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Urgent Care Coping: Supporting Patients with Severe Health Anxiety
14 March 2019
In June 2018, findings from the study ‘Helping Urgent Care Users Cope with Distress about Physical Complaints’, lead by Professor Richard Morriss of the University of Nottingham, were first presented and then subsequently published in January 2019. The purpose of the study was to compare the clinical and economic outcomes of using remote cognitive behavioural therapy (RCBT) to treatment as usual (TAU) for repeat unscheduled care users with severe health anxiety. Dr Sam Malins, Clinical Psychologist at Nottinghamshire NHS Foundation Trust, integrated Flo as an additional support tool to the RCBT group following their participation in the study. What is Health Anxiety? “Health anxiety is an anxiety condition that is often housed within the Obsessive Compulsive Disorder (OCD) spectrum of disorders. Those affected by health anxiety have an obsessional preoccupation with the idea that they are currently (or will be) experiencing a physical illness.... the person experiencing health anxiety may fixate on any type of illness…. Those who are affected by health anxiety/illness phobia are convinced that harmless physical symptoms are indicators of serious disease or severe medical conditions. For example, if a person experiencing health anxiety feels their chest is getting tight, they may believe that they are having a heart attack. Those with health anxiety frequently misinterpret physical symptoms of anxiety as a sign of an impending physical health problem.” | We were delighted to hear about Flo supporting the provision of RCBT in Nottinghamshire by providing additional support for participants in the study. Following prompts asking how they were feeling, Flo interacted with participants around how they felt by sending personalised messages. The messages were written by the participants themselves to maximise the impact of interactions. The inclusion of Flo within the study aimed to reinforce positive changes made during RCBT sessions and to support long-term behaviour changes amongst those with Health Anxiety and as a result, reduce the number of contacts with unplanned/urgent care providers. In total, 156 participants were recruited, half of whom received treatment as usual, while the other half received RCBT. For those in the latter group, CBT sessions took place either by phone, or through a WebEx video call. It was found that those in the RCBT had significantly improved outcomes for generalised anxiety, depression and overall health at 12 months when compared with those receiving treatment as usual. The findings from this study were officially published in BMC Medicine in January 2019 and is available to download here (Membership required). |
For more information please contact Sam Malins at Sam.Malins@nottingham.ac.uk
#Health Anxiety #RCBT #TAU #University of Nottinghamshire #BMC Medicine #TotallyUnique
Community of Practice Members feature in new NHS Education for Scotland Workforce Stories
28 February 2019
We are excited to share with you that five of our Simple Shared Health Care community members have been featured in the Home and Mobile Health Monitoring section:
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Each workforce story provides an personal insight into the commitment that our community members make to improving the quality of care delivered to their patients, such as fewer appointments, improved confidence and self-management, and improved clinical decision making.
To take a look at other workforce stories, please click here.
#Scotland #NHS Education for Scotland #TotallyUnique
National Year 3 Evaluation Report
The Scottish Centre for Telehealth & Telecare (SCTT) have published their year 3 evaluation of Home and Mobile Health Monitoring (HMHM); We’re proud that Florence is formally evidenced as a significant contributor across Scottish Health Boards. “ The most frequently deployed HMHM technology was Short Message Service [Florence] ” We are thrilled to be able to share this evaluation as an example of how Flo’s simple methodology and unique persona continues to improve patients lives. The report also recognises the passion and commitment from Scottish Community of Practice members who are continuing to innovate with Flo, providing high quality care that supports increased self-management and personal responsibility for health. The report takes an in depth look at how the HMHM programme has enabled health care innovation with technology to take place across Scotland, including the challenges faced, learning, and recommendations for continued scale-up and adoption. “ This report draws on evidence and valuable experience from across the TEC Funded partners in Scotland and at national level and reaffirms the important foundations that our national work has delivered to date. The report sets out key recommendations as to how we can continue to shape and inform our future national HMHM activities to support our scaling up efforts over the next few years to achieve wider population health benefits and support at scale service transformation. ”
Partner sites submitted evidence of how resources were being used efficiently and effectively, or how hospital admissions had been avoided. Importantly, patient and service user feedback is also included in the evaluation. | The report highlights evidence gathered where Flo has supported attainment of the desired outcomes. For example:
“ I like that Florence reminds me to do my BP. No improvement needed to the service – more like this are needed to take pressure off the NHS ” “ It was fantastic. It really reassured me because of my family history of high blood pressure ” “ Some people felt that Flo had helped them to stay on track while others said it gave them reassurance, ‘like somebody’s looking over my shoulder just keeping an eye on things. ” Having presented the evidence, the evaluation then goes on to further discuss scale-up and sustainability, with discussion of the implications and recommendations for next steps for the HMHM programme across Scotland as a whole. |
To read the full report, please click here
Direct references to Flo can be found on pages: 12, 13, 16, 17, 18, 19, 20, 21, 23, 24, 26, 30, 35, 42, 43, 44, 45, 46, 47, 48.
#Scotland #SCTT #Scottish Centre for Telehealth & Telecare #HMHM #Home & Mobile Health Monitoring #TotallyUnique
Maternity Network proves a hit with Midwives
30 November 2018
The Maternity Members Network was developed this year as an environment for clinicians to collaborate and share best practice developed locally through Flo’s implementation. The network hosts quarterly calls facilitating members of the wider Simple Telehealth Community of Practice to come together for one hour to share and discuss their experiences, outcomes, ideas or queries to support their maternity patients. The role of peer to peer conversations cannot be underestimated in igniting innovation; being able to chat to a like minded clinician who has already, or may be planning to introduce Flo into their pathway is a valuable part of any clinical redesign, and one that has underpinned the spread of pathways across the Community of Practice so far. | The network has so far heard from Janette, Antenatal and Newborn Screening Lead/ Senior Midwife Sonographer from City Hospitals Sunderland, part of the original team who developed the Pregnancy Induced Hypertension (PIH) and Gestational Diabetes Mellitus (GDM) pathways; to read more please click here. Based on robust early evaluation, these pathways have spread beyond the North East and have now been adopted in several maternity units as a result of the teams innovation and commitment to innovation. Karen McKillop and Ayleen Austin, both Midwives at County Community Hospital within NHS Highlands, also shared their experiences with Flo as a support to Foetal Movement Awareness for their Mum’s to be. The aim of the pathway was to help women to be more aware of their babies movements. NHS Highland’s foetal movement pathway was developed inline with current guidance practiced locally. The team also incorporated bite size messages into Flo’s protocol that shared health promotion advice and also clinic appointment reminders. The pathway commenced when mums to be reached 16 weeks of their pregnancy with Flo interacting through to 38 weeks. 50% of the team’s current caseload were being supported by Flo; patients fed back:
| The calls begin with an overview of the previous call, which is an opportunity for those who were unable to attend, to receive an update and request more information if required. This is then followed by a short update on new maternity pathways developed within the Community of Practice since the last call. The focus is then handed over to the featured team, for them to share their experiences, outcomes and any challenges they have overcome so far. There is also the opportunity for members to ask any questions or request more detailed information. |
Florence joins her third NHS Test Bed programme
05 November 2018 We are delighted to announce that after a successful pilot with heart failure patients, Florence has been chosen to be part of the NHS Test Beds programme at Royal Stoke University Hospital. Florence's heart failure protocols, along with two other digital technologies will now be scaled up with the aim of further reducing A&E admissions of patients with chronic long-term heart failure through learning to self-manage their condition. You can read more at West Midlands Academic Health Science Network - Royal Stoke University Hospital leads on new NHS Test Bed to support patients with heart failure, and NHS England - NHS Test Beds programme. #NHS England #WMAHSN #NHS Test Bed #TotallyUnique |
Evaluation of the use of Florence within NHS Highland
Joanna Gilliat
TEC Project Support Manager
Flora Jones
TEC Project Support Officer
25 July 2018
NHS Highland covers a huge geographical area in the north of Scotland, much of it rural and very remote. The Technology Enabled Care (TEC) team in NHS Highland has been using Florence since November 2015, and has enrolled over 2400 patients on Florence since then. Patients with long term conditions such as COPD, Heart Failure and Diabetes are supported to self-manage by Florence, and patients with hypertension are diagnosed with Florence’s help, but that’s just the tip of the iceberg. The essence of the approach to Florence in the Highlands has been innovation, with the TEC team responding to needs identified by clinicians, and developing a diverse range of Florence protocols. In fact, NHS Highland probably has the most innovative range of Florence protocols of all our users. Keen to provide evidence of Florence’s effectiveness, the TEC team undertook a significant evaluation exercise early in 2018, resulting in a report on the “Evaluation of the use of Florence within NHS Highland” covering use of Florence to support patients with;
| The evaluation methodology included;
Read the full "Evaluation of the use of Florence within NHS Highlands" report. |
Views & Downloads
Evaluation of the use of Florence within NHS Highland - PDF
#Scotland #COPD # Heart Failure #Diabetes #Hypertension #Evaluation #TotallyUnique
“Go Flo Fridays” celebrated at Great Western Hospital
23 July 2018
Great Western Hospitals’ Maternity Departement have recently celebrated their first anniversary with Flo helping expectant mums to monitor their blood pressure during pregnancy. Both parents and hospital staff met in the delivery suite to celebrate and discuss the experiences with Flo during their pregnancies. Local newspaper, The Swindon Advertiser, was invited to attend, and Flo and the staff at GWH were recognised for their achievements by being featured online by the newspaper. Flo has been received very well by staff and patients at GWH. Sarah Feeney, used Flo during her pregnancy; “ It was a fantastic experience and I didn’t have to come to hospital as frequently as before, when the weather was bad I didn’t have to come in, and I was a lot less anxious at home when I was taking my blood pressure. It made me feel quite empowered to be able to do my blood pressure at home. ” Dr Nusrat Fazal, who has led Flo’s introduction over the past two years has been recognised for her work by being awarded the ‘Great Western Hospital Staff Excellence Award for Innovation in Practice’ at the award ceremony held on 22nd June 2018, as well as winning a poster competition at the Bristol Quality and Safety Conference, and being named runner-up for the best presentation at the South Western Obstetrical and Gynaecological Society Meeting 2018. Nusrat led on the “Go Flo” project, which aimed to raise awareness of Flo across the organisation. As part of this, when Flo was first introduced to the department, staff took part in “Go Flo Fridays” to promote Flo with expecting mums. Nusrat commented; “ Patient feedback is absolutely fantastic and we’ve had no adverse outcome. Midwives said how it gave them more confidence in safer monitoring and how to manage time more efficiently by replacing face-to-face appointment with FLO. ” | Using Flo has also helped the maternity department to improve capacity. So far, since the introduction of Flo 600 hospital appointments have been saved, with an estimated reduction in costs at GWH by around £67,000 a year. “ Flo enables pregnant women to self monitor their blood pressure at home, which means less appointments for them at the hospital or with the community midwives. Using Flo saves with childcare, car parking costs, taking time off work. And everyone likes using their phone even if isn't for facebook! ” |
1st Pan-Staffordshire Simple Telehealth Action Learning Event
19 July 2018
Professor Ruth Chambers OBE, Clinical Chair & Staffordshire STP’s Clinical Lead for Technology Enabled Care Services, opened the afternoon highlighting her vision for the role of TECs in meeting the changing needs within today’s NHS. Ruth discussed common infrastructure challenges surrounding TECs applications, including purchasing costly equipment, technical infrastructure, patient access to broadband, and interoperability within NHS systems. Professor Chambers highlighted to the audience examples of Flo as a sustained example of TECs where patients and clinicians are able to use everyday technology that is already accessible. Ruth also shared copies of “Making Digital Healthcare Happen in Practice”1 amongst attendees. The workbook is a practical guide containing advice and suggestions to improve ease of implementation with TEC solutions.
Following on from Ruth, Lisa Taylor and Karen Moore from SSHC led a session “Making eHealth a Reality - Learning from the Simple Telehealth Community of Practice” discussing key lessons learned from delivery at scale, plus an overview of the Simple Telehealth Community of Practice and an update around the outcomes from Flo’s breadth of use nationally.
Following on from Ruth, Lisa Taylor and Karen Moore from SSHC led a session “Making eHealth a Reality - Learning from the Simple Telehealth Community of Practice” discussing key lessons learned from delivery at scale, plus an overview of the Simple Telehealth Community of Practice and an update around the outcomes from Flo’s breadth of use nationally.
From hearing speakers on the day discuss examples of the impacts made around reduced HbA1c and anxiety, Michelle chatted about expanding her interactions with Flo to focus also on these areas. Ann provided a wealth of knowledge from a practice nurse perspective and also through her facilitator role focussing on overcoming barriers that can present in primary care with a pragmatic approach to common perceived challenges. Ann addressed a common question from clinicians around how they should introduce Flo to their patient, explaining that Flo is simply part of the normal nurse to patient conversation, and importantly that she describes Flo as an extension of her care, not an alternative. Ann’s message to clinicians is to start small and build up confidence, reminding us that “ If you’re confident, your patient will be too ” Ann has shared her approach to implementing Flo in her RCNi Primary Health Care Journal column “Being tech savvy-enhances the care you give”. Ann has also co-authored “You too can be a digital practice nurse champion” for June’s edition of Practice Nurse; which is available to view online for subscribers. This approach was used in the development of new pathways such extending the impact of their local diabetes education programme, motivating adherence to the pulmonary rehabilitation programme and reinforcement of strategies incorporated within “Confident Strides”, a local falls prevention programme. Vic and Kath have shared their insights in a recent blog available here.
“ Flo makes me do it, because I know I have to send in the values following exercise. ” “ Oh she’s lovely! I can’t wait for her ringing me up in the morning! ” | Nicky Harrison, Community Matron from STHFT, followed on from her colleague Cath, sharing the story of a patient with poorly controlled diabetes that had ultimately resulted in the development of significant comorbid factors that had eventually led to the amputation of both of his legs. Nicky explained that the patient’s character was known to be very private, and that overtime he had become disengaged with his healthcare needs. Daily visits by his Community Matron to ensure that he took his medication had become a challenge and sometimes not even possible as the patient wouldn’t answer the door. The team reviewed the patient and identified issues around the personal importance of his privacy, the patient feeling disengaged due to him experiencing a reduced sense of control, and the impact of spiraling comorbidities relating to his diabetes. The team also recognised that an alternative approach was required to support the worsening challenge of ensuring that the daily visits by his Community Matron were actually resulting in an improvement in his health. The patient was introduced to Flo as an intervention to try to break this cycle, supporting the patient to regain some control via an approach that was more acceptable to him and opened up an opportunity for the patient to feel more involved and less out of control. As a result, the patient’s HbA1c has now reduced from 120 to 64, Nicky also commented that his cholesterol has also reduced. Nicky described how, because the patient is understandably feeling better than he had been, he is able to get out and about more and becoming less isolated as a result. This demonstrates how Flo’s interventions can provide the opportunity to take a holistic approach to patient care and offer a tool for clinicians to unlock challenges with complex patients. Morag then spoke to attendees specifically to share NHS Lanarkshire’s approach to both scale up and sustainability of use. Morag explained that Flo was now implemented across 77 out of 104 GP practices across the region, as well as a further 36 groups in other areas across health and social care. Morag also discussed NHS Lanarkshire’s Scale-Up BP Programme, which has seen over 2000 patients access Flo to be able to monitor their blood pressure at home, with evaluation demonstrating a saving of around 7000 practice appointments. To read more about Lanarkshire’s journey with Flo, please click here. |
It was an inspiring day of diverse showcase examples and shared learning from independent Simple Telehealth Community of Practice members. The breadth of areas of clinical innovation and transferable learning discussed demonstrated the community of practice in action, with several collaborations across Staffordshire identified and connections to the wider community made.
1 If you would be interesting in receiving a copy of “Making Digital Healthcare Happen in Practice”, please email Paula.Stather@northstaffsccg.nhs.uk.
#Staffordshire #Diabetes #Weight management #Falls prevention #COPD #Medication #TotallyUnique
Singapore fact-finding mission focuses on pioneering digital care in South Lanarkshire
22 May 2018
South Lanarkshire’s award-winning Telehealth team have been recognised by a Singapore fact-finding mission team for their experience and successful adoption of digital health and care. To share experience and knowledge, the team from Singapore visited South Lanarkshire. You can read how the visit went in this press release.
Flo showcased in #NHS70
11 May 2018
Fab news for Flo as she's recognised in the top NHS70 Innovations for her use in long term conditions such as COPD, asthma and diabetes. " Flo actively supports the model of patient self-care management and compliance, while also delivering productivity gains for services, enabling larger caseloads to be managed within existing resources. " |
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