Doctor won’t see you now: role of technology to support participatory health care

Last year, there were 338,082 non-emergency, planned hospital out-patient appointments in England everyday (NHS Digital, 2019).

Or if you like really big numbers: 123.4 million appointments in total. I’ll say that again: 123.4 million hospital appointments. In one year. If you like even bigger numbers consider that each appointment costs the NHS on average £120. In fact, such is the sheer scale of hospital outpatient attendance, a 2017 report by the Kings Fund found they account for almost 85% of all hospital-based activity within the NHS.

Given its ubiquity, this model of care must be the panacea, right? Well no, not really.

Typically these appointments provide specialty opinion, diagnosis, rehabilitation and disease monitoring. They also sit in the ‘well we’ve always done it this way and it seems to work’ camp. Yet patient experience does not always concur: uninformative and confusing appointment letters, the wait for the appointment (often scheduled at inconvenient times), the journey, parking, finding the clinic, waiting in clinic etc.

In fact, Age UK’s 2017 in-depth policy report found that 20% of those over the age of 65 reported feeling worse after a hospital appointment because of the stress involved in the journey alone. Furthermore, clinicians report challenges of meeting escalating demand, long waits between seeing patients, and severe time pressures within clinics. All of which inhibit the delivery of optimal care.

So why do we still do it this way?

Certainly there is a genuine clinical need to attend hospital for certain appointments. But for many, it is just habit – grown out of convenience for healthcare systems, not the patients they serve. In particular, for the estimated 84.3 million follow-up appointments there is real scope to consider utilising digital technology for provision of care and support remotely without the need to attend hospital.

The 2018 Royal College of Physicians publication: Outpatients: The Future and the 2019 NHS Long Term Plan, highlights the outdated and unsustainable model that is outpatient care. Utilising digital technology, and in particular wearable technology, is suggested as a potential solution in both reports.

Wearable technology is ubiquitous in today’s society. It’s in our watches and our smart phones. It can provide detailed monitoring of every step, every heart-beat, and every movement during our daily activities. It provides a wealth of data and so lends itself to monitoring many aspects of pretty much every health condition. The technology has advanced at break neck speed; it’s increasingly unobtrusive, acceptable, affordable and accurate.

And yet uptake of wearable technology remains slow within the NHS.

Here in the South West we are uniquely placed to try something innovative. We were failing to meet the needs of our growing population of people with Parkinson’s disease because we were using an outdated, inefficient, and unsustainable outpatient service. So, we have embarked on a journey to change the dynamic of care from paternalistic delivery to participatory.

Patients will no longer be passive recipients of care, but drivers of care that meets their needs.

We are using data – and lots of it – from questionnaires (soon to be an app) and wearable sensors, to capture all aspects of Parkinson’s remotely. This includes the symptoms patients are experiencing, their ability to function day-to-day, and their experience and confidence as drivers of their care. We have developed data management systems to feedback information to the patients and let clinicians know when a patient needs assistance.

Instead of routine follow-up appointments, patients are supported to monitor and manage their own symptoms and to recognise when they need to ask for help. Our vision for the future is for patients to feel confident to monitor and self-manage aspects of their health conditions at home, informed by longitudinal, objective, real-life and clinically meaningful data.

And so, as technology progresses and the evidence to support its use accumulates, digital technology is likely to support some very important healthcare developments which have remained elusive, not least a reduction in the 123.4 million hospital outpatient appointments each year.

William Gibson, the science fiction writer, wrote in 2003 ‘The future is already here – it’s just not evenly distributed’. Well here in the South West, we think so too.

Dr Terry Gorst

Dr Terry Gorst is a Senior Research Fellow at the University of Plymouth. The ‘Developing Home-based Parkinson’s Care’ project launched in July 2019 and is funded by The Health Foundation and Parkinson’s UK.

Project partners include people with Parkinson’s and their care partners, the Cure Parkinson’s Trust, Flourish Workplace, Sheffield Hallam University, Global Kinetics Corporation, Parkinson’s UK, Fre-est, Radboud University, the South West Academic Health Science Network and UCB Pharma.

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