Helping the Asthma Society of Irelands Nurseline

The goal of national health systems is to maximise the number of healthy years of life for their population. Right now many health systems are stalled! From 1870 until 1939 basic sanitation, nutrition and simple healthcare procedures narrowed the gap in the average lifespan between the rich and the poor. From 1939 until 1993, people continued to live longer, but the gap stayed the same. But for the last 25 years the gap has been widening again, it is now 1.7 years wider than it was in 1993.

Academics from the field of Actuarial Science say that life extension from medical improvements are largely played out. Recent reports “Investigations in inequalities in Adult Lifespan” and from the Adelaide Foundation say that most deaths today are from age related chronic diseases and therefore individual life choices have become much more significant for life extension than in the past. However, getting people to change how they behave is difficult. Changing long-term behaviour requires expertise more in a social and conversational space than a medical space.

Most deaths in developed countries are from chronic conditions

Publicly available data from Scotland shows that nurses working in behavioural interventions spend the majority of their time helping with just four main chronic conditions, Hypertension, Diabetes, Circulatory & Respiratory S&S, and Asthma. In Ireland with a population of just over 4m adults, 450k have asthma, up to 200k have COPD (110k diagnosed), 225k have diabetes and over 1m people have hypertension. Chronic conditions affect large numbers of our populations.

One of the most effective tools in helping people with chronic conditions live longer are condition management plans. From a medical perspective these may seem simple, trivial even. They involve a combination of people recording their symptoms, learning about symptom boundaries (time to take action), and understanding the trigger places or events for their condition – which are only learned over time. They involve communication plans for who needs to know about their conditions and what to do in circumstances of an emergency.

Much of the implementation and servicing of chronic condition management plans can be done remotely by specially trained nurses. Indeed for this kind of work, nurses are often more successful practitioners than doctors. However the reputation that “Call Centres” have built up over the years has built significant prejudice against any kind of remote service delivery.

Condition management plans extend lives

Ennovate have built a unique service package that enables remote management plan providers to effectively deliver service, that people with chronic conditions benefit from. Our approach;

Is nurse centred around the patient: Patients are asked to fill out a condition management plan by a named nurse. The plan they receive through the post has a picture of “their” nurse on the document – and a picture of their nurses eyes – research shows that this can significantly improve compliance
Is nurse centred around the practices: Engaging with patients over the telephone requires a particular mix of listening well to the patients needs as they express them and bringing appropriate nursing expertise at the right time. We Use a Commitment-based-management approach to facilitate effective group discussions around recorded patient telephone calls
Is measurable and measured: When is a call effective? What is a good call? What are the measurable over the subsequent 3 months after the first patient contact? Identifying and recording this information well is key to the success of remote behavioural interventions
Is cost effective: Specialty nurses are valuable and expensive resources. It is only appropriate to use them in a serviceline if they are delivering more value than they could do in a face-to-face setting. Ennovate have worked out the benefits case for some chronic conditions for this question.
Delivers results: Measuring the outcomes from behavioural interventions is particularly difficult. Connecting a serviceline interaction with reduced hospital admissions or more effective use of medicines can take years and cost more than the total cost of the service provision to measure – however we have received accolades from experienced service reviewers.

The Asthma Society of Ireland uses remote services to effectively help patients

In 2014 and 2015 Ennovate worked with the Asthma Society of Ireland to help them completely rebuild their Adviceline to target increased patient engagement and to produce better outcomes. The new service has continued to develop under the leadership of Pheena Kenny. Recently the Adviceline was independently reviewed by the Helplines Partnership and Sarah Hill from that organisation said of the Asthma Society:

“The service clearly has gone through a huge amount of development in the past year and a half, and is built on solid research in the sector. In particular the strategic and operational plans, confidentiality and data protection policies, and the internal quality assurance and monitoring is excellent.”