St John initiative will support people to manage hypertension from home

Publication date: 9 September 2021

St John is trialling an easy-to-use, home-based digital telehealth and monitoring service for people with uncontrolled hypertension (high blood pressure). While a service typically aimed at older adults, St John is bringing extra focus to reducing health inequities experienced by Māori. The overall aim is to improve access to essential primary health services for Māori and to promote better management of hypertension at home.

Participants receive a tablet on which their blood pressure is recorded and monitored by St John clinicians. These recordings can be accessed by the patients’ GPs. The tablet also allows participants to receive medication reminders and surveys to assess their current health.  

The St John telehealth monitoring team also carries out social check-in calls with participants to maintain ongoing contact and to mitigate against social isolation and loneliness – a feature that has proven to be very popular during initial internal trials.  

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.

The funding received by St John will cover clinician expertise, the tablets, software, and evaluation. 

St John national Māori advisor – customer and supporters, Malcolm Kendall, says hypertension is a gateway to a number of other conditions, such as cardiovascular disease, kidney failure or stroke.

‘It can be a sign of general unwellness and is an indicator for intervention.’

Malcolm says that currently, if someone experiences elevated blood pressure, it goes undetected unless they visit their GP or health provider to get it checked.

‘Some at-risk people don’t engage often enough with their primary care provider which is a concern. So, at its core it’s about being the ambulance at the top of the cliff. Proactively monitoring people in these situations means we may avoid sending a real ambulance to them later when things could be far more serious. We can prevent harm from occurring by addressing and managing the condition early.’

Product innovation manager, Kwan-Lyn Lim, says the service has been designed to be user-friendly.

‘Participants will be trained in using the system in their homes by a St John telehealth representative. The tablet and blood pressure cuff come pre-paired, fully charged and ready to go. If participants don’t have access to the internet at home, St John’s telco partner Spark will provide free broadband modems to be used for the St John telehealth trial.’

Kwan-Lyn says the design was kept as simple as possible to ensure ease of use for people uncomfortable with technology. ‘The tablet and blood pressure cuff are extremely simple to use; recording your blood pressure involves pressing just two buttons. Daily measurements upload to the data store and are viewable by anyone with appropriate access. Apart from the participant, that could be their GP, or St John clinicians. I don’t think I’ve ever seen an easier solution from a usability perspective.’

As every person has slightly different blood pressure norms, an allowable range is set for each individual. If blood pressure readings outside that range are recorded, the participant will receive a short survey via the tablet asking whether they are experiencing any symptoms – such as dizziness, headaches or chest pain. All survey results are reviewed by the clinicians overseeing the patient’s care at St John.

‘Follow-up actions are based on those answers and may involve a St John clinician giving them a call back to perform an assessment and determine the best pathway of care,’ she says.

‘This may include self-care advice, referral to the usual primary care provider or arranging an ambulance. If the participant doesn’t answer, an escalation path is activated to ensure the participant is cared for.

‘Any ongoing concerns about a participant’s blood pressure are raised with their GP to allow a discussion to take place, and a treatment plan can be formulated if needed. The GP or primary care provider can be given direct access to the system so they can look at the live data for ongoing oversight. They will only be able to view data for participants whom they provide care.’

Malcolm says, with appropriate permission, whānau may also be looped in.

‘They’d download the app to their phone, allowing them to see, for example, mum’s data and if she’s missed any readings. This opens the door to them prompting mum to take her readings – so support is coming from whānau as well as clinicians.’

Participants enrolled in the trial will have the tablet for six months. How long they keep the device after that will depend on their individual circumstances and health needs.

Malcolm says he’s really excited about being able support improvements in Māori health.

‘Being able to contribute to a deeper and richer understanding of the challenges, and providing some solutions, really motivates me. The trial we have designed mirrors some trials overseas, so the funding will allow us to undertake testing in the New Zealand context. If we can address health inequalities through this technology – fantastic.’

The St John team is focusing on building its relationships with iwi and whānau ora providers, as well as increasing the organisation’s internal cultural competency. They also have 50,000 medical alarm clients, and there is potential to fine-tune a cohort who are not accessing health services from that group.

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