Primary care cardio-respiratory monitoring aims to reduce hospital visits, provide faster results

Publication date: 9 September 2021

A Taranaki-based primary care diagnostic service will pilot the provision of cardio-respiratory diagnostic monitors to primary care. Complex referral and management pathways will be modified to ensure treatment plans are implemented quickly and accurately, while removing the need for patients to travel to secondary care services for monitors, and time-consuming referral processes.

The initiative has received funding from the Ministry of Health’s Digital Enablement Programme, which provides support for innovation in digital health care. The programme has a particular focus on co-investing in projects that improve access or participation for people who do not access health services and need to. It’s all about improving equity.

The Ministry is working closely with project teams, sharing learning between participating organisations as a community of practice and looking for opportunities to help others learn from these initiatives as they adopt and promote these or similar services elsewhere. The projects are examples of the types of innovation that will be supported by the better access to information enabled by the Hira programme.

Hira will be an ‘ecosystem’ of data and digital services that will enable consumers to access and control their health information through their choice of website or application using a digital device such as a smartphone, tablet or computer. New Zealanders will be more empowered to manage their health, wellbeing and independence. Organisations can work together to share information so that people don’t have to repeat personal details multiple times. Clinicians can harness digital technologies to improve services. The sector and digital innovators can design and contribute innovative data and digital services, making Hira more powerful.

Clinical physiologist, Jeremy Morris, is one of a team of clinical specialists at Fast Pace Solutions, which offers diagnostic tests such as blood pressure, heart rhythm assessment (ECG, Holter, Event Recorder studies), exercise tolerance and sleep studies.

He says the cardio-respiratory monitoring initiative aims to provide equal and equitable access to ambulatory blood pressure, sleep/oximetry, holter and event recorder testing regardless of where someone lives, their location, ethnicity or socio economic status.

‘We have increasing incidence of cardiac disorders in the general population, with atrial fibrillation probably being the most concerning growth area. We have packaged all the tests related to cardio-respiratory and made them available quite easily. Our main aim is to remove every single barrier to accessing these tests.’

Monitors are usually provided by a hospital, which has significant direct and indirect costs for both patients and clinicians.

‘For example, if someone needs to be monitored for cardio-respiratory issues, let’s say a 24-hour Holter, they need to go to a hospital to get a monitor. This means they may have to get a babysitter, drive for an hour and a half to the hospital to get fitted with a monitor, go home, and come back 24 hrs later to drop the monitor off.

‘If we can provide the tests in primary care, they are easily accessible, there’s no change in patients’ daily routines, and patients are more likely to use them. It also gets away from the costly and time-consuming process of referring a patient to hospital.’

The monitor is given to a patient by the GP/primary provider, or even couriered directly to them. After testing has taken place, the data is uploaded to a secure server system, and a report is provided by the Fast Pace physiology team and commented on by the appropriate specialist, usually a cardiologist. Results will be back to the GP within 48 hours and the patient either reassured, or started on the appropriate treatment plan.

Holter monitors, at the size of a matchbox, are small, reusable and easy to use. The monitor fixes onto a small patch worn by the patient. Patients can shower with it, run with it, and go to the gym with it.

The initiative is aimed at those most likely to have cardio or respiratory illness, including Māori, people with chronic illness, people with a predict score (CVRA) of 10 percent or above, and people with a BMI greater than 30.

The pilot will involve a group of GPs/primary care providers in Opunake, and aims to reach about 200 patients.

‘The service will be completely free to the patient,’ Jeremy says. ‘The systems can be run by anyone – it’s just fitting equipment. So it could be kaiāwhina, the local marae, community health providers or even the patient themselves. Once returned, the data is uploaded directly to a Cloud system. No one can see it except clinicians, who report directly to the patient’s GP.’

Jeremy says the idea for self-monitoring was born during the first COVID-19 lockdown.

‘During COVID some health services may have ground to a bit of a halt, but disease processes don’t. We went looking for a system that patients could fit themselves, found one in Australia, and continued our service through COVID by couriering the monitors out to patients.’

He is excited about the potential to find disease earlier.

‘We know the disease is out there and turning a blind eye is not helping anyone. If we don’t find it early, GPs will be spending more of their time and resources managing the patient later.’

The testing is the easy bit, he says.

‘The hard part is what happens to that data – how does it flow back into the health system and improve management of patients? What benefits are we actually providing to the priority groups? We need to make sure we actually make a difference to patient outcomes as well as time management for medical teams.’

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