Health checks by phone in Scotland

Patients with high blood pressure and chronic lung disease will be initially recruited to test new technology that allows them to measure their blood pressure, and oxygen levels at home. The readings will be sent via mobile phone into a central computer and collated into an online health record that can be accessed by both the patient and their GP.

If a reading is very high, the patient will automatically receive a text message reminding them to take medication or instructing them that extra treatment is required. Their GP could then use the latest telehealth technology to speak directly via online video link to the patient in their home.

Over the next four years the project will be expanded to include 1500 patients with diabetes, stroke and chronic lung disease. Dr Brian McKinstry of Edinburgh University, who is leading the study, said: "This project demonstrates how communication technology could revolutionise healthcare.

"By helping patients to monitor these chronic conditions at home, we hope to reduce the need for regular visits to GP practices, which can be very time-consuming for patients who live with these conditions for many years. We're also interested to see if allowing patients to check their health frequently at home leads to changes in their condition being detected and treated more quickly than they might have been under the current system."

But experts call for national CVD risk assessment tool
 But experts warn that a single cardiovascular  (CVDrisk assessment tool is needed for the whole of the UK after National Institute for Clinical Excellence (NICE) reversed its decision to recommend the use of QRISK in England and Wales in favour of the Framingham 10-year risk equations, while Scotland looks set to adopt its own risk assessment tool called ASSIGN.

NICE guidance on lipid modification was released last week after being delayed for months so the institute could consider the value of the QRISK tool that has been developed in UK general practice. Draft NICE guidance in February favoured QRISK over Framingham. But NICE has U-turned and decided to stick with Framingham.

However, the institute appears to be undecided on the value of Framingham, stating that there was an urgent need to establish which score was the most acceptable for use in England and Wales. The move spares practices a massive reconfiguration of computer systems and changes to current practice, but the recommendation reportedly goes against the advice of three international experts.

A spokeswoman for the Scottish Government said the ASSIGN tool had been piloted by practices in south-west Glasgow and would be rolled out across Scotland and made available to all practices as a web-based tool. The new tool has been developed to take into account factors that are suited to Scotland such as deprivation levels.

However, experts are warning against countries adopting their own risk tools pointing out that all tools will be inaccurate to some degree but it was important to have a consistent approach.

The NICE guidance also recommends statin therapy as part of the management strategy for the primary prevention of  cardiovascular disease (CVD) for adults with a 20% or greater 10-year risk of developing CVD. Treatments should be initiated with simvastatin 40mg. If there are potential drug interactions, or simvastatin 40mg is contraindicated, a lower dose or alternative preparation such as pravastatin may be chosen.

Before offering drugs to reduce cholesterol levels, all other modifiable risk factors should be considered and their management optimised if possible.

Cardiovascular assessment : Courtesy http://www.medscape.com

Webs :http://www.nice.org.uk/
http://www.assign-score.com/
Sources: http://news.bbc.co.uk/1/hi/scotland/
http://www.healthcarerepublic.com