GPs Warn Over Digital Divide As Alexa Offers Health Advice

Peter Russell

July 13, 2019

NHS-verified health information was made available this week for users of Amazon's voice-assisted Alexa device.

Amazon's algorithm now uses information from the NHS website to provide information on treating and managing conditions such as migraine, flu, and chickenpox.

Voice search technology has become increasingly popular, and by 2020, half of all internet searches are expected to be made through voice-assisted technology.

The Department of Health and Social Care said the link with Amazon had the potential to reduce pressure on GPs and other NHS services.

NHSX, a new programme concerned with improving health care through the use of technology, would look at ways of making more NHS services available to all patients through digital technology, it said.

Matt Hancock, Secretary of State for Health and Social Care, said: "We want to empower every patient to take better control of their healthcare and technology like this is a great example of how people can access reliable, world-leading NHS advice from the comfort of their home, reducing the pressure on our hardworking GPs and pharmacists.

"Through the NHS Long Term Plan, we want to embrace the advances in technology to build a health and care system that is fit for the future and NHSX will drive this revolution to bring the benefits to every patient, clinician, and carer."

The Royal College of General Practitioners (RCGP) said voice-assisted searches had the potential to help some patients but that the Government must guard against creating a 'digital divide' between those who could afford the technology and those who could not.

"While some patients might want to use symptom-checkers in this way, not everyone will be happy to do so and many people will not be able to afford the expense of this equipment, thus widening health inequalities and making access to care even harder for some of the most vulnerable people in our society," said RCGP Chair Prof Helen Stokes-Lampard.

The RCGP said it was also important that older, frailer people with complex healthcare needs did not rely on this technology as their sole source of health advice.

Maternity and Perinatal Care Report

An improvement in access to mental health support for pregnant women and new mothers was seen in the latest National Maternity and Perinatal Audit (NMPA).

The second organisational report provided a snapshot of NHS maternity and neonatal services in England, Scotland, and Wales.

It showed that 93% of trusts in England participated in a perinatal mental health network compared with 70% in 2017. Health boards in Wales saw an increase from 71% to 86%, while the increase among health boards in Scotland was from 43% to 79%.

However, no improvements were seen in smoking cessation and weight management support, which was available at 72% of trusts and 45% of health boards.

Prof Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists (RCOG), commented: "The report highlights that workforce challenges persist among the obstetrics and gynaecology profession, while demands on maternity and neonatal services grow."

The audit is a collaboration between the RCOG, the Royal College of Midwives, the Royal College of Paediatrics and Child Health, and the London School of Hygiene & Tropical Medicine.

Lyme Disease Quality Standard Published

The National Institute for Health and Care Excellence (NICE) published its quality standard for Lyme disease this week, which covered diagnosing and managing Lyme disease in people of all ages. It also included raising public awareness about preventing the disease.

The statements said that:

  • People presenting with erythema migrans are diagnosed and treated for Lyme disease based on clinical assessment, without laboratory testing

  • People with suspected Lyme disease without erythema migrans who have a negative enzyme-linked immunosorbent assay (ELISA) test carried out within 4 weeks of their symptoms starting have the test repeated 4 to 6 weeks later if Lyme disease is still suspected

  • People with Lyme disease have initial antibiotic treatment, with the antibiotic, dosage and duration determined by their symptoms

  • Local authorities organise health promotion activities with organisations in their area to raise public awareness about how to prevent Lyme disease

The statements are designed to drive measurable quality improvements in care. They will be drawn to the attention of GP surgeries, community pharmacies, A&E, and out-of-hours services to help ensure a high standard of care.

Caudwell LymeCo charity, which contributed to the quality standard, said it hoped the statements "go some way towards improving diagnosis rates in early stages, preventing more people from becoming chronically ill".

Hearing Loss in Adults

A final quality standard on assessing and managing hearing loss in adults was published by NICE.

It included people presenting with hearing loss for the first time in adulthood whether it started in adulthood or earlier. It described high-quality care in priority areas for improvement.

The statements said:

  • Adults with earwax that is contributing to hearing loss or other symptoms, or preventing ear examination or ear canal impressions being taken, have earwax removed in primary care or community ear care services

  • Adults with sudden onset of hearing loss in one or both ears that is not explained by external or middle ear causes are referred for immediate or urgent specialist medical care

  • Adults with rapid worsening of hearing loss in one or both ears that is not explained by external or middle ear causes are referred for urgent specialist medical care

  • Adults presenting for the first time with hearing difficulties not caused by impacted earwax or acute infection have an audiological assessment

  • Adults presenting with hearing loss affecting their ability to communicate and hear are offered hearing aids

  • Adults with hearing aids have a follow-up audiology appointment 6 to 12 weeks after the hearing aids are fitted

Dapagliflozin for Treating Type 1 Diabetes

NICE adopted a positive stance on dapagliflozin (Forxiga, AstraZeneca) in combination with insulin as an option for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2 when insulin alone did not provide adequate glycaemic control.

In final draft guidance, it said the treatment would be suitable when:

  • Patients were on insulin doses of more than 0.5 units/kg of body weight/day

  • Patients had completed a structured education programme about their condition

  • Treatment was started and supervised in a hospital diabetes clinic

Evidence from clinical trials showed small improvements in haemoglobin A1c [HbA1c] levels, and weight loss, and very small improvements in quality of life, when patients were treated with dapagliflozin plus insulin, compared to placebo plus insulin, NICE said.

'Yes' to Patisiran for Rare Condition

NICE recommended patisiran (Onpattro, Alnylam) as an option for treating the rare condition hereditary transthyretin-related amyloidosis in adults with stage 1 and stage 2 polyneuropathy.

In draft guidance, it said evidence suggested that the ribonucleic acid interference agent that suppresses transthyretin production by the liver reduced disability and improved quality of life. There was also evidence suggesting that patisiran could provide long-term benefits by stopping the progression of amyloidosis, and potentially reversing it.

The list price of patisiran is £7,676.45 per 10 mg vial. However, the manufacturer had agreed to supply the drug to the NHS at a confidential discount.

ELISA Tests

Enzyme-linked immunosorbent assay (ELISA) tests showed promise for therapeutic monitoring of tumour necrosis factor (TNF)-alpha inhibitors in rheumatoid arthritis, NICE said.

However, in final diagnostic guidance, an appraisal committee decided not to recommend their routine adoption in rheumatoid arthritis at this stage because of insufficient evidence. The next review will take place in 2022.

The tests are Promonitor, IDKmonitor, LISA-tracker, RIDASCREEN, MabTrack, and in-house tests used by Sanquin Diagnostic Services.

'No' to Bladder Pain Syndrome Treatment

Pentosan polysulfate sodium (Elmiron, Consilient Health) was not recommended for treating bladder pain syndrome with glomerulations or Hunner’s lesions in adults with moderate to severe pain, urgency, and frequency of urination, NICE said.

Clinical trials suggested that pentosan polysulfate sodium might be more effective at relieving pain than placebo. However, in draft guidance, appraisers said there was a lack of high quality evidence.

A consultation period runs until 1st August with final guidance expected in November 2019.

Plaque Psoriasis

Risankizumab (Skyrizi, AbbVie) was recommended as an option for treating plaque psoriasis in adults.

NICE said that the biological therapy could be offered only if:

  • The disease was severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more, and a Dermatology Life Quality Index (DLQI) of more than 10

  • The disease had not responded to other systemic treatments, including ciclosporin, methotrexate, and phototherapy, or these options are contraindicated or not tolerated

In final draft guidance, an appraisal committee said that clinical trials showed that risankizumab was more effective than adalimumab (Humira, AbbVie), and ustekinumab (Stelara, Janssen) at treating the condition.

Approval was subject to the manufacturer supplying the drug at an agreed discount.

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