Post on 16-Apr-2017
transcript
Barnsley Care Navigation /
Telehealth Service
Paul Hughes – Care Navigation / Telehealth
Service Lead
The Care Navigation / Telehealth Service
■ Telephonic Service
■ Patients diagnosed with Long Term Conditions
■ Promote Self Care
■ Promote Positive Behaviour Change
■ Support Front Line NHS Clinical Services
■ Skill mix within service of both qualified clinicians
(Nurse Care Navigators) and non qualified support
(Clinical Support Officers)
■ Staff trained in the deployment of Motivational
Interviewing
What does the Care Navigation /
Telehealth Service do?
Information Signpost Advocate Empower/
build skills
Care Navigation
Telemonitoring Health Coaching Post Crisis Support
Elements of Service provided by
the Care Navigation / Telehealth
Service Interchangeable and mutually supportive
Barnsley Care Navigation / Telehealth
Service
Care Navigation / Health Coaching
Pathways
Care Navigation / Health Coaching
Pathways
Nurse Care
Navigator works with
patient to identify
the appropriate
pathway to follow
Patient does
not identify
areas to change
Patient does
identify areas
to change
Care
Navigation
Health
Coaching
6 calls
12 weeks
6 calls
5 months
Barnsley Care Navigation / Telehealth
Service – Initial Outcomes
Potential benefits for the patient
Improved
understanding
of their illness
and raises
awareness of
useful services
Encourage
behaviour
change & self
care
Assists with the
reduction of
patient anxiety
Improved
patient
experience
Potential benefits for the NHS providers &
Commissioners
Potential
reduction in
hospital re-
admissions &
length of stay.
Ability to
prioritise
clinician
visiting
schedules
according to
need.
Ability to
potentially
reduce demand
on GP services.
Assists with the
management of
the increasing
prevalence of
LTC’s by
enabling
Specialist
Nurses to hold
larger clinical
caseloads
Results of Service Evaluation
(Bassetlaw CCG Area) Approximate 40% reduction in GP attendances of those
accessing Care Navigation / Health Coaching pathways.
Approximate 64% reduction in community nursing
emergency face to face contacts for those patients
accessing Care Navigation / Health Coaching.
Above data is based on a sample period of 6 months pre
and 6 months post service intervention.
Barnsley Care Navigation / Telehealth
Service – Referral Criteria
Care Navigation / Health Coaching Referral Criteria
Those diagnosed with a Long Term Condition who are:
– Over 18 years.
– Registered with GP within the Barnsley borough or resident.
– Need more information about their condition in order to become more self managing.
Why Refer?
Patient needs:
– More information about local services, self help programmes, financial services, social services etc, to meet their individual needs.
– help / support in accessing services (advocacy).
– regular telephonic support to comply with advice/treatment.
– help with motivation and confidence.
– help to change behaviour.
Service Contact Details / Hours of Operation
Barnsley Care Navigation / Telehealth Service
c/o Ward 2
Mount Vernon Hospital
Mount Vernon Road
Barnsley S70 4DP
Tel. 0800 612 1976 Email: carenavigators@nhs.net Web site: www.takecontrolbarnsley.co.uk Service operational: 7 days per week, 9.00 a.m. to 5.00 p.m.
Barnsley Care Navigation /
Telehealth Service – Patient Stories