Good health is a life-long process. Many of the most critical behaviours are established in early childhood and need reinforcing at each life stage. The health of the British population sadly lags that of most other developed countries and is beset by disparities among racial/ethnic groups and the socially disadvantaged. Recognition that this problem cannot be solved by better and more accessible medical care alone has led to the increase of interest amongst government and commissioners in population health and its underlying determinants: behaviours and social and environmental conditions.
Yet the NHS’s approach to health largely remains rooted in a decades-old ethos of treating the symptom, rather than the person. From obesity, diabetes, COPD and smoking cessation, healthcare organisations still tend to commission specific services, rather than taking an integrated approach that identifies and addresses an individual’s wider determinants of health.
Alison Meadows, CEO, Priority Digital Health, outlines how a facilitative, digital solutions platform, that can integrate multiple health and wellbeing services and connect clinical data to provide deep, meaningful and actionable insight, combined with patient engagement services, is the way forward if ICSs are to successfully address population health.
Wrong Direction
The UK population is becoming increasingly less healthy. Obese people will outnumber those with a healthy weight within five years. It is predicted that 5.5 million people will have diabetes in the UK by 2030. Diagnosis of Chronic Obstructive Pulmonary Disease COPD has increased by 27% in the last decade to 1.2 million people.
For Integrated Care Systems (ICS) it is now essential to put in place solutions that address this population health crisis. Prevention strategies have been on the agenda for more than a decade but, to date, have failed to deliver. The burden falls heavily on primary care services and, given the current GP crisis, there is growing consensus that the focus on increasing the number of appointments available is the wrong approach.
With limited GP numbers, there is only one way to increase the number of annual appointments by 50 million – reduce appointment length. And that, by default, will reinforce GPs’ requests for patients to only raise one health concern per appointment, an approach that completely flies in the face of accepted wisdom regarding comorbidities and preventative care.
Personal Time
An obese individual requires more than a one off referral to weight management. Are they also pre-diabetic and require access to a dietician with diabetes expertise? Are they also depressed? What, indeed, is the underlying cause of the obesity? With growing evidence that chemical pollution is a significant contributor to obesity, an ICS’s specific environmental factors will increasingly influence obesity understanding.
The recent news that nearly one million patients with insomnia will be prescribed a £45 self-help app instead of sleeping pills on the NHS underlines the problem facing GPs. While this six week digital therapy programme is the first line treatment, it provides GPs with no opportunities to address any underlying cause of the insomnia. From perimenopause to sleep apnoea – which is also linked to Type 2 diabetes – treating the patient, rather than the individual symptoms, is clearly far more effective. But, as GPs increasingly insist, there is not enough time.
Preventative Care
Rapid access to GPs with more, shorter appointments will work for those requiring occasional support. But with 40% of GP appointments in England consisting of ‘frequent attenders’, the elderly and those with multiple, complex conditions, it is the addition of time and personal, preventative care that will make the biggest difference. Instead, these individuals are compelled to book appointment after appointment to discuss each of their conditions – a process that is hugely inefficient for GPs, massively frustrating for patients and devastating for patient outcomes.
A better, joined up approach would not only reduce the burden on GPs but also improve patient outcomes. So how can it be achieved? Some of the foundations are in place. The ICS model is positive, bringing together diverse providers of both clinical and social care to support individuals with complex needs, tackle inequalities in outcome, experiences and access, and improve outcomes in population health and healthcare.
Furthermore, the investment in digital health over the past decade has demonstrated the power of information and tools to transform care. Patients are being empowered with apps to record their blood pressure or track their insulin levels. They are being provided with access to dedicated specialist services, such as weight loss and diabetes management. Right now, however, these services are still commissioned separately and each patient condition is managed separately. There is no holistic, joined up information and, as a result, no holistic, joined up care.
Joined Up Population Health Model
The ICS concept is excellent but it is vital to break down the siloes between services and truly understand how the population needs to better interact with the system as a whole. Just as hospital trusts have well established multi-disciplinary teams that work together to find the best holistic solution for each patient, ICSs require a single case management system that captures all patient interactions with these primary care services. Effectively, a single patient record and single patient view accessible to multiple services that enables engagement in a similarly holistic way.
At an individual patient level, the complete overview ensures clinicians are made aware of any individual requiring specific support. Plus, rather than being compelled to manage multiple apps and services and repeating the same information time and again, patients can be offered just one, integrated solution supporting self-management, education and access to experts across all their conditions and medical needs.
At a strategic ICS level, the ability to capture and analyse all patient interactions with these services will enable a better understanding of the community. With insight into population health provided by exploring the overlap in conditions, the influencing factors for obesity, for example, ICSs can create best practice in supporting effective change that reflects their broader social and care remit. How can the ICS nudge behavioural change and encourage the use of relevant services to improve patient outcomes and encourage self-care? The opportunities to use digital to transform health are within reach – but only if ICSs have a complete, end to end understanding.
Conclusion
Digital solutions have proven their value to the NHS but by applying digital tools to outdated models, they are also creating barriers between services that are adding complexity and cost, while undermining the patient experience. Pulling together essential insight and service provision into a single, joined up solution will reduce the number of interactions required by patients and ensure the interaction is more personal, targeted and beneficial. It will remove the revolving door of patients for clinicians and provide the information required to quickly deliver the education, support and care each individual needs.
It is time to elevate the conversation around digital health. Forget about individual service solutions. Stop thinking about symptoms. Focus on delivering a complete population health solution. With a single platform and patient facing app that support diverse patient needs, the process is more efficient, relevant, targeted and, from a clinician perspective, valuable.
ICSs need an integrated digital solution. It is time to stop talking service; and talk about people.