Follow up of 13 times more patients with the same resources

For the Department of Neurology at Drammen Hospital the waiting lists increased, but the resources stayed the same.
A digital solution for remote follow-up of patients through CheckWare became the solution.

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Since 2019, epilepsy patients have been offered a digital user-controlled outpatient clinic, and a more equal and efficient healthcare. Prior to this, the Department of Neurology at Drammen Hospital in Vestre Viken Health Trust experienced challenges that many other health service providers can relate to.

 

Despite an increasing number of patients in need of health care, the available resources were not increased accordingly. This resulted in long waiting lists and a focus on sending patients back to the GP for follow-up after the patients got their diagnosis.

Vestre Viken Health Trust

Vestre Viken is one of the largest hospital trusts in Norway, and deliver specialist health services to about 501 000 people among 22 municipalities.

Vestre Viken Hospital Trust is composed of the hospitals in the municipalities Bærum, Drammen, Kongsberg and Ringerike, as well as the local medical centre Hallingdal sjukestugu in Hallingdal.

vestreviken.no/vestre-viken-hospital-trustpital-trust

Digital follow-up of patients at home using CheckWare is now a highly appreciated solution. For two years, Vestre Viken Health Trust has offered digital follow-up to all epilepsy patients who have had a consultation at the clinic. This has resulted in the department being able to follow up 1210 percent more patients than they could before.

Marte Syvertsen, doctor at the neurology department at Drammen Hospital praises the solution they have used:

- The health service we offer is now more uniform and equal for all patients, and not as dependent on a specific doctor as it was before. This gives a more standardized follow-up, which leads to all patients being asked the same questions. This allows us to act at an earlier stage than before if we notice negative trends.

Patients are offered to receive digital remote follow-up when they come in for the first consultation at the clinic. Syvertsen experiences that the patients are mostly satisfied with the digital solution for self-reporting, and they appreciate that they can now participate in their own treatment from home. They no longer need to take unnecessary time off from work to attend physical appointments at the hospital.

- Traditionally, it has been a bit difficult for the patient to reach the doctor, and we experience that it is now easier by working this way. Many patients are pleasantly surprised by the fact that we get in touch with them first, because they are used to waiting in a telephone queue with the secretary, experiencing a threshold to receive the healthcare they are entitled to. We as healthcare specialists become more available, and I as a clinician can have a closer and more dynamic dialogue with the patient than before, says Syvertsen.

- The health service we offer is now more uniform and equal for all patients, and not as dependent on a specific doctor as it was before. This gives a more standardized follow-up, which leads to all patients being asked the same questions. This allows us to act at an earlier stage than before if we notice negative trends.

Marte Syvertsen

Doctor at the department of neurology and leader of Epilepsinett

A gap between national guidelines and reality

The clinicians at the department felt that there was a large gap between national guidelines and the healthcare they had the resources and capacity to offer. The national guidelines for epilepsy treatment stated that all patients should meet with a neurologist on a yearly regular basis. If the clinics managed to achieve the goal by ending the follow-up and sending the patient back for follow-up with the GP, it was applauded internally. This way, they freed up resources to treat more patients.

The patients also experienced the course of the treatment as cumbersome and uncertain. If the patient's symptom pressure was low and stable at the date of the yearly consultation, the follow-up was terminated. If the symptoms recurred, the patient once more had to contact the GP for a referral to the department of neurology. The very busy GPs then had to describe the course of the disease all over. The patient was yet again put on the department’s waiting list before they got to meet with a new neurologist who did not know the patient or their previous medical history.

Marte Roa Syvertsen, who also wrote her doctoral dissertation on the follow-up of epilepsy, says the following about the situation the patients were in:

- Many recently diagnosed patients felt insecure and alone. They experienced that they got their diagnosis, and then they were being sent home. They felt lost, scared, and insecure. In cases where the neurology department thought the patient needed followed up, the follow-up appointment was scheduled to 12 months later. Many patients had to take time off from work to attend appointments, often asymptomatic and without the need for health care.

The consequence of this was an overloaded on-call system. This was because many patients did not show up for the scheduled hours when they were asymptomatic, while others felt that they did not receive healthcare when they needed it at other times of the year than the annual follow-up appointment.

CheckWare's system frees up resources

For the patients, the follow-up has changed for the better. Where patients were previously sent back to the GP for all inquiries outside the annual appointment at the clinic, the clinic is now doing the follow up of all epilepsy patients. They are no longer sent back and forth between the clinic and the GP and can participate in the digital follow-up at home for as long as they wish.

- Epilepsy is a chronic diagnosis and will not pass. Thus, follow-up should not stop just because the patient at a certain moment does not experience a great symptom pressure, Syvertsen explains.

Today, all patients are assigned the same digital assessment at start-up, and then they receive it again every six months. Patients receive a text message with a link to the assessment. The answers are sent digitally to the hospital, and are automatically colour-coded either green, yellow, or red based on the results of their answers.

If a result is colour-coded as red (worsening of symptoms), clinicians will quickly get in touch with and give feedback to the patient. The patient is then offered a consultation either by telephone or at the hospital. If a result is colour-coded yellow, clinicians need more information, and will collect information about the patient's medical history from the electronical health records. Furthermore, clinicians can evaluate the symptom pressure and contact the patient if necessary.

 

If results are colour-coded green, there will be no need for clinicians to contact the patient, who then does not need to come in for an appointment. If patients experience an increase in symptoms, they can log in at any time and self-report on their own health. These answers will also be colour-coded and followed up in the same way as regular reports.

- The bar is set very low for an answer to get a yellow colour code, so we are very confident that answers with a green colour code do not need immediate follow-up, says Marte Syvertsen.

- For me as an epilepsy-competent doctor, there is a very big difference in how many patients I treat and monitor now compared to before CheckWare. I have observed an increase from 10 patients annually, to the current 131 patients, without spending more time on patient-centered work than I did before.

Marte Syvertsen

Doctor at the department of neurology and leader of Epilepsinett

Can offer follow-up to many more patients than before

Marte Syvertsen is employed in a full-time research position, but also follows up on additional patients at the clinic. In the past, it has been limited how many patients she has had the time and capacity to follow up on.

 

Today, a nurse on a 20% part-time contract handles 84 percent of all inquiries related to assessments. The doctors are only involved in the remaining 16 percent of the inquiries that have been colour-coded yellow or red.

The clinic's responsible doctor acts as a backup support and advises the nurse who receives all inquiries from patients. This has enabled increased capacity, and an offer of digital follow-up at home for more patients:

Vestre Vikens results

1210% increase in amount of patients with epilepsy receiving follow up.

Only 3% of patients need to attend physical appointments at the hospital.

- For me as an epilepsy-competent doctor, there is a very big difference in how many patients I treat and monitor now compared to before CheckWare. I have observed an increase from 10 patients annually, to the current 131 patients, without spending more time on patient-centered work than I did before.

These numbers correspond to an increase in patients receiving health care of 1210 percent. The clinic has also seen other positive effects of the solution: Only three percent of patients need to show up at the hospital for a physical appointment, all due to the patient-reported responses.

- We have been given a tool that allows us to follow up patients more closely, and provide them with better health services, without using more resources than we have done before. We now receive health information from patients at regular intervals, which means that we can assess the real need for contact with a doctor. In contrast to what we have done before, when we more or less guessed when the next appointment was needed, we can now do it needs-driven based on what the patients tell us about their health.

Uses the patient-reported data for research

Syvertsen is also the leader of Epilepsinett, a national network for evidence-based epilepsy care. As part of her research position, she documents the effect of this type of treatment. She points out that CheckWare is optimal to use for collection of clinical data:

- As a researcher, I am absolutely thrilled. CheckWare is a goldmine for a person collecting data for research. The most important thing is to document the effect of this type of treatment. We do something with the patient that is different from the previous standard, and when we do, we have to observe the effect of it, and see if it works the way we want it to. There is a huge potential with CheckWare within research. A clinical research project can be carried out in the exact same way

Great attention to user-controlled outpatient clinic for epilepsy follow-up

Vestre Viken's user-controlled outpatient clinic for epilepsy follow-up has received a great deal of attention in Norway. This has led to several hospitals across the country adpoting, or looking to adopt, Vestre Viken's model for follow up of epilepsy patients. Haukeland University Hospital has already established its own user-controlled outpatient clinic based on Vestre Viken's model, and several hospitals have planned their start-up.

- We have been given a tool that allows us to follow up patients more closely, and provide them with better health services, without using more resources than we have done before. We now receive health information from patients at regular intervals, which means that we can assess the real need for contact with a doctor. In contrast to what we have done before, when we have more or less guessed when the next meeting is needed, we can now do it needs-driven based on what the patient tells us about their health.

Marte Syvertsen

Doctor at the department of neurology and leader of Epilepsinett

Vestre Vikens use of CheckWare

Data export:

  • Raw data export

Integrations:

  • Partner API : Extensor

  • HelseNorge

  • DIPS

Assessments:

  • Assessments

  • Plans

  • Clinical reports

  • Assessment store

  • Self-developed assessments

Authentication:

  • Authentication module

System settings:

  • System settings

  • Access control

  • System log

  • System reports

  • Respondent management

  • Clinician management