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Flo and respiratory pathways – An overview of growth and diversification

posted 1 May 2018, 03:02 by Hollie O'Connell   [ updated 19 Jul 2018, 09:07 ]





03 May 2018 



We’ve seen steady growth in respiratory innovation with Flo since 2012; 2017 demonstrated a 75% increase on use from 2012!  The largest growth in respiratory use continues to be within COPD patient cohorts, but asthma and pulmonary rehab usage have both more than doubled over the intervening years.  We have also seen some new innovative pathways begin to develop for bronchiectasis and interstitial lung disease.


COPD
As the largest area of use within respiratory conditions, we have seen some really positive outcomes through improved understanding, management and control of the condition and its symptoms.  Flo supports the patient to self-manage their condition at home according to their existing clinical management plan, ensuring avoidable exacerbations are minimised and that if their condition was to deteriorate, any clinical intervention can take place as early as possible to avoid the patient’s condition worsening to a point where more intensive intervention, and perhaps even an acute attendance or admission is the only option.

It’s great to hear from patients whose lives have been improved by Flo, and we are excited to share some of the success stories we have seen:
  • John Stalker, a patient from Hamilton, began using Flo to help him better manage his COPD.  John had a total of 11 hospital admissions before starting on Flo, but in the 10 months since this has significantly reduced to only one.  John had previously sung and played guitar in local clubs, and although not able to sing for long periods of time, he now can now play guitar again and he feels that this is a “vital outlet” for him.  To read about John in more detail, please look here
  • Pat is a patient whose life has been improved by using Flo to help her manage her COPD.  Similar to John, Pat was calling 999, and attending A&E and her GP surgery quite frequently due a lack of confidence in understanding the symptoms that her COPD brought on.  Pat was introduced to Flo to help her manage her condition, and Pat says that Flo has given her a new lease of life.  Read more about Pat, and watch a short film about her journey here
  • Shirley also found that using Flo could help her to improve both her control of her COPD and her quality of life.  Take a look at this video to hear Shirley’s feedback.  This video also includes Maggie Whitmore, a Practice Nurse from Furlong Medical Centre in Stoke-on-Trent, describing her experiences with Flo.  As you will hear, Flo has also helped to reduce the number of doctor’s appointments required by patients at the practice by a significant amount resulting in increased capacity delivering faster access for patients at the practice.

A common theme that emerges from patients living with COPD is the challenge of managing their symptoms; understanding what is normal, and when action needs to be taken.  This is where Flo’s gentle guidance and reassurance builds confidence to follow their clinical management plan, reducing anxiety and motivating them to take the most appropriate action should they need to, helping to ease pressure on emergency and out of hours services.





Asthma
Patients with poorly controlled asthma often report that they forget to take their preventer inhaler as prescribed; therefore Flo being able to gently prompt patients is a common application proven to be very effective either as a short term intervention until the habit is formed, or for longer term use with appropriate cohorts.  Patients with asthma are also supported to more closely manage their condition according to the guidance relating to their peak flow in the patient’s action plan.  Flo’s use with asthma represents one of our most mature pathways, seeing this usage included in the NHS England Advice and Interactive Messaging (AIM) project, and also as part of the group of protocols produced in conjunction with WMAHSN.

Flo is used to support children who have asthma; often parents interact with Flo on their child’s behalf to help them to look after their healthcare needs.  This not only helps to ensure that children are taking their inhalers as prescribedbut also supports and reassures their parents as well.  You can hear a bit more about this from Dr John Alexander in this video.

More recently, NHS Highlands have been using Flo to help patients to self-manage their asthma.  A consideration for NHS Highlands is the rurality of the area.  Patients sometimes have to travel quite long distances to attend asthma clinics, and should they experience severe exacerbations of their conditions then emergency support may also be quite a distance away which can be a major risk.

Kyle Mackay is a patient with asthma, who suffered a severe asthmatic attack.  Luckily for Kyle, he was staying at a friend’s house which was half an hour closer to the hospital than he would have been at home.  However, had he not been at his friends, this added distance could have had some serious consequences for him.  Following this, Kyle’s respiratory nurse recommended that he try using Flo to support him with his asthma management.  Kyle has found that using Flo has made him more aware of his condition, and he now feels that his breathing is more stable.  You can hear more from Kyle about his experiences with Flo in this video.  Corinne Clark, who is a respiratory nurse featured in this video has also written a blog about her time using Flo, which you can take a more detailed look at here.

Similar to Flo’s COPD pathways, asthma pathways help patients to become more aware and knowledgeable of their asthma, helping to improve stability and reduce severe flare-ups.  This has the potential benefit of reducing the need for emergency care and possible admissions, helping to ease some pressure on local services.


“All Together Better Sunderland” work towards improving patient’s understanding
NHS Sunderland were able to secure funding from NHS England’s New Care Models Programme to produce patient information leaflets for use with Flo.  The leaflets cover a broad range of conditions, but COPD & Asthma specific leaflets are available.  The leaflets are a resource that any member of the Simple Telehealth Community can use, to find out more, please click here.






New and emerging respiratory use 
We continue to see new and exciting Flo developments within the respiratory field, here are a few interesting examples of the developments that have been going on recently:
  • Powys Teaching Health Board (PTHB) are using Flo to give patients who are taking part in pulmonary rehab extra support and motivation during their treatment.  Flo interacts with patients for four weeks, encouraging them to complete exercises between sessions, and has demonstrated to be improving compliance and long term outcomes.  Flo also asks review questions at 3 months (exercise compliance) and 6 months (have patients had further admissions or GP appointments).  PTHB has received positive feedback from patients so far, and hopes to roll out the pathway across the whole of Powys. 
  • PTHB, Shropdoc & The Health Foundation Have been working in conjunction with Barchester Care Homes to create monitoring protocols for care home residents with COPD and asthma.  The protocols are designed so that care home staff can take readings and reply to Flo on the patient’s behalf, with Flo sending advice back to staff.  The aim of these protocols is to ensure timely and appropriate access for patients to the Specialist Respiratory team or GP, as well as providing reassurance both residents and the care home staff.



For more information on integrating Flo within respiratory services please contact lisa.taylor@simple.uk.net