Claire McQuillan, Tunstall Delivery Manager at Remote Telemonitoring Northern Ireland (RTNI) talks about a recent study considering the use of telemonitoring to self-manage diabetes.
The TF3 consortium (comprising Tunstall Healthcare, Fold Telecare and S3 Group) was awarded a 6-year contract in March 2011, to provide a telemonitoring service to the Northern Ireland health and social care system. The contract, which represents an investment of £18million, by the Department of Health, in the management of long-term conditions, was led by the Centre for Connected Health and Social Care (part of the NI Public Health Agency) who worked with, and on behalf of, the five health and social care trusts.
The large scale ‘end to end’ managed clinical service has the capacity to support over 3,500 patients a year, and is aimed at supporting those with heart and respiratory conditions, diabetes and those who have suffered a stroke. The service also provides Telecare support to those with conditions such as dementia or epilepsy and those who are at risk of falls, helping to safeguard them and maintain their independence.
Patients enrolled onto the Telehealth element of the service monitor their vital signs at home using the relevant peripherals, such as a blood glucose meter, scales and BP monitor, ensuring qualitative patient feedback is captured via condition specific health interviews/questionnaires. The vital sign readings and patient feedback are then transmitted, via a hub, to the monitoring centre. If a patient’s data is outside of the clinical parameters set by their clinician, a TF3 Triage Nurse will contact the patient and determine whether there is a need for intervention or escalation.
A study into managing diabetes
A retrospective cohort study was carried out by the South-Eastern HSC Trust, in conjunction with the University of Ulster, analysing the medical records of patients using the telemonitoring service for self-managing diabetes. They were looking principally for any change in HbA1c levels. They gathered data from 214 previous and current users of the telemonitoring service within seven diabetes clinics within the south-eastern HSC Trust.
The average age of the patients was 61 years, with 60% of the sample being male. The average time living with diabetes was 14 years, and on average the patients had been on the telemonitoring Service for 147 days (just under 5 months). They obtained data on HbA1c, blood glucose, blood pressure and body mass index for before and after the RTNI solutions.
Although there was a slight difference in the average HbA1c results between male and female users, both showed significant improvement in glycaemic control with a fall in HbA1c of 0.9% and 2.4% respectively.
They concluded that the telemonitoring service provided accurate and comprehensive data in improving clinical outcomes, and a 95% long-term improvement in HbA1c levels amongst users was encouraging and indicated that clinical care can be provided remotely for day-to-day self-management of diabetes.
They also concluded that it may offer a target for improving complications observed for patients with diabetes and by remotely monitoring the patient, the Trust’s clinical team could improve the patient’s result and help them achieve their desired goals.
So, what does this mean for technology and diabetes?
The findings from this study were largely positive, with some highlights for the relationship between technology and self-managing long-term conditions such as diabetes:
- Technology helped capture accurate data and can provide remote care
- It gives some responsibility back into the hands of the patient, so they can manage their own conditions
- It allows patients to be maintained at home, while showing significant improvement in their HbA1c and better overall management of their diabetes