Further information: interventions to improve the knowledge, skills and confidence of patients to ma

A range of approaches are available to support patients to better manage their health conditions. These are typically on a spectrum with some being more likely to improve patient confidence than others (Box 3). They can be split into two broad categories: the first supports patients to improve their knowledge, skills and confidence, while the second recognises that people’s ability to manage their health conditions will always be varied and tailors health services to meet these different levels of need.

Examples include:

Health coaching

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A trained health coach uses techniques such as reflective listening and motivational interviewing to support patients in face-to-face sessions or remotely. Coaches help patients to set health goals, such as remembering to take their medication on time or something more personal, such as walking to the shops or playing with their grandchild in the park. They then work with patients to achieve these goals, breaking them down into manageable, achievable steps. Coaching allows patients to identify their own strengths and assets, to access local support groups like gardening clubs and to adopt the most appropriate approach to managing their condition.

Health coaching is being trialled in a number of places in the NHS and has been included as part of the NHS Innovation Accelerator (NIA) programme. For example, in Horsham and Mid Sussex, and Crawley CCGs, health coaching is targeted towards patients at risk of experiencing emergency admission or requiring high levels of GP care or other NHS services. The coaching programme begins with the PAM questionnaire and is being delivered in partnership with GP practices, which help to refer patients to the service.

Evidence

There is some evidence from randomised control trials and systematic reviews that health coaching can be a successful approach to improving the management of long-term conditions., There is a need for studies regarding the impact of health coaching in the NHS, as these will help practitioners to design, implement and continually improve these services for patients.

Online communities

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Peer support can help people living with long-term conditions to keep healthy and online communities are increasingly becoming an important place to tap into it. Much like a disease-specific, face-to-face support group, an online community facilitates groups of people with the same long-term condition to connect, share stories and support each other. While it’s not a core aim, these virtual communities could potentially improve the ability of patients to manage their own health conditions (and so might help reduce emergency admissions).

One example is the online community HealthUnlocked, which has been supported by the NIA. HealthUnlocked hosts forums for a variety of health conditions, through which people can connect and share information. It collects a patient’s PAM score so it can tailor their advice and support, and provides resources from a range of partner organisations, including patient advocacy, charity and public sector organisations. These organisations also moderate online interaction and the advice shared.

Evidence

The evidence base for the effectiveness of online communities is still developing, with few studies published to date. More studies have examined the impact of peer support methods delivered face-to-face rather than online. This evidence is mixed, particularly for outcomes such as hospital admissions and readmissions, and whether peer support reduces length of stay.

Apps and online tools

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New developments in apps and online management tools might also help patients to improve their ability to manage their own health. The following are two examples of apps and online tools:

  • myCOPD – a Health Foundation-funded resource for patients with COPD, providing information about the condition and a way for patients to monitor their symptoms online.
  • Flo – a personalised text message system that helps patients with a variety of conditions monitor aspects of their health, and adopt and maintain healthy behaviours. Flo was originally funded by the Health Foundation and is now used by 70 health and social care organisations across the UK, with 33,000 patients registered.

Evidence

While there have been numerous evaluations of e-health interventions like Flo and myCOPD, these have often been focused only on small groups of patients. Larger evaluations of similar interventions have found conflicting evidence of reductions in emergency admissions. For example, the Whole Systems Demonstrator evaluated an older version of e-health that involved patients using technology to monitor aspects of their health and relay the information to health practitioners working remotely (telehealth). Although this trial concluded that those with long-term conditions receiving the intervention were admitted to hospital as an emergency 19% less frequently than control patients receiving usual care, there were significant concerns about the validity of the control group. Other studies using different methods have not found that these interventions were associated with lower rates of emergency admissions than usual care.

While the effectiveness of e-health and telehealth interventions has been found to vary, systematic reviews have found that they are more likely to be effective if they engage patients and include an element that is about supporting individuals to manage their own health conditions.

Tailoring services to the patient

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The second broad approach is based on the recognition that not everyone is able to manage their health conditions confidently and therefore the NHS could deliver health care that is tailored to varying needs. This approach may improve the quality of care that patients receive, even if it does not improve patients’ ability to manage their own health conditions.

In some areas of England, NHS teams measure the ability of their patients to manage their health conditions, so that care can be tailored. Indeed, the NHS has invested in PAM, which is being rolled out to 100 sites and made available to 750,000 patients. Examples of how PAM could be used to target interventions include:

  • Patients who have lower levels of ability to manage their own health conditions could be prioritised to have additional time with skilled and trained team members. This additional contact time might focus on developing skills and knowledge while setting manageable goals.
  • Meanwhile, patients who are more able to manage their own health conditions could be provided with information to help them manage their condition as part of a care plan. This might include signposting to electronic resources.

Evidence

In a project funded by the Health Foundation in South Tyneside, First Contact Clinical used PAM to tailor the care received by patients with COPD. Patients were offered varying levels of psycho-social interventions, with patients with the lowest PAM scores receiving the most intensive intervention.

These interventions included sessions with a trainee health psychologist or self-care practitioner, receiving information from a social-prescribing navigator, and receiving support from a community-based peer support group. The evaluation of 410 patients reported a positive impact on patients, including increased PAM scores and a reduction in GP visits. However, this evaluation was a before-and-after study with no control group, which can be susceptible to regression to the mean. A recent randomised control trial of a similar intervention found that while there was no impact on the participant’s PAM score or quality of life, patients receiving coaching used health care less often than patients receiving usual care. Overall, health coaching was found to be cost effective in that trial.

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