A clinical health coaching programme for patients with long term health conditions commissioned by Parker Drive Practice & Manor Medical Centre, Leicester City CCG, has shown dramatic results in clinical improvements in patient care, quality improvements and activity reduction for the NHS. Interim results from the project, which launched in September 2015, are impressive with an evaluation of the GP practice showing a 100% reduction in attendances at A & E, an 80% reduction in Home Visits and a 57% reduction in attendances at Out of Hours.
A large GP practice spread over 2 geographical locations with different demographic populations commissioned a Clinical Health Coaching service from specialists Totally Health to patients registered with Parker Drive GP practice and their branch practice Manor Medical Centre. 68 patients with long term health conditions including chronic obstructive pulmonary disease (COPD), diabetes and heart failure, were recruited within the two practices, with patients aged between 61-70. The Totally Health clinical team undertook a review of clinical records for the period and condition within the service and the comparative period prior to the service starting.
The aims of the GP Practice were to provide additional support for their patients with these chronic diseases, reduce number of Out of Hours and A&E attendances and reduce the number of unplanned hospitals admissions. Overall results included a:
• 50% reduction in unplanned admissions
• 47% reduction in secondary care out-patient appointments
• 39% reduction in contacts with all health professionals in local services
• 30% reduction in GP/Practice Nurse appointments
• 22% reduction in community healthcare appointments
Ensuring patients that patients were better educated about their condition and had a greater insight into the access to specialist medical support was a key part of the work and patient improvementsfrom the project included:
Result - 95% of patients showed an improvement in latest HbA1C results
Impact - Diabetes patients had an increased understanding and control of their disease. Reducing (improving) the HbA1C results reduces the risk of complications, admissions and progression of the disease.
Result - 95% increase in the number of ‘Medication Rescue Packs’ prescribed
Impact - Patients are now more proactive with exacerbation medication, resulting in disease complication prevention.
Result - 47% increase in the number of patients with a documented Long Term Condition (LTC) review
Impact - More patients have a proactive management plan meeting their current needs
Result - 44% Increase in Flu vaccine for patients who prior to enrolment had not had a flu vaccination
Impact - More patients are protected from the risk of flu that could exacerbate their condition
Result - 23% Increase in Podiatry and Retinal Screening
Impact - Patients became more aware of the importance of screening and the impact on their diabetes. Patients understood that these appointments improve the chance of spotting complications early and help to prevent serious complex complications with diabetes, e.g. amputation and blindness
Dawn Denison, Clinical Programme Analyst, Leicester City Clinical Commissioning Group comments, “Totally Health’s clinical health coaching has given us some great results for our patients,including increasing patient satisfaction, confidence, motivation and compliance, as well as having a positive impact on the practice by improving interaction with available health services and reducingthe time and cost impact on resources.
“We’re especially pleased to see the improvement in HbA1C and increase in the amount of Rescue Pack Prescriptions. This highlights for us a much greater understanding and willingness from patients to commit to and progress with their self-management.”
Lead GP at Manor Medical Practice in Leicester, Dr Jawahar expands, “The evaluation report clearly demonstrates the effectiveness of clinical health coaching. It enables patients with long term conditions to be a major partner in managing their condition very effectively and helps the NHS to achieve valuable healthcare outcomes.”
Emma Jane Roberts, Chief Operating Officer at Totally Health adds, “Our Clinical Health Coaching services aim to help individuals make positive changes in their lives, which address long term health conditions and wider wellness issues. Patients with long term health conditions who struggle to manage their condition can often find it difficult to navigate the healthcare system, putting pressure on time and resources by over-using services such as A&E. We provide tailored one-to-one clinical health coaching to enable patients to gain the knowledge, skills and confidence to become active participants in their own health and healthcare, reducing their reliance on both primary and secondary healthcare services.”
The Totally Health model is proven to complement and support existing health care pathways. It delivers lasting changes for patients, more effective condition management, better compliance with treatment and an improved interaction with available health services.