Adopting remote monitoring via telehealth in your CCG's practices - part 1: hypertension

In January NHS Stoke on Trent made a free offer to other CCGs to trial a simple telehealth application, Florence or 'Flo'. In the first of a series of articles, Professor Ruth Chambers looks at a specific clinical area where telehealth can help patients.

'White uniform' hypertension: By Chris Chambers
'White uniform' hypertension: By Chris Chambers

The secret to the successful application of telehealth is to focus on the clinical delivery you want to provide for specific patient groups – and then find the best type of delivery method. So don’t get mesmerised by the technicalities of various telehealth equipment, focus on your clinical care.

Ensure that the telehealth approach you use is affordable, and easy for the clinician to set up and use, and patient to correspond through and understand. If you focus on patients who are pretty ill and at high risk of being admitted to hospital, then any telehealth equipment that can detect or prevent acute exacerbations of their chronic condition might seem affordable; but remember to include the substantive costs of extra clinician time such as community matrons who will provide intense care to a patient at home alongside the telehealth to prevent their deterioration – when you’re costing it up. 

Hypertension example

Here’s an example of how a simple telehealth approach can work for hypertension, using the Florence (or Flo) mobile phone texting service to deliver your clinical care, based on a dual management plan agreed when the clinician signs up the patient to Flo. You’ll need at least two different clinical protocols for: a patient with an initial high BP reading; and a patient with newly diagnosed or poorly controlled BP. You could adopt a third protocol for a patient with stable hypertension, where the patient can be reminded to take their medication regularly and feed BP readings into the practice infrequently. The same telehealth messaging cannot be used for hypertension in general; it needs to be specific.

See Table 1 which describes the purpose of each of these protocols, with the associated patient selection and success criteria.

Table 1: Purpose of two example clinical protocols for hypertension, with associated patient selection and success criteria

 

1. Hypertension: initial high BP – not yet confirmed

Purpose: To establish whether initial high BP reading is confirmed hypertension, isolated incident, or ‘white coat’ syndrome.

Selection of patients

  • Patient with BP reading > 140/90mmHg; unclear whether they’ve hypertension
  • Patient without diabetes or CKD (different telehealth version with lower BP goal)

Success criteria: 100% patients confirmed as having hypertension or not.

2. Hypertension: poor control or newly diagnosed

 Purpose

  • Improve patient compliance with medication.
  • Encourage patient to adhere to dual management plan agreed with practice team to gain control of their BP.
  • Help patient adopt a healthier lifestyle.

Selection of patients

  • Patients on practice hypertension register and on medication but BP poorly controlled, for example >140/90 mmHg who need help to comply with their medication; or support in titrating up anti-hypertensive medication. (Patient should not have diabetes or CKD with ACR ≥ 70 mg/mmol - different protocol with lower BP goal)
  • Patients who in addition have poor lifestyle habits.
  • Patients with newly diagnosed hypertension, to optimise anti-hypertensive medication.

Success criteria

    75% of patients with unstable hypertension become controlled within three months (≤140/90 mmHg sustained; or ≤ 135/85 mmHg as home BP readings – practice can decide goals)

 

Table 2 summarises the two protocols – how they might be applied in general practice.

Table 2: Two example clinical protocols for application of Flo telehealth for hypertension

Hypertension: initial high BP – not yet confirmed
  • Patient issued with a sphygmomanometer  
  • Patient signs contract  
  • Twice daily BP readings, submitted via Flo for one week, remotely monitored by clinician
  • Then – text patient if not got hypertension (and return sphygmomanometer); or arrange face to face review to start medication/organise tests and transfer the patient to other telehealth hypertension programme.
  • Read code added on practice disease register as appropriate
Hypertension: poor control or newly diagnosed
  • Patient issued with sphygmomanometer
  • Patient signs contract
  • Twice daily BP readings, submitted via Flo, remotely monitored weekly by clinician
  • Monthly responses to depression questions
  • Twice weekly information messages
  • Monthly text enquiry of patient experience
  • Evaluation (optional) – capture of healthcare usage, patient experience

So these two examples show how clinical care can be enhanced by using telehealth. You can not only help patients provide reliable BP readings, but can titrate medication speedily and safely, and provide health promotion at the same time.

* Professor Chambers is GP clinical director of practice development and performance at NHS Stoke on Trent CCG. Acknowledgements to Phil O'Connell, the innovator of the Florence service and NHS Stoke on Trent CCG

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Before commenting please read our rules for commenting on articles.

If you see a comment you find offensive, you can flag it as inappropriate. In the top right-hand corner of an individual comment, you will see 'flag as inappropriate'. Clicking this prompts us to review the comment. For further information see our rules for commenting on articles.

comments powered by Disqus