Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.
Introduction
The aim of the project was to implement a Telemonitoring pilot in Donegal for Adults with Type 2 Diabetes Mellitus commencing insulin for a period of 12 weeks. The project would include 40 patients. The objectives were to measure the effect on HbA1c at baseline, 12 weeks and 6 months and to explore the benefits of telemonitoring along with the impact on hospital admissions and GP visits.
For people with diabetes it is important to monitor levels of HbA1c. The higher the HbA1c, the greater the risk of developing diabetes-related complications. HbA1c is also referred to as haemoglobin A1c or simply A1c. Definition of HbA1c. HbA1c refers to glycated haemoglobin (A1c), which identifies average plasma glucose concentration.
The Solution
The company contracted to provide the telemonitoring was Fold Telecare which is based in Northern Ireland and currently provides telemonitoring to several Trusts there. The IT equipment and training was provided for Health Care Professionals and patients (or an identified key relative) by Fold Telecare. Two Community Clinical Nurse Specialists (Diabetes) provided the clinical monitoring of the patients.
The Community Clinical Nurse Specialist (CNS) (Diabetes) assessed each patient who met the criteria to ensure that they were suitable for telehealth monitoring. Once referred, a box called a Mymedic HUB was placed in the patient’s home by a Telecare Support Officer from Fold Telecare.
The patient recorded their blood glucose readings as normal and then, at the times agreed, the patient uploaded their blood glucose readings to a monitoring centre using the HUB which was then available for review by the CNS (Diabetes). The CNS then contacted the patient if necessary to discuss the results and any issues.
The Benefits
The Triage Manager in Fold Telecare remotely monitored the readings and flagged if a patient had not uploaded their readings as requested in the patient monitoring plan. The triage nurse based at Fold contacted the patient to ascertain why they had not uploaded their reading and requested that they do so. If the triage nurse was unable to contact the patient and / or their designated contact they notified the CNS (Diabetes).
All alert messages were e-mailed to both CNS’s if they could not be contacted by phone. Fold’s triage nurses dealt with non-upload of data (blue alerts), skipped readings (yellow alerts) and technical alerts (grey alerts) only. The triage nurse also communicated with the CNS if necessary by leaving messages on the system. After the 12 week period, the HUB was removed from the home by the Fold Telecare Support Officer and the patient was discontinued from the remote monitoring, By this stage the patient had become more confident and competent in managing their own insulin..
Next Steps
This pilot is being evaluated by St Angela’s College, Sligo.
