Increasing demand for healthcare has seen an expansion in the potential for community care to make a bigger contribution. Community care isn’t a new idea. It’s been part of many health systems for decades. Two of its features have been its underdeveloped role, so impact, and effective integration of community health services and social services.
A European Union (EU) project’s been seeking ways to improve this. Starting in December 2013 and ending in November 2015, ENS4Care presented its solutions at the EU’s 7th Innovation Summit. An overarching goal for ENS4Care is sharing good practices in nursing and social care.
ENS4Care’s five guidelines are for eHealth services for prevention, clinical practice for Chronic Obstructive Pulmonary Disease (COPD), integrated care, continuity of care and nurse ePrescribing and the design of advanced roles. Each of these is seen in a context of a vibrant, motivated and highly qualified health and social care workforce. eHealth’s role is clarified too.
The guidelines are being deployed in Romania, Bulgaria and Poland. This is in parallel to additional effort with the European Nursing Research Foundation, known as HOTUS, to apply evidence-based policy-making in European health and social care policy.
ESN4Care’s guidelines offer Africa’s health systems an excellent step up in developing their community services as part of responses to severe health worker shortages. They also show numerous opportunities for eHealth’s contribution. A short summary of each guideline’s:
- Nurses and social workers with the right knowledge and skills will add considerable value to, and form an important link between, technological innovation, health promotion and disease prevention
- eHealth tools and technologies should be user friendly for patients, carers, the public, professionals and everyone else involved
- Choices of eHealth tools and technologies should be based on sound scientific principles
- eHealth interventions should be assessed for cost effectiveness
- Nurses and social workers should assess the health literacy levels of patients, carers, families and communities to ensure they’re enabled to harness and gain maximum benefit from changing eHealth technologies
- Nurses and social workers should have the knowledge, skills, opportunities and capacity to use the tools and technologies effectively
- eHealth tools and approaches must comply with local and national policies and structures for data protection, patient confidentiality and privacy and legal and governance requirements
Clinical practice for COPD
- All eHealth services must be supported by robust governance arrangements
- Planning for all eHealth services must include statements on how ICT components will benefit practices and citizens
- During eHealth implementation, consideration needs to be given to the disruption that it may cause to staff
- In a citizen self-monitored service, citizens should maintain their own records, such as data about symptom scores and vital measurements, and assume responsibility for sending the data to hospitals, GPs, primary care centres or call centres
- Biometric measuring devices, such as equipment that monitors heart rate, blood pressure, blood glucose levels, oxygen saturation, and weight should be considered for remote monitoring and management of citizens with acute and chronic illnesses in patients’ homes
- Secure transfer, access and storage of health and social care data’s essential
- Ethical principles and standards should guide the governance and risk management structures of services
- A strong leadership presence is essential through implementation of all eHealth services
- Consideration needs to be given to developing clear and accessible staff documentation such as instruction manuals, guidelines and protocols
- eHealth education and training should involve citizens, carers, health professionals and social workers
- Evaluation processes should identify changes in key indicators that reveal areas where the eHealth service has positive or negative impact
- Maintaining citizen privacy and safety are crucial to the long-term success of any eHealth service that hosts citizen and provider data
- eHealth should be user friendly
- eHealth should be well integrated with existing ICT systems so they can be easily accepted and used by health workers.
- eHealth solutions should be considered for any health issue that requires an element of collaboration between primary and secondary healthcare and social workers
- All countries should have a common database-based network solution that can help with the coordination and communication between primary and secondary care providers, including nurses and social workers
- Integrated eHealth care needs equal involvement from primary and secondary care partners
- Outcome data and indicators of success that includes satisfaction with care, readmission rates and average length of hospital stays should be collected throughout the process
- Documentation should use the international standards of reference terminology model recommended by WHO
- Consideration should be given to establishing a single point of contact for staff support with a super-user who can respond to issues, troubleshoot and offer advice
- Jurisdictional factors, including legislation and prescriptive authorities should be considered in the initial stages of planning for nurse ePrescribing
- Informatics infrastructure and platform should be considered in the initial stages of planning for nurse ePrescribing
- Competency in clinical decision-making should be considered in the initial stages of planning for nurse ePrescribing
- eHealth should not be seen as a substitute for face to face contact with health and social care professionals that citizens need at times of crisis and during acute phases of their illness
- Nurses and social workers should offer social prescriptions when it’s appropriate to offer citizens options of assistance to change their lifestyles as an alternative to medications or other clinical interventions
- Nurses and social workers should employ telehealth solutions to empower people living at home to assess their own state of health and enable health and social care professionals to remotely monitor their physiological data for diagnosis or disease management
- Nurses and social workers should employ telecare that uses a combination of sensors and other equipment, usually in the home environment, to help vulnerable and physically less able citizens to keep themselves safe and alert a control centre if help is required
- Nurses and social workers should empower service users to participate in implementing and monitoring their own service and treatment measures of care and the related decision-making processes.
For each of these guidelines, the reports contain considerable detail about their deployment, use and benefits. They’re paths that Africa’s health systems can follow.