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Kings Fund International conference on Telehealth and Telecare

06-8.03.12:Virtual conference 


Evidence from systematic reviews of trials, Prof John Cleland at BCS 13.06.11


Telecare Aware Today


Why the NHS must embrace telehealth on a larger scale


At last there is some clarity:


Nuffield Institute Summary Video on

The Whole System Demonstrator Telehealth Project


Investment in technologies for personalised healthcare saves money and lives


Cardiovascular disease


For cardiovascular diseases, the researchers studied the cost effectiveness of prevention (exercise), point-of-care diagnostics and telemonitoring in the UK, Belgium and Germany. Results showed that by using all three approaches overall costs were reduced by 46%, resulting in:


  • 15% reduction in referrals to A&E;
  • 59% fall in angioplasty;
  • 17% reduction in bypass surgery;
  • 14% drop in the use of medicines; and
  • 13% reduction in the use of rehabilitation services.


Additionally, enabling the patients to be responsible for monitoring their own vital signs (such as blood pressure and temperature) and sending them into a central nursing unit electronically, resulted in patient adherence to prescribed treatment increasing from 30% to 92%.


The clever part is how you design changes in the delivery of care that will reproduce the changes on which this modelling is based. This is possible but needs commitment from champions at local levels and development from the bottom up, with guidelines and funding both from central government and private sources. The lessons how not to implement a large IT project a well known in the UK, avoid implementation from the top down approach without 'stakeholder' input at the outset.


WSD Trial


"Early evidence from a trial in Kent, Cornwall and the London Borough of Newham indicates a 45% reduction in mortality - equating to 120 people still being alive who would otherwise have died.


There were also significant reductions in emergency admissions (down 21%), planned hospital admissions (down 24%), visits to A&E (15%), days in hospital (14%) and "tariff" costs for treatment (8%).


The trial involved 6,191 people in 238 GP practices and was the largest of its kind in the world so far. It focused on the long-term conditions diabetes, chronic obstructive pulmonary disease and coronary heart disease."


Confusion, controversy or system failure to scale up perceived benefits of telemedicine?


Are there benefits?


WSD Action Network The evidence base for telemonitoring and heart failure

Telecare: Researching the impact on carers and care workers


Cornwall continue Telehealth project


At home, not alone’ COPD Telehealth Project  Final Evaluation – February 2010


NHS 'could save £15bn' treating more patients at home


Long Term Conditions and Government Strategy

Leicester PCT's illogical decision


Heart Institute's home monitoring cuts patients' readmissions


Cisco healthcare booths to be tried out in Scotland

TELEHEALTH HELPS CARDIAC PATIENTS IMPROVE CONDITIONS, STUDY REVEALS


Your guide to long-term conditions and self care


Telehealth in SE Essex


NHS Institute for Innovation and Improvement


Heart Failure


Fast diagnosis urged for heart failure (15/01/2010)
Doctors should not delay in diagnosing patients with suspected heart failure, according to proposals.
 
The up-dated guidelines say doctors should send a patient immediately for ultrasound diagnosis if the patient has previously had a heart attack.
 
Earlier guidelines, published five years ago, advised GPs to conduct a series of tests and only to use the ultrasound test - echocardiography - if these were inconclusive.
 
The new guidelines, published by the National Institute for Health and Clinical Excellence, say echocardiography and specialist assessment should take place within two weeks of a GP referral.
 
They support a raft of new drug treatments for patients with heart failure from left ventricular systolic dysfunction.
 
Patients of African origin should be offered isosorbide/hydralazine if the two front-line drugs, ACE inhibitors and beta-blockers, are not successful, they add.
 
The guidelines are still in draft form, allowing comments to be submitted over the next eight weeks.
 
Dr Fergus Macbeth, of NICE, said it aimed to improve the length of life and its quality for people with heart failure.
 
About 900,000 Britons currently have a diagnosis and another 900,000 are thought to have heart damage likely to lead to failure.
 
Dr Macbeth said: "The prevalence of heart failure is expected to rise in the future as more people live longer generally, people survive longer with coronary artery disease and there are better treatments for heart failure.
 
"It's clearly very important that clinicians working in this area have a guideline that is based on the most up-to-date evidence of what works best."
 
He added: "The original guideline recommended the use of echocardiography to help confirm a diagnosis of heart failure only after other tests were inconclusive.
 

"However, based on a review of new evidence about the best way for primary care physicians to diagnose heart failure published since the original NICE guideline, the updated draft recommends that people with suspected heart failure and who have had a previous heart attack should be referred urgently for echocardiography and specialist assessment." 


Dr. Forbat can provide local ECHO services to meet targets