Opinion: Telehealth as cornerstone of Covid community care

The federal government’s recent announcement giving responsibility for dealing with Covid patients mainly to GP practices includes an implication of broadening the use of telehealth.

Not only are patients expected to isolate at home, but GP practices are expected to look after patients in their homes.

To that end, patients will be supplied with medical devices such as pulse oximeters that they can quite easily be taught to use themselves.

What comes now is key as we cannot expect practice nurses to be adding home visits to their busy schedules. Home visits are simply unrealistic as most GP practices are booked out with end-to-end consultations in their daily schedules.

The best way to make this work is for patients to self monitor their vital signs and report the results to the practice nurse during a video call check in once or twice a day. The nurse can then decide whether the patient is deteriorating and needs to be transferred to hospital for more intensive care.

The decision on deterioration can be made based on the pulse oximeter reading, a patient’s self-report as well as the ability of the nurse to eyeball the patient via video telehealth.

In addition, a patient would also be instructed to immediately call their GP practice if their vital signs go outside expected numbers.

This could be further simplified through expanding the use of telehealth to review patient monitoring using a remote patient monitoring application on their mobile phone, as has been successfully done in other countries.

In that situation, patients are registered through their mobile phones with an app into which they enter their vital signs every time they take them. These results are automatically accessible to their GP practice and can be checked by nurses frequently.

Such a remote patient monitoring application further raises alarms if a patient's vital signs are outside normal parameters, so the patient doesn't have to make that decision themselves but get the support from technology.

Patients can then feel comforted by the knowledge that their health is constantly being monitored by their GP practice and their monitoring nurse and GP will make the decision when to escalate their care.

These mobile apps will also remind the patient when to take their vital signs again so they don't forget. This makes it a more reliable monitoring means.

In a final stroke of genius, if the patients are given Bluetooth-enabled devices, then these devices can actually automatically connect to the mobile phone app and upload their results so the patient doesn't even have to worry about manually entering their results into the application.

Suddenly, a patient can feel as continuously monitored in the comfort of their home as they would be if they were admitted to hospital.

This is the state of technology as it's being used by community care in many countries overseas. It's the quality of care that we should expect from our healthcare system here in Australia as well.

Not only is this technology readily available, but it's also affordable and scalable and provides the right kind of support for our healthcare providers to cope with the new normal that is COVID-19 in the community.

We need to support our GPs and practice nurses with these new challenges through technology, not only to enable them to do their jobs but also to keep them safe from infection. Caring for patients in their home also helps stop the spread of infection within the community.

New strains of COVID-19 mutations will continue to reach our shores as we open up our borders and an expected 8-10 per cent of our population will be sensitive to an infection despite being vaccinated. Mostly they will have light symptoms but we have to keep up monitoring to ascertain and capture serious cases early and can potentially even void hospitalisation for them.

Let's give patients and GPs the support they need to deal with the new normal of COVID-19. Let's give them the technology they need to feel safe and stay safe.

So how can GP practices prepare for this new normal of Covid-monitoring in the community? There are three components required:

1. Medical devices: It seems the government's announcement included a distribution of pulse oximeters through PHNs. I imagine as soon as your GP practice identifies a new Covid patient, you can order a pulse oximeter for them via your PHN.

2. Remote patient monitoring app: As you hand out the pulse oximeter to the patient, you will want to educate them in the use of it. You will also want to educate the patient how to install the mobile app that captures their monitoring results. A number of such apps are available in the market. Pick one that gives you a dashboard to monitor your patients' data remotely and is custom developed for clinical use.

3. Telehealth: Use video and phone telehealth to check in on your home isolating patients. There are a number of solutions available for video telehealth, but you get the best set-up if your telehealth solution integrates with your remote patient monitoring application.

Dr Silvia Pfeiffer is the co-founder and CEO of telehealth platform Coviu.

Posted in Australian eHealth

Tags: Telehealth

Comments  

0 # Andrew Baird 2021-11-12 12:50
Thank you very much Silivia an excellent article, informative and insightful. The article describes very clearly the current state of remote monitoring, and the potential for remote monitoring, particularly in relation to respiratory disease such as COVID-19.

Pulse oximeter measurements (oxygen saturation and pulse rate) need a clinical context for interpretation, they should not be interpreted in isolation, but should be interpreted in the context of clinical assessment, and the optimal way to achieve this remotely is by a clinician via video. This allows assessment of symptoms and an indirect physical examination - eyeballing for the 'sick' patient, respiratory rate, work of breathing, mental state. With appropriate equipment, patients can check their temperature and their blood pressure.

The remote measurements obtained can be given to the clinician verbally, or directly via the video call link (secure electronic transmission).

There may be a role for cough analysis, using the patient's smartphone microphone and cough analysis software in the video call platform. This is a decision support tool to assist with the diagnosis of pneumonia and lower respiratory tract infection.

There may be a problem with continuous monitoring of oximeter measurements - false positives due to movement and displacement of the oximeter, and nobody continuously available at the 'other end' to respond to an alert of an abnormal measurement.

But this is the way to go.

What countries are using this?

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