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Darren Umbers, Regional Director UK and IrelandHome Healthcare Solutions28th April 2010

Evolving the Management of Patient Care in the Home

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Content

• Sleep, what is it?• Sleep Apnoea• Why we address the problem• Challenges• Innovative treatment support models• Questions• Conclusions and Questions

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Three Pillars of Good Physical Health

• Good Diet• Regular Exercise• Healthy Sleep

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• Sleep Disorders are common in the general public and contribute to impairment of academic and occupational performance, increased risk of accidents, disturbances of mood and social interaction.

• Sleep disorders may lead to or exacerbate medical and psychiatric conditions.

• Sleep disorders are common

• Sleep disorders are serious

• Sleep disorders are treatable

• Sleep disorders are under diagnosed

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Sleep TerminologyDefinition of OSA

OSA (Obstructive Sleep Apnoea) occurs when the upper airway repeatedly collapses during sleep, causing cessation of breathing (apnoea) or inadequate breathing (hyperpnoea) and sleep fragmentation.

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Sleep TerminologyObstructive Sleep Apnea

Normal Airway Obstructed Airway

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What is obstructive sleep apnoea?Thus obstructive sleep apnoea syndrome is:-

Airway incompetence brought on by sleep

Recurrent brief arousal from sleep to clear the airway

Markedly fragmented sleep throughout the night

Daytime consequences of sleep fragmentation, mainly excessive daytime sleepiness

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Overnight (8 hours) oxygen saturation levels (oximetry) in OSA: >400 dips/apnoeas in total

Beginning of night

1st hr

2nd

hr

8th hr

End of night

60 minutes

3rd hr

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SymptomsNocturnal Daytime

Cyclical silence and loud snoring Excessive daytime sleepiness

Choking Morning headaches

Restless sleep Unrefreshing sleep

Nocturia Memory impairment

Sweating Increased risk of accidents

Reduced libido Impaired cognitive function

Associated hypertension

Polycythaemia

Heart failure

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Arterial blood pressure during OSA

Rise with every arousal

Recurrent dips with every obstructed breath

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Effects of OSA

• Systemic hypertension• Cardiac Function• Ischaemic Heart Disease• Cardiac Arrhythmias• Cerebrovascular Disease• Pulmonary Hypertension• Psychological• Endocrine• Renal• Cognitive• Mortality

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Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Behavioural Risk Factor Surveillance System

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Obesity Trends* Among U.S. AdultsBRFSS, 1986

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1987

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1988

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1989

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1990

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1991

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1992

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1993

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1994

No Data <10% 10%–14% 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1995

No Data <10% 10%–14 15%–19%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

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Obesity Trends* Among U.S. AdultsBRFSS, 1996

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19%

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Obesity Trends* Among U.S. AdultsBRFSS, 1997

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24%

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Obesity Trends* Among U.S. AdultsBRFSS, 1998

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24%

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Obesity Trends* Among U.S. AdultsBRFSS, 1999

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24%

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Obesity Trends* Among U.S. AdultsBRFSS, 2000

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24%

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Obesity Trends* Among U.S. AdultsBRFSS, 2001

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

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(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Obesity Trends* Among U.S. AdultsBRFSS, 2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Obesity* Trends Among U.S. AdultsBRFSS, 2003

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Obesity* Trends Among U.S. AdultsBRFSS, 2004

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

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The USA

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Tackling Obesity in England :REPORT BY THE COMPTROLLER AND AUDITOR GENERAL 2004

Key facts about obesity in England

• The four most common problems linked to obesity:– Heart disease– Type 2 diabetes– High blood pressure– Osteoarthritis

• 1 in 5 adults is obese• The number has trebled over the last 20 years• Nearly two thirds of men and over half of women are

overweight or obese

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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OSA - Why should we be addressing the problem?• As society faces an obesity ‘epidemic’ with more and more of the

population becoming obese, the link between OSA and obesity is also highlighted.

• If current trends continue, at least half the population will be obese by 2032. In less than 15 years, 86 per cent of men will be overweight, and 70 per cent of women will reach the same level of obesity in 20 years time*.

• About 1 in 25 men and 1 in 50 women are affected by OSA • 80% of OSA sufferers who should be receiving CPAP have either not

been diagnosed or have not received treatment.* T. Marsh, Associate Director, National Heart Forum

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Why should we be addressing the problem cont…• OSA is associated with an increased risk for:• Type II diabetes• High blood pressure• Heart disease and heart attack• Stroke• Fatigue-related motor vehicle and work accidents• Decreased quality of life• NICE Endorsed

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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OSA causes more accidents

OSA patients have more accidents than non-OSA patients.

HGV OSA drivers have twice as many accidents (Stoohs, 1994)

16%-20% of all RTA’s are sleepiness related (Horne, 1995)

Twice as likely to have an accident and have more accidents than non-OSA patients (Barbe, 1998)

6 times more likely to have an accident (Masa,2000)

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Principles of nCPAP

• Continuous positive pressure

• Nasal mask

• Pneumatic splint

• Prevents collapse of upper airway

• Moderate - severe SAHS

• NICE Endorsed

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Therapy Objectives

• Abolish abnormalities

• Restore normal sleep

• Relief of nocturnal & daytime

symptoms

• Improve comfort

• Optimal compliance

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Resource and service management• Staffing

• CPAP Service Staffing per 1000 patients on nasal CPAP

– Nurses / physiologists• CPAP induction • CPAP titration• CPAP Clinic review• CPAP problems / maintenance• Patient support / advice• 1.3 WTE

– Secretarial • Phone calls • Clinic letters• Booking CPAP patients• 0.2 WTE

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Review

• Compliance

• Problems

• Benefits

• Changes

• Equipment

• Consumables

• Internal / external

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Resource and service management

– Technical support• Sleep studies• Ordering• Replacement parts• Replacement machines • Loan machines• 0.3 WTE

– Medical engineering• New equipment evaluation• Electrical safety testing• Machine faults / repairs• 0.3 WTE

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Resource and service management• Finance

– Pay costs– Non-pay

• Overheads / rooms etc.

• Equipment– Machine costs – Disposables (mask/tubing

etc.)– Accessories

(Humidification)

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Who provides the service?

• Respiratory

• Cardiology

• ENT

• Neurology

• Anaesthetics

• Psychiatry

• NHS based mainly

• Room for service innovation??

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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Conclusions

• Treatment of OSA is cheap, and produces large increases in quality of life for the rest of the patient’s normal life span

• Large predicted savings in other health costs, and accident costs.

• Patients need to remain on treatment to derive such benefits

• There is a large unmet need to treat these individuals with OSA

• Treatment of OSA represents much better value for money than many interventions currently funded

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

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The Bottleneck

• Hospitals and Private Practices establish Sleep Laboratories in order to treat patients.

• Government introduces NICE Guidelines in order to provide treatment recommendations.

• UK NHS Sleep Services limited Capacity• Awareness rising• Estimated 1 Million untreated patients

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

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‘We are a long way short of meeting what will probably be an increase in demand. Even if the demand is static, we are actually not doing very well at the moment.’

Quote From NHS Sleep Forum:

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Forum Conclusions

• Funding of services is an issue• Difficulty meeting increasing demand• Non-Clinical administration increasing• Compliance rarely being monitored

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

What is MOST?

Patient Support and Management of Sleep Therapy

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

• Defined service protocols• Comprehensive patient follow up• Robust troubleshooting guides• Compliance upload and interpretation• Full audit trail and patient recording

Protocols:

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

MOST

• MOST was designed to work hand in hand with hospitals, PCT’s and Private Practice establishments in order to effectively manage patients in the following areas:

• Diagnosis • Treatment • Follow up

• MOST works closely with clinicians, nurses, technicians and other members of staff to ensure patients receive the best possible therapy.

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

MOST Objectives

• Achieve adherence to and compliance with therapy• Supporting patient and partner to achieve best outcomes• Pro-active management and timely troubleshooting avoids

failures• Ensuring the earliest resolution of symptoms (DVLA, return

to work, quality of life) *• Robust data collection, validation and reporting• Acknowledging and respecting the need of the INDIVIDUAL• Service integrity - Clinician confidence

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

Clinician Information

• MOST Net.• Window on the patient for Clinicians• Patient data can be accessed via a secure internet site.• Clinicians provided with user name and password.• Patient notes reveal:

• a comprehensive trail of interactions• Compliance data and reports for review• Notes, comments and troubleshooting advice

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

MOST Net

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

Patient Pathway

.

MOST provides customer with patient information form

Patient and clinician fill out prescription form along with

confidentiality agreement

Form sent to Philips Respironics

Philips Respironics contacts patient

Therapy commences

The real work begins!

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

Respironics UK Resources

• Dedicated experienced Sleep Support Team providing support, help and advice

• Five RPSGT Qualified team members available to help• Onsite training by qualified clinical trainers for staff and

patient groups

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

• Manage patients needs• Check and monitor compliance• Fixed costs with no capital outlay• Allow more time for clinics

In Summary

Confidential Darren Umbers, 28/4/10 Cambridge Network Healthcare Special Interest Group Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

Who we currently work with….

• Private Practices.• Companies e.g.. haulage firms.• Self referred patients.• Some of the biggest NHS Trusts in the UK.

Confidential Darren Umbers 28 April 2010 Cambridge Health Network Talk

“This document is the confidential and proprietary information of Philips Respironics and may not be reproduced, disclosed or distributed to any other person or entity without prior permission from Philips Respironics. Philips Respironics makes no warranty of any kind with regard to this material and it is subject to change without prior notice. Any medical information is provided as a general information service only and is not intended as a substitute for advice from a registered physician or other health care professional.”

• New Sleep platform with embedded TC65i Cinterion Wireless Module•Allows wireless, 2 way communication between CPAP to care provider•Wireless LAN or Mobile phone network comms•Live real time data allow therapy adjustment•Greater standard of care•Reduced hospitalisation•Won “Best embedded end to end service award” at GSMA Embedded Mobile Competition 2010 (Communications sector award)

Continued Innovation

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