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Journal of Psycho-Oncology; Supporting cancer patients with mindfulness-based CBT

posted 18 Dec 2019, 01:37 by Hollie O'Connell

18 December 2019

We are excited to share with you that members of the Community of Practice from the Clinical Psychology Cancer Service Team at Sherwood Forest Hospital Foundation Trust, have recently published their proof of concept evaluation of using Flo to support cancer patients undertaking mindfulness-based CBT in the open-access Psycho-Oncology journal. In addition to the work being published, the cancer support pathway was also shortlisted as a finalist for this years’ HSJ Awards, and has received a commendation in the category for mental health innovation at the Health Business Awards 2019.

A relatively new service, the Clinical Psychology Cancer Service was set up in 2014 to provide support to adults affected by cancer and were recently awarded a Macmillan Professionals Excellence Award for Integration Excellence. Despite the team having high levels of clinical effectiveness, the drop out rates for psychological therapies were found to be quite high, especially amongst cancer patients, who have three times the risk of developing depression and anxiety.

Dr Sam Malins and the Clinical Psychology Cancer Service Team were looking for a low-cost digital solution to develop a blended approach of face to face and remote therapy sessions, with supportive messaging between clinical contacts. In collaboration with Nottinghamshire University, their local Florence administration team and some additional support from Simple Shared Healthcare, the team developed pathways with Flo to reduce drop-out rates, encourage ongoing engagement throughout the course of treatment to achieve better mental health outcomes and improve relapse prevention.

The resulting protocols are unique & innovative with some of the responses Flo sends being fully personalised, written collaboratively by the patient and their healthcare professional. During treatment, patients receive additional support and advice between their scheduled appointments, alongside messages to reinforce learning from their most recent sessions. Whilst under the care of the team and also beyond discharge, patients are also regularly prompted to return a wellbeing score, to which they receive their personalised messages based on the work completed with their clinician.

Integration of Flo into the pathway has had some fantastic results, including:

Patients supported by Flo were eight times more likely to complete their treatment programme when compared to those not supported by Flo.
Patients supported by Flo also reported a greater improvement in depression over the course of the programme.
Interviews with patients suggested that they found Flo’s messages to be motivating reminders to practice techniques, and also acted as a personal connection.

Patient comments included:

“ I thought they were good, [Flo] sort of motivated you and was a gentle reminder really.... I thought that that was a good idea ”

“ If you found yourself getting lost they were good reminders to put you back on track ”

“ When you got it you felt “oh somebody is thinking about me.” Even though it was just a text message ”

“ You felt like - I mean, I know they [Flo’s messages] were automated, but in a silly way it felt like somebody was motivating you. I enjoyed them actually.”

“ Florence seems to text me exactly when I need it the most. Always helps me. Overall amazing ”

From the clinician’s perspective, implementing Flo has a number of benefits such as:

Prevention of re-referral.
Increased therapeutic capacity, with more patients successfully treated in each group.
Simple & easy for clinicians to implement with a low input and time cost.

The full journal article is open-access and available here, or if you would like to learn more about the pathway and the team’s journey, you can contact Sam at Sam.Malins@nottshc.nhs.uk

We are delighted that Simple Shared Healthcare have been able to support the open access publication to expand the reach of the team’s fantastic work. As a Community of Practice, we are always looking for great examples of where Flo has made a real difference to patients and clinical practice. If you are considering publishing your findings with Flo and would like to know more about how we may be able to support you with this, please do get in touch with a member of the team: Hannah.Mountford@simple.uk.net Karen.Moore@simple.uk.net Kylie.Dentith@simple.uk.net

#Sherwood Forest Hospital Foundation Trust #Clinical Psychology Cancer Service Team #CBT #Psycho-Oncology Journal #HSJ Awards

#Macmillan Professionals Excellence Award for Integration Excellence #Health Business Awards #Nottinghamshire University

Scotland’s Scale-Up team scoop three top awards with Florence

posted 6 Dec 2019, 01:19 by Hollie O'Connell

06 December 2019

Scotland’s largest health and social care conference ‘Digital Health and Care Fest’ was held on 20th and 21st November 2019 at the University of Strathclyde Technology and Innovation Centre in Glasgow in partnership with Scottish Government, NHS and the Coalition of Care and Support Providers in Scotland (CCPS). The two day event showcased the very best of digital innovation in health and social care encouraging strong debate amongst key national digital strategy colleagues from Scottish Government, the NHS, academia, industry and the care and support sector.

We were delighted to see the trend continue from the last few years, with a significant number of Flo enabled showcases at the event, ranging from innovative evaluation studies through to deployment of digital health (Flo) at scale across multiple Healthboards and diverse teams.

We were delighted to see that amongst the shortlisted evaluation case studies to be judged by the event panel, 25% were based on Flo’s unique abilities to enable the attainment of better and faster outcomes. The abundance of robust, independent evidence of clinical acceptance, improved patient outcomes, improved access to care and improved patient engagement and adherence with self management speaks for itself.

Special congratulations to winner, Mary Paterson, who on behalf of the Scale-Up BP Team accepted the winning accolade with their presentation of the impact across 3200 patients from ‘Introducing Telemonitoring for Blood Pressure into Routine General Practice at Scale: An Implementation Study’ in collaboration with the University of Edinburgh. The results described how, compared with the previous year, the participating practices:

made 18.9% fewer face-to-face appointments for any reason
patients mean systolic BP fell by 6.55mmHg
patients mean diastolic BP fell by 4.23mmHg
patients whose baseline systolic was >135mmHg had a mean fall in BP of 15.1mmHg

The evidence from this study contributed to the Scottish Government’s recent £1.2million commitment to support Scottish Health Boards to move to large scale deployment and mainstream the delivery of remote patient monitoring within primary care services with Florence, read more here.

Scale-Up BP is part of the wider Technology Enabled Care (TEC) Programme established in Scotland in 2015/16 and to date, more than 150 practices recruited Flo to support their patients requiring blood pressure monitoring either to diagnose hypertension, monitor BP or titrate medication, with over 10,000 patients benefiting.

A notable point on the use of Flo’s unique psychological techniques, is the very low dropout rate, which was less than 9% over the length of the study, something we’ve found simply isn’t achievable when using other methods or apps.

Other shortlisted Florence based studies included;
Cost avoidance achieved with Hypertension monitoring
Using lifestyle interventions to lower blood pressure
Highest success rate in Scotland for Beating the Blues CBT completion

The prestigious UK General Practice Awards were held on 29th November 2019 at the Park Plaza Westminster Bridge, London. The awards are held to recognise the very best of general practice and we are again delighted to share that the ‘Clinical Improvement Award: Public Health and Prevention’ was won on the night by the Scale-Up BP Team led by Prof Brian McKinstry. This fabulous at scale achievement in digital healthcare with Florence was a well deserved recognition for all involved.

The sixth annual Scottish Public Service Awards took place on 4th December 2019 celebrating excellence within Scotland’s public services, and showcasing some of the most innovative and outstanding work being achieved. We are excited to share that the winners of the ‘Digital Public Services Award’ were the NSS Integration Team, with their work on ‘Remote Blood Pressure Monitoring’. We worked with the NSS Integration Team to implement Flo’s GDPR compliant APIs to allow routine blood pressure data from individual GP Practices to be extracted and analysed in the NSS safe Haven.

Florence and the strangest secret of self care

posted 19 Sep 2019, 06:58 by Hollie O'Connell

19 September 2019

The use of digital technologies in healthcare is a fast growing industry with a whole host of technology start-ups offering solutions using online video conferencing, apps and AI. Within this crowded market, many come with a promise from the vendor of a clinically effective and sustainable service but all too often we see these solutions struggle to live up to the salesman's promise. Healthcare by its nature of course is a tricky area for digital technology, with the need to provide independent evidence of a direct causal clinical effect and improved efficiency for healthcare providers. This is particularly tricky within the requirements of rapid change driven by new advances in care but anchored in long established methods of care delivery.

Flo is now in her 9th year of supporting patients towards better and faster clinical outcomes and helping them to manage their own health conditions better. Along the way the evidence from Flo’s use has enabled the introduction of her US and Australian cousins (Annie and Nellie) and although these locations are very different, Flo, Annie and Nellie have all continued to demonstrate the same positive and sustainable outcomes.

So what makes Flo, Annie and Nellie different to other digital technologies and what’s the evidence?

In this short webinar Phil O’Connell, our founder, talks through our unique methodology and how the secret to self-care has little to do with digital technologies, and everything to do with human behaviour.

Home and Mobile Health Monitoring Evaluation - Economic case studies

posted 13 Sep 2019, 03:15 by Hollie O'Connell [ updated 3 Oct 2019, 05:12 ]

13 September 2019

We are delighted to announce another exciting publication, “Home and Mobile Health Monitoring Evaluation - Economic Case studies” by Digital Health & Care Scotland, who have previously published their National 3-year evaluation "Towards Scaling Up Home and Mobile Health Monitoring 2015-2018". This report provides us with a detailed analysis of the considerable cost savings across three varying locations in Scotland; Ayrshire and Arran, Lanarkshire and the Western Isles, where the substantial outcomes were fundamental in the decision to Scale Up with Flo.

The aim of this report was to look at the return on investment when using HMHM (Flo) to support patients with Hypertension and COPD, and explore the “monetary equivalent of capacity released, the monetary equivalent of reduction in resource demands, the cost of HMHM compared to baseline costs, and the number of cases that would need to be implemented to break-even.”

When looking at COPD patients supported by HMHM (Flo) key findings were:

HMHM is cost effective - Using Net Present Value, savings over a 10 year period per 100 patients:

Ayrshire & Arran £26 - £28 million
West Dunbartonshire £496k - £1.4 million
Highland approximately £23 million

Fewer NHS24, ambulance call outs and emergency admission bed days
The number of items prescribed increased (due to more appropriate prescribing)

Key findings when using HMHM (Flo) to support patients with Hypertension:

HMHM is cost effective - Using Net Present Value, savings over a 10 year period per 100 patients:

Ayrshire & Arran £52 - £73k
Lanarkshire £15 - £67k
Western Isles £62 - £85k

Capacity is released. Comparing costs and benefits shows that to break even:

Ayrshire & Arran need 56-76 patients to use HMHM (Flo)
Lanarkshire need 42-68 patients to use HMHM (Flo)
Western Isles need 13-18 patients to use HMHM (Flo)

Patient travelling time is avoided, 33 - 50 hours were saved per 100 patients
Productivity is increased - estimated that £1,800 in loss of earning is avoided per 100 patients by having their BP monitored remotely
Savings can be increased by recycling of BP monitors

“ Despite considerable local variation between the partners providing data for these case studies, all of the scenarios modelled were shown to be cost effective over a 10 year period. Although most of the benefits are non-cash releasing, aspects such as avoided appointments do create additional capacity for staff working across primary and secondary care, many of whom work under considerable pressure. “

You can read the full report and evidence towards these savings by clicking here.

Thousands of patients in Lanarkshire evaluation

posted 3 Sep 2019, 08:29 by Hollie O'Connell

03 September 2019

Towards Scaling Up Home and Mobile Health Monitoring in Lanarkshire - An evaluation towards

scale-up, spread and sustainability June 2019

We are pleased to announce the publication of “Towards Scaling Up Home and Mobile Health Monitoring in Lanarkshire - An evaluation towards

scale-up, spread and sustainability” where the substantial high quality evidence base helped support the further £1.2 million investment into Scotland’s National BP Scale-Up with Florence.

NHS Lanarkshire received an exciting opportunity to be part of the National Home and Mobile Health Monitoring (HMHM) Programme which looked at how HMHM could improve clinical outcomes and explore the potential for sustainable scale-up with Florence. This document provides an in-depth and detailed independent evaluation of evidence gathered over a number of years, where the passion and commitment of clinicians combined with Flo’s unique persona and methodology were able to over deliver on targets and demonstrate that HMHM can be successfully integrated into multiple conditions including hypertension, mental health, health lifestyle/health improvement, diabetes and pain management.

Examples of the highlighted outcomes for patients are “people have positive experiences of services, supported by HMHM”:

More people self-manage their health and care - one piece of evidence gave a total of 7,455 patients supported with Flo by 28.4.2019
Condition control improves - “One person who refused to believe they had hypertension accepted their diagnosis after using Flo. Their blood pressure was 183/87 before remote monitoring and 135/80 after accepting the diagnosis and medication”
Face to face contact are optimised - “3,545 people have texted BP readings to their GP surgery to support diagnosis and medication titration, ensuring that accurate readings are available to support diagnosis and hypertension management”
Access to services increase - “HMHM is particularly useful for people whose working hours clash with surgery opening, who are stressed by the time they get to their appointment, and then have high readings. Now after an initial visit to start Flo we follow up the readings sent in remotely by phone”
Resources used effectively and efficiently - “An average of 4.3 blood pressure monitoring appointments were avoided per patient. For 3,545 patients each avoiding 4.3x10 minute Practice Nurse appointments = £82,467 (greater savings where GPs did the BP monitoring)”

While key learning of HMHM on effectiveness and efficiency:

“HMHM appears to be a catalyst for shifting responsibility away from healthcare professionals to people/patients, thus increasing the effectiveness of interventions.
HMHM can increase engagement with services e.g. more people start an on-line programme, it is easier to text readings from the workplace than get to a GP surgery.
Fewer HMHM efficiencies are observed when the service doesn’t have someone to lead or it is not highly valued by staff, even when people/patients appreciate the support.
Where HMHM enables more accurate diagnosis e.g. hypertension, it can also save ‘White Coat’ prescription costs.
HMHM has been most effective in Lanarkshire when those using it appreciate its value, the set-up is relatively straightforward, and there is expert support to resolve any issues.
HMHM avoids the need for some appointments e.g. remote blood pressure monitoring increases staff capacity and reduces patient travel costs. “

Sharing the Learning: Efficiencies Delivered Across Acute, Primary and Community Healthcare

posted 31 Jul 2019, 03:25 by Hollie O'Connell [ updated 2 Aug 2019, 04:18 ]

31 July 2019

We are pleased to publish a series of resources that encapsulate the unique outcomes and benefits realised by our members. The collection of Efficiency Savings summaries have been developed to offer a concise overview across Primary, Acute and Community Care.

Each resource provides highlights of how Flo has delivered efficiencies in healthcare delivery based on evidence shared with us from members of the Simple Telehealth Community of Practice.

Areas covered in the documents include;

Primary Care:

COPD
Asthma
Hypertension
Medication concordance

Acute Care:

Maternity
COPD
Asthma
Hypertension
Oncology

Medication concordance
Diabetes
Orthopaedics
Ascites management
Renal transplant

Community Care:

COPD
Children’s community nursing (enteral feeding weaning & BP monitoring)
Diabetes
Mental health
Wound care

Paediatric and Young Adult Member’s Network Launched

posted 30 Jul 2019, 06:01 by Hollie O'Connell

30 July 2019

Paediatric and Young Adult Member’s Network Launched

Over the years, Flo has supported many children and parents with their healthcare needs, with the benefits being enjoyed by both patients and clinicians. Consequently, the Community of Practice is now seeing a sustained increase in clinical interest in this area. Therefore, in support, we are extending the reach of our Condition Based Member’s Networks and launching a new area of interest for clinicians delivering paediatric and young adult services. The network’s aim is to share and discover how other like-minded clinicians have been innovating with Flo, and the learning that has been created by this. For an example of one of our other networks, please see here.

To launch the Paediatric and Young Adult Member’s Network, we would like to take this opportunity to share with you an overview of some of the inspirational innovation that is being delivered across the Simple Telehealth Community of Practice.

Supporting Children and Young Adults with Type 1 Diabetes

One of the most sustained applications of Flo’s support is for patients with Type 1 diabetes. Children and young people diagnosed with Type 1 diabetes can find adapting to and managing their condition particularly challenging, as it often happens at a time in their life of already increased physical, psychological and social change. Much like with adult diabetes pathways, Flo is on hand to provide additional support to help children and young adults: engage with their health, feel more in control of their condition and improve their education early on via an accessible and effective tool; their mobile phone. Flo has proven to be particularly effective within younger cohorts due to their familiarity with technology and the fact that they find that receiving simple SMS text messages is discreet, uncomplicated, and does not interfere with their wider use of their handset e.g. using data.

Two patients who have benefitted from Flo’s helpful messages are Naomi and Erin. Naomi had struggled to manage her diabetes throughout her teens resulting in raised HbA1c and the development of diabetic bulimia due to concerns over weight gain. But with Flo’s support she was able to significantly reduce her HbA1c, which improved her long-term health outcomes. Similarly, Erin was struggling to manage her diabetes, and had been unfortunately previously admitted to hospital with ketoacidosis. Following her admission, Erin was introduced to Flo and was also able to reduce both her HbA1c from 112mmol to 83mmol, and also the risk of long-term complications due to poorly controlled diabetes.

Supporting Early Years Practitioners to embed changes in their clinical practice

NHS Highland have integrated Flo as part of their “Words Up” initiative. Words Up provides training to Early Years Practitioners, Teachers and Pupil Support Assistants to ensure that adult-children interaction is of a high quality to help to improve language and communication skills. The team have harnessed Flo via a unique and interesting approach by providing support to practitioners in reinforcing key elements of their training. Practitioners interact with Flo around the topics covered, which in turn refreshes and compounds the key messages shared during their training. Practitioners are also asked how easy or difficult they are finding making changes, which allows them to reflect and seek additional support if needed. To find out more about Words Up, take a look at this blog.

Improving Compliance with Inhaler Regime for Children and Young Adults with Asthma

For patients with asthma, ensuring compliance with inhaler regimes is key in controlling the condition and symptoms. For younger children with asthma, parents or carers usually take on the responsibility for ensuring that inhalers are taken as prescribed which can sometimes be difficult due to the competing priorities of family life. As a helpful prompt for parents, Flo has been recruited as a timely nudge to administer their child’s inhaler. You can find out more by watching this short video of Dr John Alexander from the University Hospital of North Midlands talking about how Flo has been helping his patients and the benefits she brings to patients, parents and his team.

Children’s Community Nursing - Enabling Remote Enteral Feeding and Blood Pressure Monitoring

The Children’s Community Nursing Team within Shropshire Community Health Care NHS Foundation Trust developed two innovative pathways around supporting parents whose children undergo enteral feeding, and also those whose children require scheduled blood pressure monitoring. Around enteral feeding, parents are prompted to send Flo their child’s weight, instead of having to arrange their schedule around a visit from a member of the Children’s Nursing team. For children requiring BP readings to be taken at regular intervals, Flo prompts parents to take them and reply with the reading. For both pathways, augmenting the patient’s normal shared management plan, if any child’s readings are outside of the desirable range, the Children's Community Nursing Team would be notified, and be able to take appropriate action.

The implementation of Flo into these pathways has benefitted both staff, children and their families. For families, sending readings into Flo gives them the freedom to not have to plan around visits from the Children’s Nursing Team. Flo also reassures them that if there is cause for concern, a member of the team can pick this up when reviewing the readings, and initiate any required action. For clinicians, Flo is helping to reduce the number of home visits required by some patients, enabling them to better manage their caseload and allocate resources to other patients who may require additional support.

A summary report by Children’s Community Nursing Team found that across only 7 patients, a total of 795 clinical hours were saved, which released the same capacity as an extra 1.0wte nurse working for over 21 weeks. To find out more about these pathways, take a look at the following blog.

Capturing the Benefits: Evidence-Based Hypertension Micro Business Cases

posted 18 Jul 2019, 03:38 by Hollie O'Connell

18 July 2019

Developed from evidenced pathways across the Simple Telehealth Community of Practice, a series of short micro business cases are available in support of understanding the benefits derived from Flo’s integration.

The micro-cases are a resource for community members to use to demonstrate savings when using Flo compared to normal care, and also as a model to adopt for local engagement and planning. The tables within the document are editable, so can be adapted to match your local costings or pathways.

Please note: to edit and input your own costing values, double click on the table within the document which will open an editable Excel spreadsheet. Please be aware that any edits you make will be transferred to the Word document.

The new group of micro-cases focus on hypertension, including (Membership required):

Micro-cases are available within the Member’s Zone on our website. If your organisation is part of the SSHC Community of Practice, but you are not able to access the Members’ Zone, please contact Hannah.Mountford@simple.uk.net or Kylie.Dentith@simple.uk.net to get you started. If you would like to learn more about developing your own local micro-cases, please do not hesitate to contact one of the team.

Digitally Transforming Primary Care – Making it Happen at Scale

posted 27 Jun 2019, 01:20 by Hollie O'Connell [ updated 28 Jun 2019, 01:47 ]

Karen Moore

Advanced Capability Lead SSHC

27 June 2019

On Wednesday 19th June we were delighted to be invited to speak on the main stage at Facebook HQ in London for the “Digitally Transforming Primary Care – Making it Happen at Scale” conference, where Phil shared Simple Telehealth’s journey from its inception to the unique international Community of Practice we support today.

The event was hosted jointly by Facebook and the NHS Stoke-on-Trent and Staffordshire CCG Digital Nurse Ambassador Programme. Who following a hugely successful pilot, were granted funding to embark on a series of action learning events to support the spread and adoption of technology and social media tools across Primary Care Networks in England.

The agenda for the day was led by Dr Ruth Chambers OBE, Clinical Lead for Technology Enabled Care Services in the Staffordshire STP, and offered valuable insight and practical advice for NHS Leaders, commissioners and clinicians about how technology and digital tools can be used at scale to support the care delivered to patients.

Delegates were also given the opportunity to ask questions of the Digital Nurse Ambassadors and heard from both clinical teams and patient groups across the UK who shared their enthusiasm and experiences; with examples of where they have been able to successfully incorporate technology in their local practice to improve outcomes, and engage with patients with education about their health and wellbeing.

Phil spoke about the need for a reality check before engaging with any of the thousands of digital ‘solutions’ being promoted for healthcare and talked about how today’s market is rife with ‘snake oil’. He went on to encourage delegates to look for technologies with substantial independent evidence of efficacy and to be clear about how and why they will use digital. Phil endorsed the Digital Nurse programme with it’s clear and uncomplicated agenda and it’s aim of helping patients to help themselves in the simplest of ways, which consistent with the researched evidence base behind Simple Telehealth, can consistently deliver better and faster clinical outcomes.

Ann Hughes, who is a Digital Nurse Ambassador from Stoke-on-Trent and is part of the team facilitating the National Action Learning Event programme, joined Phil for his session to share her own personal experiences of using Flo to support her patients.

Ann had an elderly patient who needed to have cataract surgery, however disappointingly the surgery was cancelled due to a high blood pressure reading taken at her pre-op appointment. To determine whether this patient had hypertension or white coat syndrome, Ann signed her up to Flo and the patient sent in her BP readings. With Flo, the patient’s BP was shown to be within the normal range which then enabled the surgery to go ahead despite the white-coat readings at pre-op. “.. by the middle of the week I’d got enough readings to be able to print them off and fax them over to the pre-op team...and they did the operation based on those readings.”

More from Ann:

“.. I use Flo extensively in my practice… it’s just so easy to use and saves time..”

“.. the impact for this lady was massive… it changed her life.”

“.. that’s as simple as it is. It’s so easy to use, patients feel at home with it… and trust in it.“

We’d like to thank Facebook for their hospitality and congratulate Ruth and the team on a really fantastic day, hopefully the first of many! You can find out more about the event and view the presentations from the day via this link Digitally Transforming Primary Care – Making it Happen at Scale Conference.

To keep up-to-date with the latest news, blogs and case studies in our community, you can follow us on Facebook @Simple Telehealth

Flo continues to grow: Mental Health

posted 21 Jun 2019, 05:42 by Hollie O'Connell

21 June 2019

Mental health use and diversification with Flo maintains momentum into 2019

Following on from our overview "Innovative Clinicians Drive 20x Growth in Maternity: Supporting Mums and Mums-to-be" clinicians continue to innovate with more patients being introduced to Flo for increasingly diverse applications. In particular, the integration of Flo in mental health care has seen substantial growth in use and diversity. Back in 2012, mental health application of Flo was divided roughly 30/70% between appointment reminders and medication reminders with positive outcomes demonstrated; take a look at the following case study and video for some of the work that has taken place within the community of practice. However, since 2012, clinicians have built on these early foundations to apply Flo as a beneficial interactive tool to support patients receiving mental health care.

Members of the Simple Telehealth Community of Practice have received recognition for their application of Flo in their delivery of mental health care. In 2015, the Primary Care Mental Health Service in Tameside and Glossop were recognised as winners of a national Health Business Awards for Innovation in Mental Health, while in 2016 East London Foundation Trust were selected by The Health Foundation to be part of a £1.5 million innovation programme, focussing on integrating Flo to support mental health recovery and self-care for those with severe mental illness.

Newly Developing Areas

Flo’s use in mental health has continued to grow, and by 2017, the number of patients had increased by 16x those in 2012. While such an increase is worth celebrating, the real change to note is the diversification in the innovative approaches that clinicians are developing to integrate Flo into their care delivery. While medication and appointment prompts make up around 9% of usage in 2017, a number of new applications are now in use. These include:

Cancer support pathways – much of the care that patients with a cancer diagnosis receive focuses on treating the disease, however support pathways are now being used to provide care which supports the patient’s mental health in these difficult circumstances.

Mood monitoring – these are interactive pathways that allow clinicians to remotely monitor the mood of their patients based on the readings they send to Flo. This means that clinicians are able to check the patient’s scores regularly and tailor care to patients, providing additional timely support if required.

Dementia and Mild Cognitive Impairment/Depression and Low mood – pathways have been introduced that offer support and information to patients with these conditions, which aim to support memory strategies and improve patient confidence and emotional well-being. One example of this is North Staffordshire Combined Healthcare’s Autographer project.

Course/group support – pathways have been developed to support patients who are attending groups or taking courses to help them improve their mental health. Flo supports patients throughout the length of the sessions by helping them to register and get started or attend their first session, reminding them when certain modules may be due or sessions are scheduled, as well as sending motivational messages which aim to consolidate their learning from their therapy.

Personalised interactive pathways - a number of pathways have been co-designed between the patient and clinician to maximise Flo’s personal nature. Clinicians have been working closely with their patients to design specific, meaningful responses, personal to each patient, that Flo will reply with dependent upon symptoms reported in real time.

Course & group support pathways

The latter group of pathways now accounts for almost 90% of the use of Flo within mental health. They represent an increasing trend towards a holistic approach to mental health, aiming to treat the patient’s well-being as a whole. For example, patients with depression have traditionally been medically treated via antidepressant medication, but many patients are now being referred to CBT courses or other talking therapies. These treatment pathways aim to address the root cause of any mental health issues the patient may have, and in doing so, encourage proactive steps to change the patient’s behaviour; Flo is now being used to maximise the impact of these treatments to further support and encourage positive actions by the patient. For example, South Tyneside Foundation Trust have been seeing promising results using Flo to support patients who attend appointments with Gateshead Talking Therapies.

Health authorities are increasingly looking towards online courses to do this, as they are both time and cost efficient, as well as convenient for patients. One such standout example being used by members of the Simple Shared community is “Beating the Blues”.

NHS Lanarkshire has had great success using Flo to further support those patients who they have been referred to “Beating the Blues”. You can read more about their approach here. Lanarkshire’s success using Flo alongside the “Beating the Blues” programme has been noted, and community members from Powys are now looking to implement a similar approach to help patients with their mental health. It is exciting to see community members sharing their success and best practise with members from other areas, as this continually improves services for patients.

A personalised approach to mental health with Flo:

Flo has also been used in Nottingham to support patients attending CBT sessions. Patients joined a “Stress Spiral” pathway with Flo, where Flo would ask the patient how they were feeling, and then reply with a response dependent on this. For this pathway, the patients worked with their talking therapy clinicians to devise their own personalised stress spiral that identified certain personal behaviours as their anxiety and stress increased, and the responses Flo sent were also written by the patients. Ensuring that Flo’s responses were personalised is an innovative approach, it made Flo’s replies even more impactful and helped patients to further reflect on their progress during therapy.

East London Foundation Trust (ELFT) are another organisation who have incorporated Flo into their mental health pathways to great effect. Flo is used in ELFT’s REFRAME telehealth project, which aims to support patients with severe mental illness, including chronic psychosis, self-manage and maintain independence. Flo prompts patients to take their medication as prescribed, as well as enquiring about their well-being indicators, which are personalised measures developed by the patient and clinician to recognise behaviours specific to the individual to indicate a decline in their mental health wellbeing. Similar to the Stress Spiral protocol in use in Nottinghamshire, this personalised approach ensures that the messages have meaning and impact for each individual. For more information about ELFT REFRAME, click here.

Mental Health issues are now receiving increased recognition due to changing awareness, management and treatment, where once mental health was rarely discussed openly. The Simple Telehealth Community of Practice is continuing to demonstrate that Flo can further enhance the high-quality care and support that is offered to patients, helping to improve self-management and self-care, improving independence especially during a time where there are well-publicised issues with funding for this area of healthcare.

#Mental Health #Mental Health Care #Support Pathways #Tameside and Glossop #East London Foundation Trust #North Staffordshire Combined Health Care

#Gateshead Talking Therapies #NHS Lanarkshire #Beating the Blues #Nottingham #TotallyUnique

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