of exacerbation.  Corrine identified that Flo would be able to increase the engagement of these patients to self manage their asthma better, and ultimately lead to an improvement in their asthma outcomes.  Corinne has the additional challenge of rurality, as she is the only specialist covering acute asthma for a large geographical area, where patients may have to take a 5 hour round trip to attend a clinic appointment. 

How does Flo support your patients?

The inclusion criteria for patients accessing Flo as part of NHS Highlands asthma pathway included:
  • The patient has a confirmed diagnosis of asthma;
  • The patient has had a previous hospital admission for acute exacerbation of asthma;
  • Or, the patient had been referred to the Respiratory Community Nurse for specialist input.
  • Patients also need access to a mobile phone to interact with Flo.

Patients are provided with a peak flow meter and a 7 day supply of their prescribed rescue medication.  The protocol that the patient is enrolled onto is assessed by Corrine according to their current best peak flow reading.  Flo then acts as an electronic asthma action plan for the patient, prompting them to take and reply with their peak flow readings.  The patient’s peak flow reading will fall into one of four zones; Flo replies to the patient motivating them to follow the appropriate advice according to each zone. 


What were your outcomes with Flo?

The integration of Flo into the asthma pathway delivers benefits for both Corinne, her patients and the wider health care economy in NHS Highlands, and this is supported by external evaluation by Maria Wolters from the University of Edinburgh. 
  • 100% of patients would recommend Flo.
  • 94% agreed the protocol was easy to understand.
  • 88% agreed that Flo helped them to self manage.
  • Asthma inpatient hospital admission decreased from 129 to 29.
  • The average number of bed days decreased from 52 to 15.
  • GP contacts decreased from 6 to 1.6 per patient.
  • Primary care showed an improvement in the appropriateness of medication reordering.

In addition to the findings from the evaluation, Corinne also reports fewer DNAs to her clinic since implementing Flo.

 Further development & future plans

NHS Highlands have worked to integrate Flo’s Data with SCI Store (an information repository that provides clinicians with secure access to patient information at the point of care), whereby on a monthly basis the data is migrated across so that it is available for all clinicians with access to view the SCI Store.  Corinne has also presented the results of using Flo for Asthma across the country, as well as visiting Milan to talk about her success with Flo at the European Respiratory Society International Congress in 2017.

Looking to the future, Flo will be incorporated into “Near Me” clinics (whereby patients have an appointment with a clinician via a video), which will enable more effective conversations around the patient’s health.  Corinne is always looking to develop and refine the protocols that she has created with Flo, for example, Corrine identified that it would be useful for clinicians to understand the frequency of patients starting their rescue medication.  Flo now prompts the patient asking them to confirm this in order for clinicians to monitor how often this happens and plan any adjustments to treatment accordingly.  Additionally, Corinne and the telehealth team have developed a “Florence Lite” protocol to extend the reach of Flo’s support to the cohort of patients who require less frequent interactions.  The new protocol motivates the patient to take and send two peak flow readings per week over a 3 month period and is then reviewed.  It is hoped that this will be of interest to Primary Care services and will help the spread and adoption of Florence further across NHS Highlands.