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Covid-19 drives change in long-term conditions management

Paul Midgley and Oli Hudson, of Wilmington Healthcare, explore how patients are being empowered to manage their conditions at home

Covid-19 drives change in long-term conditions management

Paul Midgley and Oli Hudson, of Wilmington Healthcare, explore how patients are being empowered to manage their conditions at home

Introduction

As the coronavirus response has taken up considerable NHS resources, the need to enable other patients, particularly those with long-term conditions, to take more responsibility for their health has never been greater.

The Long-term Plan said that for ‘many health conditions, people are already taking more control supplemented with expert advice and peer support in the community and online’. However, covid-19 has forced more fundamental change in service delivery.

Managing exacerbations

Prompt treatment is vital for managing exacerbations in patients with long-term conditions and the NHS has tried to convince people to seek urgent help for potentially life-threatening symptoms during the pandemic.

However, despite this advice and the creation of ‘safe hubs’ in hospitals for non covid-19 patients, data on A&E attendance suggests it will take a while to fully restore patient confidence.

Going forwards, it is likely that we will see three distinct hospital settings with a ring fenced, red ward for covid-19 patients and separate safe areas for emergency outpatients and elective work. However, efforts to keep people out of hospitals, where possible, and provide more care in the community, as outlined in the Long-term Plan, will continue to be a priority.

Monitoring

The covid-19 pandemic has expedited digital NHS service delivery. Enabling patients to access more services in this way is a key aspiration of the Long-term Plan, which promised that the NHS would ramp up support for people to manage their own health over the next five years.

Remote monitoring is key to enabling more people to successfully manage their conditions at home and one area in which it can be successfully deployed is in respiratory diseases. A key resource in this field is myCOPD - a specialist self-care app designed and built by COPD experts, and externally peer-reviewed by leading NHS consultants.

In common with many other long-term condition patients, people with respiratory diseases may have been having conversations with clinicians about managing their illness during the coronavirus pandemic. They may have been moved on to treatments that are easier to manage at home and do not need as much intervention from a healthcare professional. However, if more patients are taking their medications at home, rather than in hospital, there will be an increased need for digital devices to monitor adherence.

Mobilising the wider healthcare workforce will be important for enabling self-care, as the burden of management shifts away from hospitals, particularly outpatients and acute care consultants, and into the community. Here a multidisciplinary team of GPs, clinical pharmacists, district nurses, specialist community nurses and health advisors will be responsible for supporting and managing patients.

Among these key stakeholders, we may see clinical pharmacists become a particularly important stakeholder group for pharma and take on a more prominent role in primary care.

Education

As patients become more closely involved in making decisions about their treatment and take on more responsibility for managing their conditions at home, it will be interesting to see how the traditional patient/clinician relationship changes. For example, will patients begin to actively request certain drugs that they have researched themselves, rather than simply accept the first, or second line treatments that a clinician would routinely prescribe?

It is too early to say what the longer-term impact of empowering patients might be in this regard. But certainly, there will be a clear need for access to educational resources and supporting information. We may also see greater patient participation in online forum debates about treatments and a growing interest in online support groups and other group activities.

This demand is likely to be met by healthcare charities which will play an increasingly important role in providing information and advice via channels such as telephone support lines, website resources and apps. Indeed, some charities have already been proactive in offering support to patients via GP surgeries during the coronavirus pandemic.

It is possible that some charities might have direct access to information on the latest treatments that are being recommended nationally within their specialism and so they could become a useful conduit of information for GPs as well as patients.

Conclusion

The paternalistic relationship between patients and clinicians is changing. However, the road to increased independence is likely to be fraught with challenges for many patients; hence educational resources and ongoing monitoring will be vital to help them acquire the knowledge, confidence and skills required for self-care.

There is a valuable role for pharma to play in working with charities and clinicians to provide educational resources on specific conditions and drugs. Industry can also lead the way in supporting adherence and providing the treatments and tools required to empower patients and help the NHS make a seismic shift in service design and delivery. The time for digitally-supported pharma products is now.

Ends

Paul Midgley is Director of NHS Insight and Oli Hudson is Content Director, both at Wilmington Healthcare. For information on Wilmington Healthcare, visit www.wilmingtonhealthcare.com

31st July 2020

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Wilmington Healthcare

01268 495600

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