Written by Dr Katie Stephens, GP
Dr Katie graduated from the University of Manchester in 2007 (MBChB) and completed her GP training in the West Midlands in 2012 (MRCGP).
As I wrote in last week’s blog ‘How to manage your health from home?’, the term ‘remote monitoring’ in a healthcare context generally refers to data gathering that is done directly by the patients somewhere other than the usual setting of a doctor’s office or healthcare clinic. Examples of the type of data that is gathered are blood pressure, blood sugar, temperature, pulse (heart rate), height, weight and oxygen saturation.
With a whole range of these data-gathering devices now available, it is worth examining what the benefits of using them are in detail
Helpful prompts for seeking medical attention
COVID-19 has certainly caused an increase in demand for pulse oximeters (machines that measure the oxygen level in your blood) – and for good reason! With one of the complications of COVID-19 including breathing difficulties, plus given what we know about low oxygen levels in general potentially being a sign of an infection becoming more serious, pulse oximeters have a useful role to play in assessing how poorly someone is.
The NHS has a handy guide around using pulse oximeters during a COVID-19 infection, which includes a useful reference table of oxygen levels and the corresponding recommended actions1. The guide makes the very important point that pulse oximeters can help detect low oxygen levels even before symptoms appear. For people who are at risk of becoming quite unwell from COVID-19, or those with underlying lung issues, it may be a good idea to pick up a pulse oximeter in case of an infection. Using a pulse oximeter in these instances might help you become aware of the need to get medical help sooner than if you were relying on just monitoring symptoms alone.
Of course, pulse oximeters can come in handy in other scenarios as well (lung infections in general, for starters). In the near future we’ll be publishing articles that look into each of the main remote monitoring devices, including pulse oximeters, in greater detail
Similarly, without going into too much detail, other devices can also help prompt early but appropriate treatment of medical attention.
Improving diagnosis of high blood pressure
Unfortunately, in the UK we are way behind other countries when it comes to diagnosing high blood pressure (hypertension). Only 35% of people who have hypertension in the UK have it both diagnosed and treated well enough, compared to a much higher 65% in Canada (and similarly high levels in America)2.
Most people with high blood pressure don’t actually have any symptoms and so if they aren’t actively looking to check their levels themselves at home, they may only find out that there is an issue when they see their doctor or nurse for an unrelated reason and have their blood pressure checked opportunistically, or worse, if their raised blood pressure causes a stroke or a heart attack.
I wonder if this may be partly why detection levels in the UK are so low – GPs here aren’t funded to do annual ‘well person’ checks like doctors in other countries (when blood pressure issues may be picked up) and generally have greater pressure and demands on them. The result is that they are often fire-fighting, trying to prioritise time and appointments for those who are ill and need to be seen more urgently. This means less blood pressure checking in general compared to other countries, and so fewer cases of hypertension being picked up. With even fewer patients being seen in person since the pandemic started, I suspect even more people with raised blood pressure may be going undiagnosed.
The good news is that medical expertise is not at all necessary when it comes to checking blood pressure, and there are a variety of machines available that are both reliable and affordable (Kinetik’s devices are seen here3). If we can get more people checking their blood pressure at home, we can hopefully start to pick up more cases of hypertension before they lead to problems.
Improving management of long-term health conditions
For those who have been diagnosed with high blood pressure, or other conditions that require monitoring such as diabetes, it can be very handy indeed to be able to monitor your numbers at home without having to wait for the next available nurse appointment. Of course, I’d still strongly recommend liaising with your NHS nurse or doctor regularly as you would do otherwise – having their clinical input on the data you get is important.
But by taking an active role in knowing your recent blood pressure numbers, for example, (or blood sugar for those with diabetes), you are more likely to spot earlier if things are headed in the wrong direction, and equally are more likely to be able to see the effect of any positive lifestyle changes you make. It can be rewarding to see things improve in response to changing your diet or exercise (or just in response to taking your medication more regularly, for anyone who this might apply to!). Even just knowing that you can check your results yourself may be motivation enough for those contemplating taking action on some healthy New Year’s resolutions.
Improving remote interactions
With many doctor’s appointments, both privately and via the NHS, now being done remotely, it can be a huge benefit to both you and your physician if you are able to find out yourself some of the data that the doctor would normally check eg your temperature, heart rate, oxygen levels, etc.
In the case of someone who is feeling newly unwell, some of these parameters are important indicators to how well or poorly the body is coping with whatever is troubling it. You may have heard of the term ‘sepsis’ which is essentially a potentially life-threatening emergency where an infection has spread to the blood and is causing damage to the body. Signs and symptoms of sepsis that can be measured with devices very fast heart rate, newly low blood pressure, low oxygen levels and a cold temperature4. (If you are concerned you or someone you know may have sepsis, please seek urgent medical attention and read further information from the NHS here5.) When doctors assess someone with an infection, one of the things they consider if the person seems unwell is whether or not this could potentially be sepsis. Having some of these numbers available can help the doctor with their assessment and potentially save a trip to A&E (or conversely, might help prompt a necessary visit when needed!)
Having your data or ‘readings’ available can also be useful in the less urgent setting. For instance, for those who are having a routine check up for a chronic condition, knowing your recent data may mean you can do the visit from home and spare the time and effort of having to travel to a clinic.
Easing pressures off of the NHS
We are probably all aware of the significant pressures the NHS has been under even pre-pandemic due to a number of factors such as caring for an ageing and increasingly complex population and issues with recruitment and retention of professionals. These pressures have only been compounded since March 2020 – there are significant delays for elective procedures, long waits in A&E, and there has been an impact on cancer treatment6. A lot of what the NHS has managed to do has also been off the backs of people working unpaid overtime to do their absolute best to care for the person in front of them; a survey done in 2020 of over half a million NHS England workers showed that a majority of people worked unpaid overtime every single week – with over 10% of respondents working unpaid for 6 hours or more each week7.
It therefore makes sense to do what we can as individuals to reduce the healthcare burden to more manageable levels. Alongside obvious methods of helping, such as following government guidance around preventing the spread of COVID-198 or looking after our own well-being through eating healthily or quitting smoking, there may be a role for remote monitoring to play in relieving some of these pressures:
- As discussed above, providing more data for remote consultations (temperature, pulse, oxygen level, blood pressure etc), may save an unnecessary in-person visit to the NHS GP or Emergency Department. As in-person GP visits now consume more time with the need for donning new PPE each time and the need for cleaning and sanitising equipment and furniture after each individual appointment, this essentially frees up time for clinicians to see more patients. And of course one fewer patient in A&E means one less person ahead of you in the queue.
- Certain chronic conditions can be monitored with data reported to the NHS Practice Nurse (blood pressure, weight, blood sugar where relevant, etc) which may reduce the need for in-person reviews.
- Similarly, this can be particularly helpful for those with a borderline raised blood pressure who don’t officially have ‘hypertension’ but need to have their blood pressure monitored as they might be headed that way. Previously, this might have meant multiple trips to see the nurse to have your blood pressure checked. With doing this at home instead and feeding the results back, not only does this save the need for multiple nurse appointments freeing up nurse time, but probably also gives you a more accurate reading (provided you’ve got a reliable machine). We know home readings are generally better than clinic readings due to the ‘white coat’ effect.
- Linked into this, according to a government report, high blood pressure costs the NHS some £2.1 billion2 just due to the disease it leads to, not even accounting for costs in time and money to the GP in managing the blood pressure alone. If we can do better at picking up hypertension before it causes problems, clearly that is a huge benefit to the individual (!) but also the benefit to the NHS is significant too.
So there are a few good reasons to consider when debating whether or not to pick up a remote monitoring device. If you do end up buying one, please make sure to check that it is up to the right standards. I will be going into more detail on what these might be as I look at different devices in turn in upcoming articles, but a brief piece of advice would be to check that any blood pressure machine that you are looking at is on the British and Irish Hypertension Society’s approved list9 and any other device is clinically validated/meets any relevant ISO requirements10.