Redesigning the health review for patients with long term conditions

There are 15 million people in the UK with long-term conditions. They are the most frequent users of health care services, accounting for 50 percent of all GP appointments, with 70% of the total health and social care expenditure being spent on their treatment and care. Self-management is particularly important amongst this patient group as they spend less than 1% of their time in contact with health care professionals. Health reviews are viewed as a proactive approach to care, complementing existing self-management strategies.

 

Apollo

Apollo is a digital service, which allows people with long-term conditions to complete their health review in an easy and flexible way, helping them to play a more active role in their health.

Apollo has been initially designed to replace the annual asthma review amongst patients with well controlled symptoms. It is flexible and easy to use, personalised, provides a consistent experience, and promotes learning.

For healthcare professionals it provides a broader and more accurate picture of how patients are managing their health condition and also has financial and time benefits  

Research

Long-term conditions are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example diabetes, asthma and high blood pressure.15 million people in the UK have a long term condition, which is roughly 20% of the population,2.9 million (20%) have 3 or more long term conditions. They are the most frequent users of health care services, accounting for 50 per cent of all GP appointments and 70% of the total health and social care expenditure is being spent on the treatment and care of these patients. The NHS has set out its priorities for the next 10 years, which includes its commitment to increasing support for helping people with long-term conditions manage their own health, which has shown to have benefits for both the individual and the healthcare system as a whole.

Self-management 

From the interviews we realised that effective self management is made up of 4 key components. 

The first of which is Behaviour- in particular how motivated a patient is, which is affected by their beliefs around their illness and treatment as well as their mood, The second component is skills, which is about having the tools and techniques to choose healthy behaviours. Thirdly it’s about relationships and the need to have a collaborative partnership between the healthcare professional and patient- which we explored further to understand that there needs to be honesty and trust between both parties.Lastly it’s adherence to the treatment regimen, which covers taking medication, attending all appointments as well as taking advice related to lifestyle behaviours, such as diet or exercise. And if all four components are in place then a patient is in a good position to effectively self manage their condition. 

Case study - Asthma

Having explored the landscape of long-term conditions we decided to focus on asthma and use it as a case study. It affects over ⅓ of all people with long-term conditions and can affect people of all ages at different points in their life. Self-management programmes amongst asthma patients have been shown to reduce unplanned hospital admissions, yet the figures around these admissions are currently very high despite the manageability of the condition.

Mapped the journey once they get into the cycle of self management, and we realised that like most other people with long-term conditions they spend most of their time managing it outside of a clinical setting, with intermittent interactions with healthcare professionals. And we discovered that most of the pain points were during the annual asthma review and because of the poor experience during the review, the cycles of ‘before’ and ‘after’ within the self management phase remain the same and are repeated every year.

So we understood that people weren’t satisfied with the review as it is now, and what the good review is, we realised that both patient and healthcare professional are striving for the same thing. They both want the patient to become empowered and more active in their health. 

Solution

Apollo is a digital service, which allows people with long-term conditions to complete their health review in an easy and flexible way, helping them to play a more active role in their health.

Key - functions

Aside from completing the annual asthma review Apollo asks the patient what they are interested in learning about, and sends them information throughout the year if new evidence becomes available.There is also the option to speak to a chatbot and It sends push notifications every three months asking the patient the same questions that are covered in the existing annual review, but also considers the best time during the day to send them. Which means that Apollo moves away from a ‘snapshot’ to a broader and more accurate picture of a patient’s health and how they are managing.

When a patient is due to collect a prescription it sends a message to the patient reminding them of the role of the Pharmacist and encourages the patient to ask any questions they may have. And also can check their peck flow and inhaler technique. 

Service journey: the patient is made aware of ‘Apollo’ by the healthcare professional who normally carries out the review.The patient then goes onto the website to find out more and downloads the app. They then register with the service.And use the app over a twelve month period and then repeat annually.

Each stage of the existing review is not considered to be easy or valuable, but with Apollo we hope to minimise the pain points, whilst making the experience better for the patient so that it leads to positive and continual change within the self management phase.

 Apollo offers a lot of value, For patients it provides a consistent, flexible and easy experience with health benefits.For the healthcare professional  there is a clinical, cost and medico-legal benefit.And for the pharmacist there is a financial and professional benefit. And for the healthcare system we believe that it is scalable and could be applied to other health checks as well as reinforcing the role of Pharmacists, which would hopefully reduce some of the pressure on Primary Care

And measuring the impact through higher attendance rates for reviews across all health conditions, a reduction in did not attend rates and unplanned hospital admissions as well as greater and richer data capture.

Validation

We spoke to NHS Digital who reinforced the need to emphasise the benefits for the patients and not make it seem too clinical, as well as confirming our hypotheses that Apollo can promote self management and consequently relieving some of the strain on front line services.From the conversation we also understood the data flow in more detail and how it could be integrated with the patients healthcare systems, as well as connecting to open API data sources related to weather and pollution as well as other asthma related apps that they are using. 

Therefore we propose that Apollo would be paid for by these primary care networks, initially on a trial basis.

They would disseminate this information to the GPs within the network, who in turn would recommend it to their patients for free. Apollo would also form partnerships with Pharmacies who would be paid for any inhaler or peak flow checks carried out.

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