Royal Free adopts app to manage liver patients in the community

Royal Free London NHS FT has introduced a new tool to help manage liver cirrhosis patients in the community.

The CirrhoCare® App allows clinical teams to monitor patients with liver disease and spot any potential deterioration while they are at home.

Liver consultant Professor Raj Mookerjee and his team, launched a pilot of the technology, where patients were asked to take a range of daily measurements including blood pressure, weight and their ECG (using simple hardware technology). In addition they are also asked to do a modified ‘Stroop test’ – a simple animal naming test – to measure their brain function.

The trust said: “Its been introduced to manage patients at the end stage of liver disease, who often experience a rapid decline in their health which can result in multi organ failure and invariably acute admission to hospital. They are often in and out of hospital and may require intensive care treatment, including support with ventilation and their kidneys.”

Professor Mookerjee found that patients using the technology were “much less likely” to need hospitalisation compared with those not using it – and if they needed admitting, patients using the app were likely to be discharged sooner and needed fewer outpatient procedures, such as abdominal fluid drains.

Professor Mookerjee, said: “The participants said it was easy to follow the instructions, gave them a focus and a better understanding of their condition and it helped them feel more in control.

“These are very sick patients for whom the average mortality may be as high as half within six to 12 months. For us, it was very helpful because we could tell if, for instance, someone was struggling with their brain dysfunction or fluid accumulation, and arrange for changes to their treatment in the community, or if needed, bring them into hospital to help them.”

The results of the study were announced earlier in the month, and the full study has now been submitted for publication. The study notes eight liver-related admissions for the group using the app compared with 13 in the observed control group. For the group of patients using the app, hospitalisations averaged five days, which was shorter than that seen in the control cohort.

Professor Mookerjee, added: “Up until now, this group of patients has had to rely on reactive medicine when they became sick, which was particularly an issue during the bed-pressures of COVID-19. Now for the first time, we have the technology to monitor and manage cirrhosis remotely and proactively, and the information patients provide, gives us a daily insight into their health which means we can intervene earlier. This is very much personalised treatment, whilst empowering patients to be more involved in their care and be aware of changes to their condition.

“We had been wanting to see if we could do more in the community but COVID-19 hastened this because we were needing to reduce footfall in the hospital.”

The study has been funded by Innovate UK and granted an extension to continue.