Around 15 million people in England have a long-term condition. Heart failure, chronic obstructive pulmonary disease, asthma, diabetes and kidney disease are the most common, with each of these conditions accounting for five of the top 10 reasons for an emergency admission and 70 per cent of total inpatient bed days.
The insidious burden of chronic disease has been growing for decades draining resources, expanding health inequalities and multiplying costs. In 1990, healthcare accounted for 5 per cent of the UK’s gross domestic product. Today, it is around 12 per cent of GDP and almost half of UK government spending.
Multimorbidity (having more than one condition) is also a growing issue with a projected two-thirds of adults aged over 65 expected to be living with multiple health conditions by 2035. In line with the ageing population, healthcare spending would need to increase exponentially to even maintain today’s precarious standards.
COPD is known to be one of the costliest inpatient conditions treated by the NHS with nearly a third of admitted patients readmitted within three months. According to the National Institute of Health and Care Excellence, one in eight emergency hospital admissions is for a patient with COPD, which makes it the second largest cause of emergency admission in the UK.
While long-term condition management of COPD resides largely within community and primary care settings, research has shown 70 per cent of COPD-related healthcare costs are for acute care following an exacerbation.
As with many other industries, technology can transform expensive services into affordable goods. Think of the cost of a custom-made shoe versus a factory-made one or a farmer hand ploughing a field versus running a fully computerised operation.
A recent study by NHS Greater Glasgow and Clyde examining the effectiveness of a co-designed digital service model for the management of COPD, can offer some valuable insight into how digital enabled home care for COPD may be used to maximise the impact of virtual wards spending.
Used across the NHS in Scotland and now launched in Hull University Teaching Hospitals NHS Trust (HUTH) to support virtual wards and long-term management through a recent SBRI award, the Lenus COPD Service is clinically evidenced technology that combines data from patient-reported outcomes, medical and wearable devices, and electronic patient record data.
Patient health information is aggregated in a cloud-based clinical dashboard, where clinicians are presented with visualisations to better understand the likelihood of an exacerbation, allowing them to provide early intervention and prevent unnecessary hospital admissions.
The introduction of clinically actionable, AI derived, risk prediction scores, that are being trialled as part of a NHS Artificial Intelligence in Health and Care Award, will further help reorientate the management of COPD patients to a proactive and preventative model.
Perhaps in 50 years we might look back at how care teams work today and be shocked at how few digital biomarkers were available to them compared to their more modern contemporaries and how much of the information gathering work of clinicians can be achieved using machines and automation.
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