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.
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
Success criteria: 100% patients confirmed as having hypertension or not.
|2. Hypertension: poor control or newly diagnosed|
Selection of patients
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|
|Hypertension: poor control or newly diagnosed|
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