Comments

1. 

   Charlie Sharp 22 Jul 2019

   This is a great idea.  One thought - a major hurdle to PR is patient uptake prior to attending for the course assessment.  Might this be a resource to use in primary care (or secondary care) to encourage patients to take up referral?

   Often there is resistance to the idea and this could improve referral rates by that means.

   Apologies is this is something you have considered and trialled previously.

   1. 

      Steven Ariss 29 Jul 2019

      Hi Charlie, sorry for the delay, and thanks very much for your interest in the idea.

      I completely agree that the video intervention has a number of possible uses in various settings, and this upstream application will be very interesting to explore further. The possibility of usefulness in various settings was a driver for the development of the shorter video, which can be used more flexibly, depending on local needs and particular organisational environments. Hopefully, if we are funded, we will be able to look into this in more detail.

       

      Thanks again.

2. 

   Matthew Halkes 11 Jul 2019

   Dear Steven, Dimple and Tony,

   Your comments exactly mirror our experience of using video here in Torbay and South Devon. They have potential impact and benefit along the entire clinical pathway:

   • Prevention: supporting healthy choices
   • Self care: Enabling management of minor issues independently
   • Health navigation: Helping identify services that can support patients and carers and how to access them. This isn't restricted to NHS and can include peer support / voluntary sector etc. It is also important that expectations are managed in terms of what the service may provide and what the patients input will be. (This is what I see your video is trying to achieve Steven and like you its as much about educating the referring staff as the patients).
   • Effective consultation / Shared Decision Making / Consent: All facilitated by providing digital information (ideally beforehand) with some initial evidence that this can focus the consultation of the personal news of that patient, save time and increase satisfaction.
   • Preparing for and recovering from therapeutic interventions: These maybe medical eg understanding drug therapies to increase compliance or surgical procedures. We have shown decreased demand on MSK services post shoulder surgery by providing patients with videos describing the exercises they need to undertake / removal of need for follow up appointments post nail surgery (patient does the dressing change themselves)
   • Avoiding the need for admission / enhancing discharge: Through avoiding crisis by better understanding their condition and / or enhanced compliance. Saving time in discharge processes by basic information being provided through video enabling a more personalised discharge discussion (and information readily available for ongoing reference)

   The latter touches on Dimple's point re driving people into a service that then struggles to cope. This can be offset by the efficiencies gained / capacity generated by implementing the other steps above. For example our cardiology team have had 25% uptake of video based preparation for angiography and those that do come in have a group session where the video is played followed by Q+A. In combination this has saved significant staff time. Our Healthy Lifestyles team have added a completely digital offer (app based videos) for diabetes and weight management to enable them to reach more patients with the same resource.

   Interestingly we have just been approached by our CCG re trialing video based pulmonary rehabilitation - so another point of overlap. myCOPD is also being used in Devon (to some extent). The work the CCG wants to undertake isn't a comparison of one vs other, but more wanting to understand the impact of each approach and where the best fit is for each approach. Feels like a lot of potential for collaboration here.

   Many thanks

    

   1. 

      Steven Ariss 11 Jul 2019

      Hi Matthew,

      thanks for your comments and sharing your experiences. There are some very interesting points and observations. I like the consideration that efficiency savings can offset increased uptake of services. This whole-system approach and finding balance across the pathway to reach more people, more effectively is very important to bear in mind.

      This connects to your final point about not comparing one approach to another but finding the best fit. I'm so pleased to see that the CCG are embracing this approach to evaluation, which aligns with my interests in evaluation of complex interventions and finding what works, for whom, in what circumstances and in what ways.

      Definitely lots of potential for collaboration and shared learning.

      Thanks.

3. 

   Dimple Keen 7 Jul 2019

   Hi Steven,

    

   Such an important initiative; access to PR has many proven benefits for patients.

    

   One 'challenge' I'd like to raise - assuming the videos meet one of their goals and raise awareness of PR and increase referrals into the service - is the service set up to cope with the increasing volume? I've heard of extremely long waiting lists in some areas and this infrastructure needs to be able to manage the demand to help patients get the best out of pr. I'm sure you've thought of this but possibly worth highlighting in your proposal?

   I came across another proposal about a framework for evaluating videos. It's a slightly different angle and focuses on the questions patients may have pre clinic, but I wondered if it might helpful to connect you both to share learning?

    

    

   https://q.health.org.uk/idea/2019/impact-evaluation-framework-for-patient-information-videos/

   Good luck with the bid.

   Thanks

   Dimple

   1. 

      Steven Ariss 8 Jul 2019

      Thanks Dimple,

      this is an important concern that deserves a mention in the proposal. I recently evaluated a falls risk assessment project, which overloaded the local falls prevention team, so am very familiar with the issues.

      One of the main problems is lack of completion of the course (possibly due to patients not knowing what to expect when they arrive), so courses are run with spare capacity. However, increased numbers would also be an expected outcome.

      I've had a look at the other video project, and it seems that there are lots of potential applications and potential to collaborate on evaluation methods.

      Thanks!

4. 

   Tony Jamieson 5 Jul 2019

   Hi,

   I like this project. Y&H AHSN has a project in development on Personalisation of care in Respiratory disease and your work could well inform that.

   Do you already use MyCOPD?

   Tony

   1. 

      Steven Ariss 8 Jul 2019

      Hi Tony,

      it would be good to have a chat about how this might fit in with other AHSN work on respiratory disease.

      Linking up with MyCOPD, especially for people that are more suited to or prefer a more self-directed approach to their rehab is a great idea!

      Thanks.

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