Karen Kemp is a Long term Conditions Nurse at Turning Point/Croydon University Hospital and here she talks about a recent pilot where a personalised approach has made a difference to her patients by working in partnership with them and being focused on what matters to them. At the end of the pilot they reported notable health gains; a better understanding of their condition and medication as well as now attending outpatient appointments and a reduction in A&E attendances.
“I focused on adults with a diagnosis of liver disease, alongside alcohol/drug use. These patients have a high rate of unplanned hospital admissions and premature death. They are often homeless or in temporary housing and suffer additionally with mental health issues. Liver disease is the fifth biggest killer in the UK, and alcohol and drug use are significant factors in the continuing upward trend in liver deaths, specifically for adults under the age of 75. Alcohol use is also the main accelerants to death in adults with hepatitis.
“For the pilot the 13 clients were selected from Turning Point and then we noted their number of A&E attendances; what long term conditions they had; their poor history of engagement with services and their history of alcohol dependency. My role was to support these clients by focusing on the physical effects of their long term conditions, as well as working as part of a multidisciplinary team to help improve health outcomes for these clients and to reduce unnecessary hospital admissions.
“Throughout the pilot I worked very closely with the clients offering a wrap-around, personalised service – underpinned by a personalised care and support plan. Each of the clients varied with regards to where they lived, were employed and their housing status. One was a professional and another a housewife, with the remainder unemployed with social housing or on the street homeless.
During the time of the six month pilot all 13 clients have reported health gains and they all have a better understanding of their condition and understand what their medication is for. They improved their attendance to outpatient appointments and have shown a reduction in A&E attendances.
Using this integrated, personalised approach enabled me to work with families and carers also, educating them on the conditions of their loved ones and how to manage when things become more difficult. I also referred them to the family and carer service which is provided through Turning Point. Family and carers I worked with report that this was huge help for them and enabled them to meet other people with the same problems, sharing their experiences has helped all involved and they gained support from each other.
I believe this new way of personalised working will achieve positive long term outcomes. Using this integrated personalised approach gives clients the opportunity to be part of their own care. By this I mean if a client wants to continue using a substance be it drugs or alcohol then that doesn’t mean they are not entitled to best level of care, some clients just want to achieve controlled drinking. Controlled drinking can be frowned upon but clients who achieve this deserve credit as they are making a reduction and every reduction is significant for these clients.
Clients can also aim to achieve sobriety but this isn’t something that can be achieved in a short space of time as it takes planning, engagement and psychosocial intervention. Clients are generally reluctant to engage with psychosocial aspect of treatment but a way to resolve this is let them be part of their care plan which is very empowering for them and eventually they engaged with CBT and psychosocial interventions.
Clients also need to know what is available to them, as unfortunately this client group is not a ‘one fits all’ group of people, so it’s important to allow clients to see what interventions could be best for them, as well as exploring the different groups, counselling etc, all of which will help them engage and commit to their program.