Now we are at the beginning of the end of lockdown measures, it begs the questions: what have we learnt from the crisis and how will we adapt going forward?
General practice has had to adapt to new ways of working, such as boosting numbers of telephone and video appointments. In this time of substantial transition to technology-enabled and digital service delivery options, what else can be used to support the wider population?
Fortunately, one such potential adjunct to our situation has already been invented. It is time to make use of our commercially-provided digital assistants so they can bolster the national efforts of doctors, nurses and social prescribers across the country by empowering patients to better manage their health and wellbeing.
Who can digital assistants help?
Over the past 18 months, pilot projects involving over 50 patient (and carer) participants in Staffordshire have been exploring digitally assistive ways to support people of all ages and levels of ‘tech-savviness’.
The most recent cohort was focused on diabetes but prior to that, it was piloted for those living with cognitive decline, social isolation, MS, dementia and bipolar to name a few. The intervention? The now familiar talking digital assistant provided by Amazon.
The device is called an Echo Show 5, it has a touchscreen, a camera, a speaker, internet connection and Alexa - the digital assistant to speak and listen to. Of course, other devices and assistants are available, but this was our most affordable option at the time that came with a screen, an asset which we found greatly improved its overall utility.
The aim has been to enable and fact find from the ground-up, i.e. provide the device plus basic user instructions and support at installation, then let people use it and tell us what they found it helpful for.
Feedback was mainly provided by phone survey 2-3 months post-installation and in focus groups. The process was informal and benefits self-reported, but the data provide real-world stories about how the basic functions of digital assistants can be adapted to improve people’s self-management of their healthcare needs.
We are using the invaluable experience shared by our participants to guide the project’s extension.
Benefits of this approach
Perhaps unsurprisingly, one of its strongest advantages is that it is a commercial product and not a medical device. It is relatively affordable, user friendly and aesthetically pleasing, attributes not common to many medical devices. Even better, standard functions can be adapted to serve health and wellbeing needs right ‘out-of-the-box’.
The digital assistants are by no means perfect and do not work for everyone, but the large majority of our participants now say it is an indispensable part of their health routines. It is not hard to see why – reminders that work for watering the plants, work just as well for taking medication, or going to a GP appointment, especially as they alert you by phone outside of the house too.
Video calls are not only great to stay in touch with friends and family generally, but also those who need care. Being able to ask any question also widens access to internet services and importantly to health information sourced primarily from the NHS website for people without formal IT skills, or those with visual impairment.
Supporting patients in the new environment
Primary care is under pressure to find solutions to support the wider population during this pandemic. NHS England’s ‘phase two’ strategy is asking primary care to ‘lock-in’ beneficial changes such as ‘technology-enabled service delivery options’.
The next stage of our project aims to support primary care in meeting these objectives by involving social prescribers. It is already underway and will primarily help people who are isolated and/or in the ‘shielded’ category during the coming months.
In this time of social distancing, there is a way forward to improving self-care, as well as facilitating contact between family, carers and potentially engaging with healthcare providers such as a practice nurse or community carer by arrangement.
If we are to take positives from this situation, one may be that at least we have the digital means available to help people self-manage their health as traditional methods are forced to adapt. But we have to start making use of them now.
Top 5 benefits
Key benefits that digital assistants offer for primary care, straight out-of-the-box:
- Reminders for medication and healthcare appointments, even when on-the-go.
- Easy video calling for carers and patients, potentially even healthcare professionals.
- Mental health benefits for patients – company, meditation, relaxation and entertainment.
- Voice-activation widens access to digital resources like the NHS website for people lacking formal IT skills
- Boost existing technology enabled service delivery options, as per NHS England guidance.
Key cases from the projects so far
A person with early onset dementia was able to regain her lost independence, through videocalls, reminders and smartphone alerts – she no longer needs constant care visits from her parents and is able to cook and care for her young son again.
A man with bipolar condition whose improved adherence to medication through his use of reminders, meant that he could move out of supported living to his own accommodation – he no longer even requires care visits to ensure that he has taken his medication because his adherence is so reliable now.
- Dr Ruth Chambers OBE, MD, FRCGP is a retired GP and Staffordshire STP’s clinical lead for technology enabled care, digital workstream. Paul Beaney is a medical student and project evaluator