New virtual home care trial for chronic conditions

A new digital health project, safe@home, led by Flinders University, aims to provide affordable and effective primary care services to people living with chronic diseases in low socio-economic neighbourhoods.

The $1 million project hopes to make virtual care and telemonitoring more efficient and accessible to reduce emergency department and hospital admissions, GP clinic waiting times and ambulance ramping.

“With the unrelenting pressure on our healthcare system, and aging population, we will be focusing on creating a robust primary care framework for people living with high needs, such as heart failure, diabetes, hypertension and chronic obstructive pulmonary disease (COPD),” said Robyn Clark, Chief Investigator — Caring Futures Institute and Flinders University Professor from the College of Nursing and Health Science.

Clark will work with key public health groups across the Adelaide metropolitan area on the initiative with funding from an almost $1.1 million National Health and Medical Research Council (NHMRC) Partnership Project.

SA Health and other agency involvement includes the Northern Adelaide Local Health Network, the Adelaide Primary Health Network, Australian Telehealth Society, Digital Health SA and Integrated Cardiovascular Clinical Network SA.

“Along with providing quality care in the home setting, we aim to improve the everyday quality of life for these patients by giving them more regular health checks and access to professional help,” said Clark, a Professor of Acute Care in Cardiovascular Research with the Caring Futures Institute at Flinders University.

“Even more than this monitoring, it is the clinical decisions and actions taken based on information obtained by monitoring that will alter patient wellbeing and outcomes.”

Dr John Maddison, the Executive Director of Medical Services at the Northern Adelaide Local Health Network, said, “Embracing technology and linking general practice with hospital care is the best way to keep our patients safe at home, which is better for patients and also helps take the pressure off our emergency departments.”

The new project will engage and train clinicians across disciplines (doctors, nurses and allied health) in both hospital and primary care to create a new digital health workforce.

Home telemonitoring and virtual care will involve consumers in their model of care and give them incentive to increase their self-care and self-monitoring to manage their conditions.

It will also be used to develop a business model using routine Medicare item numbers for primary care and a framework for scaling into routine care, including refinement of the interfaces with the electronic medical records and patients’ clinics.

Professor Clark also leads the CHAP (Country Heart Attack Prevention) team which is wrapping up a previous $3.2 million NHMRC Partnership Project that built a four-step model of care and clinical pathway for the translation of cardiac rehabilitation and secondary prevention guidelines into practice for rural and remote patients.

Caption: Robyn Clark- NHMRC project infographic. Supplied by Flinders University.

The Heart Foundation notes that 1.4 million Australians have a high chance of having a heart attack or stroke in the next five years, with key factors contributing to heart conditions such as high blood pressure and high cholesterol largely preventable. National Health Week is marked in Australia this week (1–7 May 2023).

Top image caption: Professor Clark’s digital health team has also developed a mobile phone app and virtual carer avatar program for the Heart Foundation suited to rural, remote and people living with chronic heart conditions in the community. Image courtesy of Flinders University.