New Years Resolutions, Gamification and Maintaining a Healthy Behaviour Change

Gamification, #NewMe2013 and Maintaining a Healthy Behavior Change

This post is about New Years Resolutions . How to phrase the goal so you are more likely to succeed. It includes a link from Dr Mike Evans about the reasons why New Year is a good time to make a change, and includes some useful websites and tech ideas that could help us succeed in maintaining those healthy behaviors we have in mind.

Please watch the videos from the links and consider tweeting your New Years Resolution for 2013 with the #NewMe2013 hashtag.

If you know of other sites or ideas that you would like to share then please comment below.

Doctor First - One Practice's Journey...

Reblogged from Heather Wetherell:

Doctor First Appointment system – A 21st century Solution?

"Accept the things you cannot change, and change the things you can"
       -  Reinhold Niebuhr

No one can argue that current 'demand' in the NHS is high.
We can argue until the cows come home, as to why, or who/what is responsible for this ever increasing demand.  But unless we think we can alter this demand in the immediate foreseeable future, maybe - just maybe - we should start thinking about how we can manage it.

Read more… 4,620 more words

One GPs View of Their New "Doctor First" Appointment System. Is the grass greener?

Imagine a World Where NHS Paid For Replacement Car Tyres

Imagine the following scenario; NHS decides that to reduce the costs associated with car accidents they will introduce a way of reducing the number of cars with faulty tyres on they roads.

TyresSmart is a company that wins the contract to provide replacement tyres.

They then write to all their customers, and get really good at raising awareness of their service.

All you have to do is ask your doctor for a referral to TyreSmart. This is a win win situation for TyreSmart – but maybe not so good for the NHS.

What do you think would happen ?

If the NHS was a Food Outlet , what would it be ?

When was the last time you went out for some food? Was it to a restaurant , a take away or just a bakers? The chances are that you entered into a contract with the provider of the food about what you would consume in exchange for a particular amount of money. It’s a standard transaction for a modern economy.

A few weeks ago I had a fantastic Chinese banquet. Choosing the banquet option meant that we had a bigger selection of things to choose from and savour, but this came at the price of committing to buying a bigger quantity of food than we would have consumed with a traditional three course meal.

The NHS National Health Service in the United Kingdom is in a state of transition, and has been for several years. Budgets are being adjusted ( usually downwards ) which means that there is less money to pay for as many things as before. There are increasing pressures on the remaining staff, and increasing expectation from the consumers of health care about what they choi,d be receiving.

Going back to the food model. I’d like to suggest that hospitals and many aspects of Secondary Care are like the a la carte restaurant – dishes are served up with a pre arranged price tag, except in the health scenario the customer is blissfully unaware of the cost of the item or the experience they are receiving.

General Practice , or family medicine, in the UK has more in common with the “eat as much as you like buffet”. Providing you can get through the front door, you can fill your boots with as much health advice and medication as you wish. I have enjoyed some really great buffets in my time, and some not so great ones. You generally get what you pay for – your expectation of the quality of the food inside is influenced by the expected financial cost.

Steve Spangler – the Geeser with the Geysers ( mins in coke man) discusses youtube, what makes a viral video & analytical tools for Social Media

The blog is good ,links great & the podcast is worth listening to

Steve Spangler Is the chap who came up with the idea of dropping a mint into a coke bottle to create a fountain.

He trained as a science teacher , then started looking for other ways of making science fun & stimulating.

He had approx 61 episodes on YouTube before the coke fountain experiment caught on and went viral.

www.polkaspots.com/ Could this be the solution that brings wifi access into GP waiting rooms

Looking for a WiFi solution for your waiting room? then check out their site

http://polkaspots.com/

It Looks great – a cloud based management – self service of access to wifi and logs use from the public bit – stops dodgy stuff being downloaded

Looks like the single location option is free.

Includes features like timed vouchers to limit use of wifi

They sell base stations that are high powdered with 50m radius for £300

Looks very easy to set up and manage.

Can buy extra base stations to extend the range

Their website is very easy to follow to get all the info about how it works ,pricing and security.

Now all we need to do is to persuade the masters of NHS IT systems to let us plug it in …..

Apptamism : New Word of the Week

New word of the week = Apptamism . The art of being optimistic about what will happen once an organisation develops its own apps.

I agree that apps need to offer more than their parent website – or what’s the point ?

Offline access to info & data can be important for the segments of society not on all inclusive data packages.

I’ll continue these thoughts on twitter … @stuartberry1

Compassion debate :nature or nurture & why it’s worth considering the bigger picture before rushing to “fix” the NHS through more rules & regulations

Compassion in NHS is big news this week. The Francis report is out, and all branches of healthcare are considering its implications. This article discusses the fragility of compassion once the environment becomes stressful. When resources ( time, nurses, cleaning staff, etc ) are in short supply then group survival mechanisms kick in.

Article from Health & Social Care journal discussing compassion in NHS. Please read the comments at the end of the piece by the Professors

It’s the old nature vs nurture debate, and it had its routes in the biological evolution of societies and culture. Tribes of people & staff develop ways of differentiating themselves from the people who are not in their tribe. This is done through words (jargon & abbreviations), appearance (uniforms), and rules or regulations which may not be obvious to the uninitiated.

Make 2013 your year to get Social in Health & Buisness

Do you have a digital footprint yet?

Is your Buisness or Organisation making the best use of social media ?

These facts may help you to build a case for upping your game in 2013

http://m.techcrunch.com/2012/12/12/pew-social-networking-most-popular-in-the-uk-and-despite-the-smartphone-app-boom-voice-calls-remain-king/

article on global attitudes survey 2012

In the UK, only 15% of respondents said they did not have Internet access

Global attitudes project stated that ;

46% of social media users discuss community issues

52%, of adults using social media services like Facebook, Twitter and YouTube

Wouldn’t it be great if your club, department, patient group or small buisness had a way of sharing useful or interesting news, updates or offers with the Internet users?

Green Dreams Project In Nelson & East Lancashire

Worthwhile Project in East Lancashire offering people a fresh start Green Dreams Project in Nelson

I have been looking at the new look website for this popular resource today. Please take a look at their site and consider if there is anyone you know who may benefit from their help.

Nelson Project

Sue Hogg works with patients at Reedyford Health Care in Nelson. She has supported patients with finding voluntary work in a local community centre, getting in touch with Inspire for alcohol issues, securing emergency food parcels and being introduced to social groups. Sue has also worked with patients who want to live a healthier lifestyle, eating more healthily and doing more physical activity, including those with long term health conditions. She has been able to provide information about job search support, eco- therapy placements and benefits advice, working with partner organisations. Many patients are experiencing mental health problems, including stress, depression and anxiety, low self- esteem and confidence, and bereavement.

Where are your Internet Hotspots and Notspots ? #wifi,#CShiftNHS

Notes from http://www.peskypeople.co.uk #Digifutures12 event in Shropshire 2012

3.91 Million people in the UK have never used the internet. That is approximately 1 in 10 adults in the UK.

1 in 6 adults have some form of hearing loss. These people may be reliant on using email, sms or social media channels for accessing your services.

Ken Eastwood of Digital Nomads said…

Radio Shropshire reaches 30% of the target population every day. Half the population is online every day , but 1/3 are never online at all.

#Digifutures12 Digital Futures Conference – what I’m hoping to learn…

What do you want from your local services online ? What are you expecting to see when you look at your local councils website, or try to check out out your doctors surgery website for information about flu vaccine clinics ? Does your local council have a Facebook , twitter, YouTube or website presence?

The digital futures Shropshire conference is taking place on Monday, and I a shall be attending. I am interested in learning more about how to encourage people to use online services or information. What makes a website a hit or a miss? In this age of austerity I believe organisations have a responsibility to be making sure that they are making the best possible use of resources. This means spending some time considering who is actually using the information that is being provided digitally ? Who is looking at their web pages ? Which groups are missing out on this and what could be done to help change the current status quo ?

Internet has a massive potential for helping information spread about society, communities and special interest groups. As a GP I have an interest in helping people to find and use “quality” websites. I’m a big fan of the concept of getting the information out of the reservoirs and flowing down the pipes to the people that want it. I’m interested in using some of the tips and tricks that social marketing can offer to help to nudge people into a more informed position. What can we learn from those who work in the marketing industry? What examples of social media marketing can you spot at your breakfast table ? On the cereal packets?

Telehealth wiki? Or Spreadsheet

I don’t know if anyone already produces this – but wouldn’t it be great if there was a nationwide / worldwide chart of telehealth projects with clickable links.

Each project could be presented in a vertical column with key aspects of the projects listed down the side.

For each project we could indicate if it is uses remote monitoring ,video or telephone communications. ( or email, SMS etc)

A vertical column could indicate what parameters are being measured ; bp , pulse oxygen Sats from finger probe, temp, weight, peak flow ( for asthma) bm etc

Could list project start & end date & link to a review / interim report on the progress.

COPD Telehealth in East Lancashire

Remote monitoring in COPD ; how much & how often ?

As a GP associated with the East Lancs COPD Telehealth Project I have been considering what evidence there currently is for the model of Telehealth which is being proposed.

I was asked to join this project in spring 2012. The choice of providers & type of teleheath technology had already been agreed. The aim was to explore how the technology could be used in East Lancashire COPD patients, and shed some light on how much impact this could have on the patients experience of COPD and what impact it had on the healthcare workload.

We are planning on using remote monitoring technology to enable remote recording of the patients blood pressure, pulse oximetry and temperature. These readings are taken by the patient ONCE a day and sent to a remote monitoring hub which effectively aims to spot significant changes and decides if the patient needs to have contact with a clinical team member.

Patients will be selected on the basis of those at high risk of needing a medical admission in the following year using the Blackpool NHS Predictive Risk Tool. This tool is being incorporated into the GP patient record systems of practices which signup to working with the project.

Kaiser Permanente Mobile Apps Making Massive Impact

“I have a heart condition and have to get my Coumadin (#warfarin)checked regularly,” said Kaiser Permanente patient Richard Miller, 76, of Vallejo, Calif. “I get an alert that I have new test results, and they email me if I need to change my dosage. I also go to the encyclopedia to tell me what my lab results mean, and I can make and change appointments.”

The above paragraph illustrates the potential of mobile health applications to revolutionise the way we interact with our healthcare providers. Wouldn’t it be great if an email could be generated to let the patient know when their blood result is back and has been auctioned by their clinical team? Think of the savings in time and reduction in risk. Emailing the results means that the doctor knows that the result has been received ( could incorporate a read receipt system).

It would be fantastic If we could offer this in the UK. What are your views on this ? Please click on the speech bubble to leave a comment & share the link on your preferred social media. Thanks. @stuartberry1
websites for kaiser permeate blog& apps

A&E attendance for serious conditions 🆙3.4% in East Lancashire

The 999 demand over recent weeks has been very high, it continues to rise and shows no sign of easing. The Category A (life threatening 999 calls) have risen particularly sharply. The daily average Cat A incidents in May is 1062 incidents this is 13.2% up on May last year and is higher than December (our traditionally busiest time of any year), May is showing a 3.4% increase on April.

#elth #eastlancs

Save NHS Resources through improving Patient, Carers and Clinical Staff Access to online GP Health Record

[attachment=0]20120508 How we saved 20 a patient by offering records access.pdf[/attachment]

Dr Rimon Chowdhury , one of my partners at Reedyford, emailed this link to me recently. There was a piece in Pulse about the benefits of allowing patients to access their own records. This can save money through reducing duplication of investigations, less missed appointments and can facilitate #selfcare

I can envisage a time when patients attending A + E are able to allow the clinical staff access to their online GP notes so that they can see what medication they are on , and possibly even leave details of a suggested management plan, follow up arrangements in trauma clinic etc.

The main challenge would be how do you roll this out to the patients? I propose that a roll out programme be developed that would free up admin time to lead groups of patients through a familiarisation process that would lead to them being given a kind of “online access driving licence”

If videos are made, and the learning prescription tried, and refined the process could become more slick and could even be delivered online. It hasn’t been clear what the possible total costs of doing this would be.

Please comment below so I can add your views to this posting

Language Podcasts or Video to facilitate spread of Health Information

Language lessons Via podcast or webcast , YouTube Vimeo site to facilitate language that is used when visiting the doctors. In polish, Lithuanian and Urdu.

Could feature health information so there are several strands to this. I have been approached to work with the community radio in producing some health information podcasts – this could be part of this . Builds engagement in the community , breaks down barriers , and improves communication skills.

Contact me @stuartberry1 or retweet this / share the idea.

We have very limited resources in the nhs to support these ideas. Social media can help to spread the ideas, build the momentum & encourage our leaders and councils to consider them in their plans.

Vitamin D Public Information Campaign. Idea for saving Money

Vitamin d education. I could easily request via d levels (£30) and treat for fit d deficiency ( £40 ) a year for most of my patients . > 90% have low levels. As the population realises that many memebers of the community have low levels this causes more people to come forward. The vitamin d djinn or genie has come out of the bottle.

Vitamin d deficiency wasn’t something we looked for or treated 3 years ago. I suspect it is one of the fastest growing expenditure item on the drugs budget.

It is also not confined to the Asian population. I have encountered many ung white adults with very low levels of vitamin d as well. This should not just be attributed to modesty clothing.

Proposal is that we could devise a programme to raise awareness of the lifestyle factors that cause vit d deficiency. Encourage people to see vit d as a part of their diet ( we don’t routinely prescribe protein on nhs )

I suggest we adopt the line of one or two courses of vit d replacement to build up levels to therapeutic norm , then advise that the patient maintains this through diet. People mayb say they don’t want to take or buy CID liver oil supplements or eat fish – but I don’t believe the nhs can support vit d supplementation long term.

This could be costed out & worked up in more detail if there is enough interest.

How to Get the Most out of Your 10 Minute GP Consultation

This is the roundup of the suggestions from the twittersphere about how to get the most out of your 10 Minute appointment with the GP. Big Thanks to all the comments and clicks this got … clearly this was worthwhile doing and is not finished yet. #10minsGPguide

Please feel free to post more comments. These have been collated using @Grabchat

Notes from RCGP 2011 conference

Oldham : knee decision aid 6/10 patients modified their expectations of knee replacement as treatment of osteoarthritis after reading the decision aid from nhs direct http://www.nhsdirect.nhs.uk/en/DecisionAids

” if they don’t have Internet access at home they can come one hour early and do it with a helper. One room with pcs costs £20,000 = 3hip replacements”

http://www.pmskp.org/ pendle mak partnership

from Hippocrates to Hugo and back again humanistic lessons
These look like the slides used by Anna louise Kirkengen

http://www.ntnu.no/c/document_library/get_file?uuid=d787695d-79cb-4611-98ce-9e815683c822&groupId=10297

Dementia Care Suggestion

So the UK government has decided to launch a three-pronged initiative to help those who have dementia or care for someone who has it. Their plan is to encourage the early detection of memory problems, improve the quality of care received in care homes, and have also pledged to invest in research that may one day offer a cure.

These are great ideals – the problem is that they are coming at a time of NHS cutbacks. Care agencies are businesses working to a model that needs to generate profits in order to continue to deliver the service. If we want better care then we will have to pay for it one way or another.

Dementia clinics or memory assessment clinics have a long waiting list and patients can face intervals of several months between outpatient appointments. Early detection of dementia will be useful for the carers of these patients as hopefully it will enable them to link up with local support groups earlier, but unless extra investment goes into providing more dementia clinic appointment slots the patients will inevitably be looking at an even longer wait before their memory clinic appointments.

COPD Proposed Pilot to Facilitate SelfCare in East Lancashire

Self-care for patients with COPD – Formal Proposal of the Pilot

Background

An estimated 3 million people have chronic obstructive pulmonary disease (COPD) in the UK. Most people are not diagnosed until they are in their fifties. However more people are being diagnosed with COPD at a younger age – from their late thirties to their early fifties. COPD is a condition that makes breathing difficult. COPD is a broad term that covers several lung conditions, including chronic bronchitis and emphysema. It usually develops because of long-term damage to the lungs from breathing in a harmful substance (such as cigarette smoke or chemical fumes). The treatments available for COPD help people to breathe more easily, but they don’t repair the damage to the lungs.

COPD Selfcare Proposal

We are knocking about with some ideas for a COPD self-care project. I would appreciate some feedback before getting the idea worked up in more detail. This is the more patient friendly version. The more formal proposal is here ;

http://simplestuffblog.wordpress.com/2012/01/31/copd-proposed-pilot-to-facilitate-selfcare-in-east-lancashire/

Please comment by clicking on the speech bubble.

I am a GP ( family physician ) in Lancashire . I set up a weight loss challenge last year that was a pilot for combining health promotion with an element of competition to make it more fun, and try out some gamification concepts. I have been wondering what we could try next. COPD is another health issue that we are not short of in Lancashire.

COPD is a breathing disease that is much more likely to affect you if you smoke. It starts off as a mild irritating cough but can progress to life limiting dependence on piped oxygen. The only thing that stops the progress of the COPD is stopping smoking. Exercising more can help people with COPD regain some of their quality of life. The “pulmonary rehab” tends to be offered to the patients with more severe disease, once they have had a couple of hospital admissions for chest infections. The patients with more mild COPD may not realise that they have it – attributing their cough to their smoking habit. A special breathing test called spirometry is used to help diagnosis. It is available in many GP practices.

Two more Cartoons Explaining the tragedy of the commons concept

Both are worth watching and offer different takes on an idea that is completely relevant to how we use healthcare systems today

Enjoy !

Epigenetics – your prebirth fitness programme

Epigenetics
Work in progress

medical matters bbc podcast

This BBC podcast explains why the environment that your mother was exposed to can influence the health of your children. Your vulnerability to specific conditions seems to be influenced by the conditions your parents were exposed to. Adverse environments can cause genetic damage. The legacy of poor nutrition can span generations. It could explain why heart disease is more common in deprived populations.

There is a suggestion that the higher prevalence of obesity,diabetes and radio vascular disease in the southern states of America can be explained by the hardships the population experienced in the American Civil War.

The environment that the male finds themselves in also has an impact on the vulnerability of their children to particular metabolic diseases.

Epigenetics Wikipedia entry

Governing the Commons ; what can it offer the NHS

Click here to be taken to post that suggests what the NHS can learn from the Elinor Ostrom’s book “Governing the Commons. The Evolution of Institutions for Collective Action”