Published: 02/05/2002, Volume II2, No. 5803 Page 12 13 14
Doris Ella's previous encounter with new technology ended in stalemate - she remains unconvinced about the merits of a video recorder. But when the suggestion was made that a telemedicine monitor to measure her 'vital signs' be installed in her home, she accepted without hesitation.
'I hate being in hospital, ' says Mrs Ella, 75, who has been admitted seven times with respiratory and heart failure since June 1999. 'At home, I like to have a cup of tea when I want, look at my garden, feed the birds and listen to the radio when I go to bed. The monitor meant I could do all of those, and still feel confident that any changes in my condition were being recorded.'
Mrs Ella was one of nine patients in a trial of telemedicine monitoring carried out in West Yorkshire by the Pontefract emergency response team (PERT).
After careful demonstrations of how to operate the equipment - which displays a step-by-step guide clearly on its screen - patients are required to take an agreed number of clinical readings three times a day, before transmitting the results remotely via a modem to a monitoring centre. Patients have access to support on the telephone 24 hours a day.
If any of the readings, which include blood pressure, temperature, pulse and breathing rates, breathing amplitude and blood oxygen saturation levels, exceed those recommended by the patient's clinical team, the information is immediately transmitted. The response team can also access the data remotely via a personal computer.
The PERT scheme was one of two separate trials run last year by the West Yorkshire Metropolitan Ambulance Service trust (which conveniently incorporates NHS Direct, doctors' out-of-hours and community alarm monitoring services at its Wakefield base) with monitor designer Tunstall.
The attractions of telemedicine to an overstretched health service are obvious - early discharges from hospital, fewer readmissions and a reduction in the number of home visits by a nurse or health visitor.
In March this year, at the fourth birthday celebrations of NHS Direct, health secretary Alan Milburn said one of the next steps for the service was 'supporting people with chronic conditions to live safely in their own homes'.
During the first two weeks of the nine-month PERT trial, only one patient was re-admitted to hospital, with an unconnected problem, compared to the normal rate of one in four.
A study of the trial says all patients found the telemedicine monitor easy to use and all found being cared for at home beneficial. They said they were willing to be nursed at home with this level of support.
Several trials of different uses of telemonitoring began after Tunstall, a major supplier of home re-assurance systems, took part in SAFE21 - social alarms for Europe in the 21st century - a research and development project, with financial support from the European Commission.
Its aim was to develop a system for monitoring patients in their homes through the integration of medical technology into an existing community alarm system.
It is estimated that more than 1 million people in the UK use a community alarm system at home.
Pilots in the UK - running alongside similar trials in the Netherlands and Spain - included the ongoing development by Newcastle primary care trust of a nurse-led intermediate care unit in sheltered accommodation provided by the city council.
Funded via a heath action zone innovation project, the facility can either prevent hospital admissions with chronic obstructive pulmonary disease - the third most common cause of death in the EU - or enable earlier discharge of those patients.
Nigel Davison, assistant director of nursing at Newcastle PCT, says: 'By using telemonitoring, we have demonstrated that we can keep people out of hospital. Now we need to find more creative uses for it, which link into the national service frameworks.
'We know how important ECGs are in detecting cardiac problems - the portable monitors mean we can establish clinics or test patients virtually anywhere.'
With funding a major issue, Tunstall estimates the cost of telemonitoring to range between£20 and£50 per day, depending on the number of readings required. This includes training a patient to use the equipment, maintaining an electronic patient record, responding to monitoring exceptions, telephone support and remote access and reports for the clinical team.
In another study which took place last year at Dewsbury and District Hospital, West Yorkshire, consultant respiratory physician Dr David Currie used telemonitoring for patients with suspected sleep apnoea, which in its severe form can lead to heart failure, and creates obvious dangers for drivers and those working with machinery.
Instead of an overnight stay in hospital to monitor sleep patterns, with inherent problems of bed availability, short notice for patients, and the alien environment likely to disrupt sleep anyway, patients were monitored in their own beds, in their own homes.
'We always aim to carry out a couple of sleep studies in hospital, but in reality time pressures often do not allow for that, ' says Dr Currie.
'The monitor also offered us the chance of improved readings as it measures oxygen levels, pulse and breathing rates and the depth of breathing.
'We found the study very useful - it certainly picked up some cases of obstructive sleep apnoea, where the upper airway is obstructed, ' he says.
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