Scaling up telemedicine for adults with cochlear implants - are you ready?

Cullington, H.E., Kitterick, P., Margol-Gromada, M., Riggs, C., Finch, T. and Weal, M. (2018) Scaling up telemedicine for adults with cochlear implants - are you ready? British Cochlear Implant Group Conference, , Belfast, United Kingdom. 17 - 18 May 2018.

Abstract

AIM 1. Roll out telemedicine tools to adults using any cochlear implant device in the UK 2. Commission a formal evaluation to establish whether the new care model improves: • patient empowerment • equity of access • patient and staff experience • clinic efficiency METHOD We will introduce a remote care pathway choice to adults using cochlear implants in participating centres in the UK. Benefits will be available to users of any device. This is a complex intervention comprising four components successfully trialled together previously. The elements are: • personalised responsive web app (hearing rehabilitation, music, advice, troubleshooting, training, ordering spares, goal setting, questionnaires, reminders, monitoring of implant site photos) • home hearing test • self device adjustment at home (with appropriate devices) • upgrading of sound processors at home rather than requiring a clinic visit Remote care tools will be used in the patients’ homes, with visits to the clinic only to solve problems or access specialist resources. Clinicians will access an online dashboard to monitor their patients, and will receive alerts if patients are not interacting with the tools or other indicators are achieved. Wessex Academic Health Science Network will undertake an independent formative evaluation. RESULTS We previously completed an RCT of remote care tools at University of Southampton Auditory Implant Service (Cullington et al, 2016). We examined patient preference using conjoint analysis. The main outcome evaluated was patient empowerment. The remote care group had a significant increase in their empowerment after using the telemedicine tools. Their hearing improved, suggesting better ability to take action to keep hearing stable. Our Discrete Choice Experiment showed that patients were more likely to choose remote care over usual care if they had a home hearing test or could do self device adjustment. They also preferred a remote pathway if it included a personalised online support tool in addition to support from the centre. CONCLUSION We need high quality evidence that a remote care pathway delivers our aims. An independent evaluation will be done by Wessex Academic Health Science Network to answer the following questions: 1. Does the new care model improve patients’ confidence to self-manage? 2. Do users of the new care model have stable hearing as a result of self-initiated monitoring and action? 3. Does the new care model improve equity of access to follow-up care? 4. Does the new care model improve patients’ experience of follow-up care? 5. Does the new care model improve the experience of staff? 6. Do staff have confidence in the new care model? Do they recommend it? Does the new care model improve use of resources through reducing the need for follow-up appointments and enabling the service to be delivered by a different skill mix? 7. What lessons can be learned from the implementation process that will benefit spread and adoption of this model? REFERENCES 1. Cullington H, Kitterick P, DeBold L, et al. Personalised long-term follow-up of cochlear implant patients using remote care, compared with those on the standard care pathway: study protocol for a feasibility randomised controlled trial. BMJ Open 2016;6(5):e011342. 2. Cullington HE. Introducing telemedicine for cochlear implants [YouTube video]. University of Southampton; 2017. Available from: http://v.ht/remotecarevideo.

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Contributors

Author: H.E. Cullington

Author: M. Weal

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