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Clinical Engagement and Telemedicine Church View Surgery Andrew Innes
Why clinical engagement? Makes sense Viewed as self-evident in current UK health policy (1) “ Improvement of the performance of healthcare depends first and foremost on making a difference to the experience of patients and service users, which in turn hinges on changing the day to day decisions of doctors, nurses and other staff”.(2) High Quality Care for All: NHS Next Stage Review final report. London: Stationery Office, 2008. (2) Ham C. Improving the performance of health services: the role of clinical leadership. The Lancet 2003;361:1978–80.
General barriers to clinical engagement Lack of time Pressure of competing demands Lack of understanding Lack of expertise Disinterest Frank prejudice
Clinical culture and the role of clinical trials
Cum ScientiaCaritas First the science Then the caring Medical training
Science Epistemological schism Mixed quality (better in heart failure than COPD) Problems of considering cost effectiveness
Caritas Antithesis of personalized healthcare? Remote Cost-cutting? Concerns about clinical governance and safety
Overcoming barriers to telehealth – What excites clinicians? Improved quality of care – an additional window on a patient’s problems Improved clinical relationship with patients Improved efficiency Improved cost effectiveness A different way of working Application of technology
Overcoming barriers to telehealth – What excites patients? Empowerment – the expert patient Effective, timely and safer care Improved access
Why must clinicians change? Tsunami of long term conditions LTC affect 31% of the population and account for 52% of all GP appointments and 65% of all OPD Around a 25% in the numbers of patients with LTCs over next 25 years Changing practice with risk tools and community MDT
Key components of resolving clinical engagement Adopt a communication strategy that addresses the problems and the benefits in terms that clinicians understand Good clinical evidence of benefit Prioritise clinical domains rather than management targets Local “Champions” Funding – pump prime through enhanced service or QOF mechanisms. NB. Little evidence to support much of what QOF does and yet GP’s perform well in this framework