Coronavirus (COVID-19): remote care through telehealth

Special Collection: Coronavirus (COVID-19): remote care through telehealth
Cochrane Library updated 10 August 2020

• This Special Collection includes Cochrane Reviews that address using telehealth to support clinical management of various conditions, including asthma, diabetes, cardiovascular disease, dementia, reproductive health, and skin cancer. It includes reviews of using telehealth to provide carer and parent support as well as empowering patient self-management of their long-term conditions.

Technology and innovation for long-term health conditions

Technology and innovation for long-term health conditions
Kings Fund 3 August 2020

• This paper, commissioned by the Academic Health Science Network, looks at four digital innovations in health services from the UK and the Nordic countries: the TeleCare North programme, which provides remote treatment for people with chronic obstructive pulmonary disease (COPD); the Patients Know Best portal and electronic health record; remote diabetes monitoring for children at Helsinki University Hospital; and the Huoleti app that connects patients with a support network.
• The case studies illustrate the potential of digital technology to transform care, particularly through empowering patients, supporting stronger therapeutic relationships and effective teamworking across professional boundaries, and creating networks and communities to support patients.

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
The Lancet 31 July 2020 DOI:https://doi.org/10.1016/S0140-6736(20)30367-6

• A growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. This report adds three more risk factors for dementia: excessive alcohol consumption, traumatic brain injury, and air pollution. 
• Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.

COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

COVID-19 and Dementia: Factors affecting patient outcomes and experience along the dementia pathway

Wessex Clinical Senate July 2020

• Recent webinars have brought clinicians, service managers and commissioners together to consider factors affecting the dementia pathway in a Covid environment. This document aims to give an overview of factors identified that affect the pathway.

Asthma patients with a history of opioid use have worse outcomes

Asthma patients with a history of opioid use have worse outcomes
NIHR Evidence Alert 16 July 2020

• A study of 275,151 asthma patients analysed asthma outcomes among past or present opioid use disorders (OUD) patients. Over a 12 month period, those with current or past OUD:
• were less likely to attend an annual asthma review
• were more likely to have received three or more prescriptions for an inhaler containing corticosteroids (inhaled corticosteroids, ICS) as preventer therapy
• were more likely to have been prescribed oral prednisolone, which can be used as a marker for asthma attacks
• were more likely to have been diagnosed with the common long-term lung disease, chronic obstructive pulmonary disorder (COPD), which also describes long term breathing difficulties.
• This study raises the challenge of how self-supported care, as presented in UK guidelines, can be provided for people with a history of OUDs. 

See: A primary care database study of asthma among patients with and without opioid use disorders. npj Primary Care Respiratory Medicine 2020; 30:17

Association between prediabetes and risk of all cause mortality and cardiovascular disease

Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis
BMJ 2020; 370:m2297 doi: https://doi.org/10.1136/bmj.m2297 (Published 15 July 2020)

• Analysis of 129 studies (n=10 069 955 median follow-up time of 9.8 years) found that in the general population prediabetes was associated with an increased risk of all cause mortality, composite cardiovascular disease, coronary heart disease, and stroke.

Abstract

The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study

The Impact of Cardiovascular Disease and Chronic Kidney Disease on Life Expectancy and Direct Medical Cost in a 10-Year Diabetes Cohort Study
Diabetes Care 2020 Aug; 43(8): 1750-1758. https://doi.org/10.2337/dc19-2137

• A retrospective cohort study [Hong King?] of adults with diabetes [n=208,792] concludes that the effects of heart diseases, stroke, CKD, and the combination of these conditions on all-cause mortality on adults with diabetes are independent and cumulative.

Atrial Fibrillation Toolkit

Atrial Fibrillation Toolkit
AHSN Network July 2020

• Methodologies, resources and support for commissioners and clinicians working to reduce AF related strokes.

Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study

Global, regional, and national estimates of the population at increased risk of severe COVID-19 due to underlying health conditions in 2020: a modelling study
Lancet Global Health 15 June 2020. https://doi.org/10.1016/S2214-109X(20)30264-3

• Analysis of prevalence data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 and UN population estimates for 2020 shows that about one in five individuals worldwide could be at increased risk of severe COVID-19, should they become infected, due to underlying health conditions, but this risk varies considerably by age. The estimates are uncertain, and focus on underlying conditions rather than other risk factors such as ethnicity, socioeconomic deprivation, and obesity, but provide a starting point for considering the number of individuals that might need to be shielded or vaccinated as the global pandemic unfolds.
• Figure 3: Proportion of population at increased risk and high risk of severe COVID-19 by country and region.

Summary

Long-term condition support - tools and resources

Long-term condition support - tools and resources
UCL  9 June 2020

• This site contains tools and resources designed to enable primary care teams to continue to effectively manage patients with long-term conditions. Includes:
• Search and risk stratification tools that can be used with EMIS (and SystmOne to follow), accompanied by user guidance.
• Education and training resources including protocols, guidance, videos and virtual training sessions to upskill the breadth of primary care team members to proactively support patients.
• Digital tools - A selection of a clinically appraised digital tools to support patient activation and self-management in the home setting.
• See blog Support for long-term condition management during and after COVID-19 

Remote Patient Monitoring Technologies for Predicting COPD Exacerbations: Review and Comparison.

Remote Patient Monitoring Technologies for Predicting Chronic Obstructive Pulmonary Disease Exacerbations: Review and Comparison.
JMIR Mhealth Uhealth 2020;8(5):e16147

• A list of handheld and hands-free commercially available remote patient monitoring (RPM) tools which focused on predicting COPD exacerbations were identified. They were assessed based on forecasting ability, cost, ease of use, and appearance. Devices that ranked higher on all criteria tended to have a high or unlisted price. Commonly mass-marketed devices like the pulse oximeter and spirometer fulfilled the least criteria.

Abstract

Development and validation of the DIabetes Severity SCOre (DISSCO)

Development and validation of the DIabetes Severity SCOre (DISSCO) in 139 626 individuals with type 2 diabetes: a retrospective cohort study
BMJ Open Diabetes Research and Care 2020;8:e000962. doi: 10.1136/bmjdrc-2019-000962

• A new severity scoring system for type 2 diabetes may be better at identifying patients at risk of declining health than the current commonly used blood test. The Diabetes Severity Score (DISSCO) is a computer algorithm that combines information routinely collected in primary care. Researchers found that a higher DISSCO score was linked to an increased risk of hospital admission or death.
• DISSCO combines information on 34 indicators of the severity of the disease, which are routinely coded in electronic health records. It would be possible to develop an electronic version of DISSCO for primary care. This could support doctors in providing more tailored interventions for their patients.

Plain English summary here: New tool for assessing the severity of type 2 diabetes could help personalise treatment and improve outcomes

Abstract

Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases

Effectiveness of Mobile Applications on Medication Adherence in Adults with Chronic Diseases: A Systematic Review and Meta-Analysis
Journal of Managed Care & Specialty Pharmacy April 2020;26(4):550-61. DOI 10.18553/jmcp.2020.26.4.550

• A systematic review of the literature identified 14 studies which measured the effect of mobile apps on medication adherence in adults with chronic diseases involving 1,785 participants. The meta-analysis showed that the use of mobile apps was associated with a significant improvement in patient adherence to medication (Cohen’s d=0.40, 95% CI=0.27-0.52; P<0.001), but the studies were of low level of evidence and short intervention duration.

Undiagnosed dementia in primary care: a record linkage study

Undiagnosed dementia in primary care: a record linkage study.
Health Serv Deliv Res 2020;8(20) April 2020

• Extrapolation of analysis of the medical records of patients (n=449) with dementia suggests that
•  in 2011–13 around 43% of people living with dementia had a recorded diagnosis, an increase from 35% in 2008–11. 
• People with more severe dementia, in particular those with worse memory, were more likely to be diagnosed. 
• On average, people lived with dementia for 3.5 years before their diagnosis. 
• Being diagnosed did not help people to live longer or stay out of care homes; 
• there was not enough reliable information to estimate how aspects of life such as anxiety or social activity were affected.

Abstract

COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study

COVID-19 – exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study [preprint, accessed 29 April 2020)
Wellcome Open Res 2020, 5:75, 23 April 2020

• An estimate Years of Life Lost (YLL) attributable to COVID-19, before and after adjustment for number/type of LTCs.
• Conclusion: Deaths from COVID-19 represent a substantial burden in terms of per-person YLL, more than a decade, even after adjusting for the typical number and type of LTCs found in people dying of COVID-19. The extent of multimorbidity heavily influences the estimated YLL at a given age. More comprehensive and standardised collection of data on LTCs is needed to better understand and quantify the global burden of COVID-19 and to guide policy-making and interventions.

Abstract

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia

Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia – A systematic review, meta-analysis, and meta-regression
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 17 April 2020, v14(4) p395-403

• Diabetes was associated with mortality, severity, and acute respiratory distress syndrome in Coronavirus Disease 2019. The association between diabetes and poor outcome was greater in studies with younger and less hypertensive patients. Gender, cardiovascular diseases, and pulmonary disease did not influence the association between diabetes and poor outcome.

Evaluation of the Electronic Asthma Management System: A Point-Of-Care Computerized Clinical Decision Support System

A System Uptake Analysis and GUIDES Checklist Evaluation of the Electronic Asthma Management System: A Point-Of-Care Computerized Clinical Decision Support System
J Am Med Inform Assoc 10 April 2020;ocaa019. doi: 10.1093/jamia/ocaa019

• Test of Electronic Asthma Management System (eAMS)-an electronic medical record system-integrated, point-of-care CCDSS for asthma in 3 Canadian primary care sites over 1 year.
• Factors affecting uptake include varying workflows and cultures across clinics, physician beliefs regarding asthma diagnosis, and relevance of the clinical complaint influenced uptake.

Abstract

Adult Asthma Audit Report 2019

Adult Asthma Audit Report 2019
HQIP 13 December 2019

• Data describing the cohort of patients admitted to hospital in England, Scotland and Wales with asthma attacks that arrived at hospital on or after 1 November 2018, who were admitted to adult services and were discharged by 31 March 2019. Data includes age and sex and smoking history.

National Diabetes Audit - Report 2 Complications and Mortality, 2017-18

National Diabetes Audit - Report 2 Complications and Mortality, 2017-18
NHS Digital 13 December 2019

• The National Diabetes Audit (NDA) is part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). 
• Report 2a covers complications and mortality associated with diabetes (excluding diabetic eye disease or hypoglycaemia). 
• Report 2b investigates associations between patient characteristics and adverse outcomes and includes:
• 1. Outcomes and characteristics
• 2. Identifying the most significant associations
• 3. What might be the impact of changes in lifestyle and treatment targets?
• 4. Variation by CCG
• 5. Severe Mental Illness (SMI) and outcomes
• 6. Learning Disability (LD) and outcomes

Digital health interventions and inequalities

Digital health interventions and inequalities: the case for a new paradigm
BMJ Evidence-Based Medicine 21 November 2019. doi: 10.1136/bmjebm-2019-111282

• A discussion of the potential of digital health interventions in CVD and diabetes mellitus to worsen existing health inequalities.