April 3, 2018

DIGITAL HEALTH IN PRIMARY CARE

Patient Groups Contribute to Regulation For Digital Health in Primary Care

Have you seen the latest report into digital health primary care/General Practitioner health services by the UK Care Quality Commission? It suggests that although quality of care is improving, there are still significant hurdles to overcome including:

Significant safety concerns
Lack of integration between the private eHealth providers and the patient’s state National Health Service General Practitioner
Lack of accountability and enforcement when a eHealth service provider is based in one country but delivers care in another country.

As part of the annual review, patient groups were asked to contribute their views.

Patient group views

The Care Quality Commission gathered a range of views on using digital health in primary care from major patient groups:

Age UK raised the concern that “take-up of such services is likely to be very low” and expressed concern about “the scope of services in the context of older people or patients with complex needs.”
Mental health patient organisation, Mind, highlighted the importance of signposting “patients to other sources of information and support, including to relevant mental health organisations”
The Men’s Health Forum felt that “Providing care online may increase the likelihood of men seeking help as it is easier, quicker and more discreet to do so.”

Ensuring safety

Reports from the Care Quality Commission have in the past been pretty stark about deviations from patient safety procedures. Although we have moved from the recent position from where 86% of providers checked violated safety procedures, this has now dropped to 43%.

That represents a significant improvement. Clearly with nearly half of providers failing the safety thresholds, there is a need for urgent improvement.

Safety issues cited in the report included:

Inappropriate prescribing, for example of antibiotics, or medications for long-term conditions
Failing to monitor medication use, for example the number of asthma inhalers required by individuals
Failing to take satisfactory measures to safeguard children and other patients who may not have the “mental capacity to understand or consent to a consultation”.

Historically, the position of some of the eHealth providers is that they are being measured against criteria better suited for bricks than clicks. Following on, the new measurement protocols are needed for digital health services.

In fact, the providers scored generally well on two measures:

97% met regulations about being caring
90% met regulations about being responsive, including accessibility and languages.

Disconnected health

The report also revealed a lack of communication between the eHealth service and the patient’s main National Health Service General Practitioner. For example, this lack of coordination can have an impact on prescribing decisions and continuity of care.

Accountability and enforceability

The Commission also identified the challenging regulatory area, familiar to the app arena, where a service provider is based outside the country of use.

The report highlights the implications for patients:

“This means services that are available in England but based outside England may be unregulated.” Care Quality Commission

Looking to the future

The demographic and budgetary pressures mean that in most countries using digital health to support primary care services is inevitable and vital. From a UK perspective, there is already a pressing shortage of GPs. More are heading for retirement, and access to a GP can be challenging in many areas.

Digital primary care will play an important role as acknowledged by the Care Quality Commission:

“This way of delivering primary care has an important place in the future of health provision. It is still evolving. We must all work together…to ensure that this model fulfils its promise of accessible, responsive care while ensuring that the care delivered is always safe and high quality”. Professor Steve Field, Chief Inspector of General Practice at the UK Care Quality Commission.

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