Seen the doctor on the Tele? Patient centred care needs to arrive for all, and none more urgent than for our older patients

Chris Subbe is a Consultant in Acute, Respiratory & Critical Care Medicine. He is a Service Improvement Fellow with the Health Foundation. He does research on patient safety at Bangor University. He tweets @csubbe

Unsurprisingly many of us have more medical needs as we get older. While some people manage to stay remarkably fit, for others it is getting more difficult to get around town or worse across country. The hike around an overflowing car park of an inner-city hospital does surprisingly little for mobility, and most people get little value from sitting in an outpatient waiting area to wait while their medical team is struggling with the application of queuing theory to healthcare.

A few years ago, when granddad was sent a follow-up appointment for his cardiac surgery several months after the operation, I was suspicious. I rang the secretary of the colleague who had done an amazing job on his heart to ask for the reason for the review. “An important part of quality assurance: we like to make sure that everything has gone well”. I explained that granddad had been in hospital, survived prolonged rehabilitation, and had already been followed up by an excellent local geriatrician and one of our brilliant cardiologists. He felt well. I suggested cancelling the appointment.

Innovative digital technology; A truly viable option for our older patients?

Esther Clift is a Consultant Practitioner Trainee in Frailty with Health Education Wessex @EstherClift

We are facing unprecedented times in the NHS. Those of us working from within, we know only too well that the demands and pressures mean we need to do things differently, in a cost efficient way, while safeguarding quality and standards of patient care. Digital technology has been heralded as the panacea for our situation, with telecare, telemedicine and telehealth offering viable alternatives to our reduced staffing, and pressured workloads. Digital is non judgmental and non discriminatory.

Which one is a better deal – home visits or phone calls?

Frances Wong is a professor at the Hong Kong Polytechnic University. 

Our recent research has revealed very interesting findings about the power of a telephone call as compared to home visits for post-discharged patients. Patients are discharged from the hospital as soon as the immediate problems are resolved. Some care issues only emerge when the patients return home. The issues usually involve patients’ confidence and ability for self-care, symptom management, adherence to medication regimen and so on. If these concerns are not addressed properly, the patients will present themselves to the hospitals again. Like a revolving door syndrome, patients returning to the community come back to the hospital within a short time. The mean readmission rate within 28 days after discharge is 15% and the rate can escalate to 35% for the chronically ill patients. 

What role can social media play in healthcare?

Victoria Betton is a social media & mental health PhD researcher, Deputy Director at Leeds & York NHS PFT. She tweets at @VictoriaBetton and blogs at digitalmentalhealth.co.uk

Social media is the term used for online platforms which enable people to consume information as well as produce their own content – from 140 character updates on Twitter through to sharing photos on Instagram, and much more besides. Whether we use social networks or not, they are increasingly incorporated into day to day life, and not just for younger people:  Age UK report that the number of 55-64 year old internet users creating a social network profile rose by almost half last year, and many use social networking to keep in touch with family and friends and to reduce social isolation.

Independence through technology – how far have we come?

Mark S. Hawley is Professor of Health Services Research, University of Sheffield.

Stuart G. Parker is Wm Leech Professor of Geriatric Medicine, Newcastle University.

Telecare and telehealth are being championed as important components in the response to the needs of an ageing population. What happens when you ‘open the black box’ and take a look inside? A review of a large scale piece of research suggests the answer might not be as clear cut as we might like.

Cyber-care – The benefits and drawbacks of new technology

A conference report from the BGS Spring Meeting in Belfast, by Liz Gill.

The benefits – and some drawbacks – of new technology was the subject of the BGS Special Interest Group for Telecare and Telehealth where Dr Frank Miskelly, consultant physician at Imperial College London, had this key message for his audience. “The secret is to look at the problem and then ask how you can use technology to solve it.  Too often you get companies who want to sell you some kit saying ‘we’ve got the solution, can you now find the problem?’”

Digital inclusion and older people

Emma Solomon OBE is Managing Director of Digital Unite, an independent organisation that helps people, particularly older people, to understand and use computers, the internet and other digital technology.

image by southerntabitha

Having the skills to use digital technology is a must-have in today’s modern society. It can save us time and money, make us feel better connected, less lonely and better informed.

For the citizen as a patient, having digital skills means being able to book and cancel doctors’ appointments more easily, order repeat prescriptions, improve the access to information and services to support their own care and that of others.

By 2015, the NHS Commissioning Board aims to guarantee every patient the opportunity of online access to their own medical records. This is an ambitious target made even more challenging because today in 2013, many older people still either aren’t online or don’t have good enough digital skills to use such a service.

Should we invest in newer forms of telecare?

Mr Adam Steventon is Senior Research Analyst Nuffield Trust.

As David Oliver’s recent blog mentions, there’s much interest at present in the potential of telecare to help frail older people maintain their independence at home. Telecare can take many forms. Since the Department of Health’s Building Telecare in England report, the number of pendant alarms in England has increased to around 1.5 million. Some local authorities are now beginning to invest in newer forms of telecare like automatic falls and bed occupancy sensors.

Advocates have claimed that telecare can deliver benefits for older people and their carers while reducing costs – the latter happening through reduced admissions to care homes and hospitals, and shortened of length of stay in hospital by virtue of faster discharge with the safety assurances that come from telecare. However, evidence about the effect of telecare on use of care services has been scarce, with several systematic reviews commenting on a paucity of high-quality research.

“Admission prevention” and “care closer to home” for older people – between the sceptics and enthusiasts

Prof David Oliver is BGS President-Elect, is a Consultant Geriatrician at the Royal Berkshire Hospital, Visiting Professor of Medicine for Older People at City University London and a Kings Fund Visiting Fellow. He recently stood down from his role as National Clinical Director for Older People at the Department of Health.

This is my first blog since becoming President-Elect of the British Geriatrics Society. Alongside my day job as a busy coalface geriatrician, I have spent the best part of four years seconded to the Department of Health as a senior government advisor in the Civil Service. I resigned at the end of 2012 because I couldn’t reconcile my new role as a BGS officer with the role as National Clinical Director or (as the press would have it) “tsar”.

No longer bound by the Civil Service Code, I am free again to speak my mind. A particular issue I want to discuss here is the thorny subject of “admission prevention”, “admission avoidance”,  “care closer to home”,  “care outside hospital” – take your pick.

Phone App Review: Qx Calculate

Qx Calculate

Costs: Free

Devices: iPhone, iPad, BlackBerry and Android

Target Audience: All levels of doctors

Review: Ever needed to calculate a GRACE score in a chest pain patient? Or an eGFR in an elderly patient about to initiate bi-phosphonates?  RANSON score in pancreatitis? This excellent medical app for your phone provides ‘at your fingertips’ access to wide variety of medical risk scores.

The app can be customised to UK laboratory units. All manner of scores from Cardiology to Gastroenterology to Neurology to Cardiac surgery are covered and updated free of charge. This would be an invaluable tool on ward rounds or on an on-call shift in the emergency department. Highly Recommended.

For more details and to download, visit the website.