Flo Telehealth

Flo (Florence Simple Telehealth) is a text messaging system which can help patients understand their condition. From reminders to take medication, use an inhaler, or attend appointments to remote monitoring of blood pressure readings, or measurements of pain level or depth of depression, Flo helps patients to change their behaviour, and become regular medicine users, or partners in the management of their hypertension or weight loss. Although Flo is most commonly used for hypertension, a little imagination can adapt the messages to help with any situation where reminding or monitoring is beneficial.

Messages of encouragement can help people to quit smoking or drinking alcohol, while regular requests for readings can instil better understanding and control of their condition. Although only a computer-generated text message, people often regard Flo as a person, and have described ‘her’ as ‘a friend’ or ‘ a medic in my pocket.

The situations Flo is often used for include: Asthma, COPD, diabetes, hypertension, reminders for medication, weight management, smoking cessation, reminders to take inhalers, depression and anxiety, early dementia, heart failure, continence, reminders to attend for appointments in 12 weeks (eg for vitamin B 12, or Depo Provera), or for repeat contraceptive pills after 6 months. A full description of common Flo protocols is in the resources section. A number of clinicians have recorded comments on the use of Flo in different situations. Videos of this can be found below.

For asthma, Flo reminds patients or their parents to administer their preventer inhaler each day. In addition, patients can be asked for a daily peak flow reading, to have a better understanding about when they are developing an infection. Readings always receive a reply, usually reassuring the patient if in a normal range, but can issue warnings to seek help if they are far from what is usually expected. Advice may be given daily, to encourage adherence to better habits, or to make suggestions about actions that would be beneficial. The patient should have a management plan as well as sign a consent form. Advice in the plan depends on the patient’s individual ability when in good health, so this is usually measured at an annual review, and written on the management plan. There are explanatory patient leaflets in the resources section.

With COPD, the patient also needs to sign a consent form, be given a management chart, a thermometer, and preferably a pulse oximeter as well. They should also have some ’rescue medication’ – steroids and antibiotics- which they can put in a cupboard to take when appropriate. The patient is asked each day to compare the colour of their sputum with a chart on their management plan, and text this to Flo. If the sputum colour suggests an infection may be starting, they are asked further questions about temperature and shortness of breath. If they have green sputum, a high temperature, and are short of breath, they are told to take their rescue medication, and inform the surgery if they are not improving within two days. They are also asked daily for a reading of their blood oxygen level, which is recorded together with other information on the Flo website, and can be accessed from the clinic or surgery. For patients, being part of the Flo programme can help them to understand when to take their rescue medication, and also when it is not necessary to be worried, so they learn how to manage their condition. There are explanatory patient leaflets about this in the resources section.

Using Flo for HYPERTENSION can help patients understand about how their lifestyle affects their blood pressure, and the importance of taking their antihypertensive medication. Patients need a blood pressure monitor and a management plan, and to sign a consent form. There are different choices in Flo for ready-made programmes of messages, starting with a 7-day programme, with readings twice a day to determine if a patient really is hypertensive. A two-month programme to get the blood pressure under control while starting antihypertensives makes the blood pressure readings, sent from a relaxed patient at home, more reliable than those taken by an anxious patient who has rushed to keep an appointment at the surgery. Further programmes, where the blood pressure readings are taken at weekly and monthly intervals can be used once the hypertension is controlled. For patients with CKD or diabetes, a programme using lower normal ranges of BP readings can be used to achieve greater blood pressure control. There are explanatory patient leaflets in the resources section.

REMINDERS TO TAKE MEDICATION are the simplest, yet very effective intervention. Patients easily forget to take their tablets or inhaler, and apart from the wasted cost of unused medication, the outcome can be life-threatening. A reminder by Flo can be set to be sent at several different times a day if needed, and can establish a pattern of regular dosage, which should help the patient’s control of their condition. Consider whether you need to use a consent form: the patient only receives messages, and generally does not need to respond; however, if they feel the messages are intrusive, they may feel they never expected this. All they need to do is to text ‘STOP’ and the messages will cease. There are explanatory patient leaflets in the resources section.

Often there can be an issue which clinicians find difficult to manage, which Flo can help with. Nurses have often said that patients forget to make an appointment for their next six months’ supply of the contraceptive pill. When they realise that they have run out, they want an immediate appointment, and cause consternation, as there is not always a doctor who can easily sign a prescription at short notice. So there is now a reminder in Flo to make an appointment for the contraceptive pill check, which is sent out at 5 months, and keeps reminding the patient every few days, until they reply that they have made the appointment.

Flo has great potential for many situations, and can be adapted to help in unexpected ways. Below in one of the videos, you can watch how it is used to help someone with Asperger’s and learning difficulties, who needs to be sure that he has locked the house at night.

In Staffordshire University, Flo was adapted to successfully help new undergraduates settle in, by reminding them to get their library card, prepare their assignment, meet support staff, etc, in order to prevent many students leaving the course after a few weeks.

So it’s up to you to think how you would like to use Flo to help your team or your patients!