SELF-MANAGEMENT Telehealth is transforming lives and the government has plans to roll out the technology to three million patients, writes Rowenna Davis
Many people with cardiovascular disease and other long-term illnesses live with symptoms that don’t warrant hospital admission, but still cause worry. Some suffer in silence and leave themselves at risk; others spend too much time in hospital waiting rooms.
Telehealth, technology that uses telephone or internet-enabled devices to monitor people’s health, may offer a solution. By putting patients in charge, this technology promises to let people regain a sense of control over their health.
Mike Worden, head of healthcare advisory services for the telehealthcare provider Tunstall, has a clear notion of the role these companies can play. “What we’re offering is self-care. There are lots of examples of lives being saved, and there is also an impact on carers and families. Both parties don’t have to worry so much. It’s life-changing for them,” he says.
One Tunstall device, My Medic, takes patients’ blood pressure, weight and oxygen levels, and sends them to a monitoring station staffed by nurses. Patients can call for advice if they notice any significant changes and feel more confident about going out if they don’t. Landlines and mobile phones can be set up to deliver prompts, while follow-up health conferences with doctors can be arranged over the internet via Skype.
Until recently, the British have remained skeptical of the telehealth revolution. While private healthcare companies have been pushing a wide uptake in the United States, experts say that less than 10,000 people use telehealth in the UK. Why?
“The reason telehealth hasn’t been picked up earlier was there was no evidence,” says Maureen Talbot, senior cardiac nurse at the British Health Foundation. “Companies were plugging it, but clinicians just didn’t know the evidence. Nurses had the traditional view of being proud to see and talk to patients. Machines weren’t going to replace nurses. But, now more studies have been done, that attitude is starting to change. We’re beginning to see it can be very cost-effective.”
The Department of Health has carried out the largest telehealth evaluation. Recently published in the British Medical Journal, the Whole System Demonstrator pilot involved more than 3,000 patients. It found that telehealth reduced hospital admissions by 20 per cent and cut deaths by 45 per cent. At a time when the NHS is pushed for funding, this evidence base is winning people round. The Department of Health now aims to roll out telehealth to three million people in the next five years.
But academics remain cautious. Adam Steventon, senior research analyst at the Nuffield Trust, who helped lead the study, says that, although emergency admissions were reduced, there was a spike in admissions in the comparison group when the equipment was taken away. This could mean that telehealth increases anxiety when it is taken away as people become psychologically dependent on it. And, although there were cost savings, the admissions that were prevented were generally minor and less expensive, and the start-up costs of the devices were high.
“On the basis of this trial, we’re still not sure whether telehealth saves money,” says Mr Steventon, “The cost of implementing it is quite substantial and could outweigh the benefits, although the cost could come down with economies of scale.”
However, telehealth is not for everyone. It is not suitable for patients with emergency or critical conditions, and works best for people who are motivated and able to take charge of their own health. Overall, Ms Talbot is confident that telehealth will offer growing benefits.
“What the information is showing anecdotally is that patients feel better monitored,” she says. “They have people watching and checking them on a daily basis, and they say they feel they have control over their treatment. Most significantly, they can see now that they are being admitted into hospital less. That’s a great freedom.”
‘Monitoring made me feel safe’
June Smith-Parker, 68, from Dunnington, York, uses a telehealth device to monitor her blood pressure, pulse, oxygen levels, temperature and blood sugar.
She says: “Last summer I was taken to hospital with what I thought was diabetes and the doctor said I could have a heart attack in days. He said the right ventricle of my heart was damaged and that meant my oxygen levels were 68 when they should have been close to 100. I just wanted to sleep all the time and water retention meant that I could hardly walk.
“Telehealth helped a lot. The NHS installed a device in my house that let me take my own measurements every day. I used the little gadget to check what I should and shouldn’t do. If I was walking too far, standing too long or trying to hoover, my back would start to ache, then I’d get a rapid heartbeat and I’d know I needed to stop.
“It’s a marvelous thing. It gives you independence over monitoring your own health. And, of course, all the data also gets sent to a centre and, if they don’t like what’s happening, they can ask you to take another measurement or contact a doctor.
“I don’t think there are any downsides. I did make a mistake once – I put my arm through the wrong bit of the machine and it said I had a blood pressure of over 300. I thought I was going to explode. But you can ring the people at the centre any time and they can help.
“It’s been very good for my health. I’ve slowed down a bit and spend more time with my family. For the first time I could go and visit my daughter in Holland and my grandchildren, because the constant monitoring made me feel safe. I’m going again this October – and this time I’m driving.”