Use of Telehealth in Antenatal Diabetes clinics. Chandi Idampitiya Consultant Endocrinologist Cumbria Partnership NHS Foundation Trust

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1 Use of Telehealth in Antenatal Diabetes clinics Chandi Idampitiya Consultant Endocrinologist Cumbria Partnership NHS Foundation Trust

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3 The problem Increase prevalence of gestational diabetes Increase demand and unmatched capacity Challenging geography Socio- economic factors Staffing issues /resourcing clinics Availability/ accessibility of premises

4 Statistics Deliveries National stats prediction for WCH WCH 2014 WCH 2016 Type 1 diabetes Type 2 diabetes Gestational diabetes All types of diabetes

5 Steps Delivering weekly consultant led antenatal clinics Increasing the duration of the clinic session by extra hour Initiation of DSN led new gestational diabetes clinics Incorporation of technology enabled care services (TECS) by introducing Florence telehealth service for patients with gestational diabetes.

6 Florence Telehealth Florence Flo a web-based system Designed to provide support and advice to patients to enable self-management of certain conditions via SMS text Remote monitoring of blood glucose of patients with gestational diabetes

7 Florence Telehealth Is telehealth a solution for demand and capacity issue at joint antenatal clinics? Can telehealth improve the patient experience in antenatal clinics? Is telehealth cost-effective? Can pregnancy outcomes be improved by use of the telehealth?

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11 User feedback Yes No was the Flo beneficial? was Flo easy to use? did you find the advise test messages useful? Woud you recommed this service?

12 Advantages of Florence telehealth Themes The constant reminder. Easy to record readings. Helpful for focus on eating at the correct times of day. Provision of Positive / negative response quickly. Saved on frequent appointments at the hospital. Usually there is a long wait in the hospital to be seen. Keeps you on track and gives advice. Quicker appointments as staff had already monitored my levels through the telehealth

13 Disadvantages of Florence Themes Face to face appointments help give information to support your personal needs. The Flo texts were generic. When the reading was too low or high, it usually sent an urgent message to call the diabetes clinic which causes stress and worry. Value of face to face meetings. If had a question there was no appointment to go to.

14 Solution for increased demand

15 Reduce face to face appointments for gestational diabetes( 0.8 face to face contacts per patient ) Provide required time for patients with Type 1 and Type 2 diabetes

16 Cost effectiveness The cost of the license is 12,600. ( 37,500 text messages) Commissioned in Cumbria ( for GP practices) Agreed for West Cumbria diabetes service to use as only few practices continued to use( 6 of 29 practices signed up) Cost ;18 months for west Cumbria diabetes service - 6, 924- (129 patients/86,562 text messages)

17 Outcomes Parameter( NIDP audit endpoints) Percentage of pre term deliveries in Type 1 diabetes Percentage of macrosomia in Type 1 diabetes Percentage Caesarean section of Type 1 diabetes Percentage of HBA1c <48mmol at 28 weeks Percentage of macrosomia in gestational diabetes Outcome 75% 60% 15% reduction in pre term deliveries in Type 1 diabetes 75% 50% 25% reduction in macrosomia in Type 1 diabetes 100% 80% 20% reduction in caesarean sections in Type 1 diabetes 26% 60% 34% improvement in achieving HbA1c targets at 28 weeks 10% 2% 8% reduction in macrosomia in gestational diabetes

18 Summary Florence telehealth was an effective solution for increase demand in antenatal clinics Regular contacts reduced the macrosomia rates in gestational diabetes cost effective

19 Further Developments Cumbria CCG split to North and South North Cumbria CCG-discontinue funding for licence and text bundle from May 2018 Provider ( CPFT) to take over funding hence licence Not sufficient uptake from CPFT community services to justify funding Exit plan for telehealth monitored patients

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