The pandemic has changed the way we interact with GPs, consultants, nurses and other healthcare providers, as well as online exercise classes, countless well-being apps and trackers.
I have been participating in a project for Parkinson's sufferers with Alice, she works for the UCL/Royal Free as a Parkinson's Care Research Assistant. The results of the project will be available at the end of 2023. Below is a piece she wrote last year about the changes in health care that's coming down the line to help patients.
Inevitably there will be a lot of debate about the effectiveness of digital platforms for patients, however I have read articles recently saying that the aim is to use the internet for home triage to cut waiting times. We shall have to watch and wait. It feels inevitable.
In the last three or four years I have done weekly Tai Chi and Neuroheroes exercises online, I regularly use the Dr IQ app, track my steps online, monitor my health in general and the symptoms of PD.
The rise in digital platforms and use of self-management approaches in people with complex health conditions.
Self-management approaches have been developed and tested to give insight into their effectiveness and which population group may benefit. So far, research has received mixed results on the impact that self-management can have on complex health conditions outcome measures, such as wellbeing, function, quality of life, and caregiver wellbeing. Further high-quality research needs to be conducted.
Rise in use of digital technology after the COVID-19 pandemic
Services, relationships and healthcare all depended on online communication to work through the COVID-19 pandemic. This resulted in a vast acceleration in the use of digital technologies, such as social media and telemedicine, to abide by social distance regulations whilst maintaining communication across the world.
COVID-19 also resulted in considerable strain on service delivery across the NHS in the UK, causing a significant backlog in elective care. Six million people are now on the waiting list to be seen, up from 4.4 million pre-pandemic. Unfortunately, the impact of waiting longer for treatment and medical advice is wide ranging, from worsening outcomes for patients, to increasing pressure and strain on NHS staff, evidenced by the latest nursing strikes. This burden is exacerbated by the rise in the ageing population and increased life expectancy. Although we are living longer, we are not necessarily living healthier, as the emphasis has changed from managing infectious diseases to supporting complex health conditions, with over 50% of clinical appointments and 70% of hospital bed resources currently used due to complex care needs.
How do we support people with complex health conditions?
Clinician appointments for complex health needs are important for supporting with debilitating symptoms. They offer person-centred medical advice and treatments for the specificities complex conditions bring. Due to rising demand, lack of resources, and backlog from the COVID-19 pandemic, reviews with specialists tend to be infrequent. Patients are often left feeling isolated and alone, particularly in the months following a new diagnosis.
Self-management approaches offer a solution and emphasise the central role that individuals have in managing their health. Example approaches include learning new skills, patient education and monitoring symptoms. Self-management tools increase autonomy and independence in managing patients’ complex conditions, guided by the latest research. In recent years, there has been increasing interest in these approaches for complex conditions. Evidence shows that self-management can improve functional outcomes and wellbeing, as well as decrease health care utilisation.
The rise in use of digital technologies go hand-in-hand with the increase in use of self-management tools. The government is investing over £300 million in creating new online services and technologies to meet the needs of our ageing society and those with complex conditions, making healthcare support more readily accessible for those who need it. Self-management tools enable individuals to learn about their condition, understand treatments, and track symptoms which they can further discuss with their healthcare professional. It enables the individual to be more prepared for clinical reviews, for them to run more efficiently, and to have more control over their healthcare and treatment. Self-management also facilitate individuals to reach their own health-related goals that contribute to wellbeing and enhanced quality of life. Autonomy and independence are considered an integral component of wellbeing, and self-management approaches centralise this.
Autonomy in deciding what is most important to an individual when managing their complex health condition is crucial. The proliferation of treatment options for complex conditions can add demands and burden to the patient, and the treatment guidelines focus only on clinical outcomes, often ignoring patient capacity and motivation. When there is an imbalance between patient capacity and treatment workload, patients are less likely to engage with healthcare professionals, or may ignore other important aspects of their lives. The term ‘minimally disruptive medicine’ refers to evidence-based, supportive care that fits into the patient’s capacity, prioritising goals that are important to the individual and focus on improving wellbeing. Self-management approaches follow guidance of minimally disruptive medicine and aim to improve autonomy and confidence in those with complex health conditions.
Research what self-management could mean for you and discover how to adopt approaches into your daily life.
By Alice B, Parkinson’s Researcher from University College London.
References
R., & Lam, C. S. P. (2021). Remote monitoring and digital health tools in CVD management. In Nature Reviews Cardiology (Vol. 18, Issue 7, pp. 457–458). Nature Research. https://doi.org/10.1038/s41569-021-00548-x
Rosen, Rebecca., Rosen, Rebecca., & King Edward’s Hospital Fund for London. (2005). Self-management for long-term conditions : patients’ perspectives on the way ahead. King’s Fund.
Sinead Mac Manus. How can technology help us meet the needs of our ageing society? (https://www.britishcouncil.org/anyone-anywhere/explore/communities-connections/technology-ageing-society).
Abu Dabrh, A. M., Gallacher, K., Boehmer, K. R., Hargraves, I. G., & Mair, F. S. (2015). Minimally disruptive medicine: The evidence and conceptual progress supporting a new era of healthcare. Journal of the Royal College of Physicians of Edinburgh, 45(2), 114–117. https://doi.org/10.4997/JRCPE.2015.205
Marwaha, J. S., Landman, A. B., Brat, G. A., Dunn, T., & Gordon, W. J. (2022). Deploying digital health tools within large, complex health systems: key considerations for adoption and implementation. In npj Digital Medicine (Vol. 5, Issue 1). Nature Research. https://doi.org/10.1038/s41746-022-00557-1
Panagioti, M., Richardson, G., Small, N., Murray, E., Rogers, A., Kennedy, A., Newman, S., & Bower, P. (2014). Self-management support interventions to reduce health care utilisation without compromising outcomes: A systematic review and meta-analysis. In BMC Health Services Research (Vol. 14, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/1472-6963-14-356
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