The Florence Community of Practice is a unique environment harnessing clinical innovation to rapidly expedite the adoption of safe, innovative digital healthcare. Over the past 10 years through the passion and commitment of Community of Practice members, a robust foundation of independent evidence has organically grown.
This wide ranging evidence base, regardless of Flo’s application or patient demographic, consistently demonstrates a direct causal clinical effect and improved efficiency for healthcare providers. Unsurprisingly this has attracted international attention enabling the introduction of her US and Australian cousins (Annie and Nellie.). Although these locations are very different, Flo, Annie and Nellie have all continued to demonstrate the same positive and sustainable outcomes.
Whether using either Flo, Nellie or Annie, people feel that they have a ‘human’ connection to their healthcare provider, making them feel that they are not facing this alone. They have a friend in their pocket who will help to mitigate the significant mental health issues that self-isolation may cause in many patients.
South Eastern Melbourne Primary Health Network (SEMPHN) have shared a selection of short patient stories from across their clinical pathways supported by Nellie bringing this evidence to life. Nellie has been helping South Eastern Melbourne Primary Health Network (SEMPHN) patients to become an active partner in their own health for over two years.
Patient quotes:
“I tend to describe Nellie as a cheerleader to help them stay on track with the action plan.”
“So simple, and yet powerful.”
We have gathered together some short patient stories which capture some of the life changing work.
Case 1: Ruling out hypertension
Mrs JW is a 50 year-old woman with pre existing anxiety, occasional mild depression, domestic stress, and chronic pain resulting from a previous workplace injury. As part of her ongoing clinical management, Mrs JW’s blood pressure readings had been routinely taken during consultations at her practice over the past few years and were consistently both erratic and elevated with blood pressure readings up to 190 systolic and 110 diastolic.
During an appointment at her practice, Mrs JW explained that she was due to travel to South East Asia in three weeks’ time, which was adding to her stress as she was worried about travelling and also the possible risks of being away from home with high blood pressure.
With Mrs JW’s history in mind and keen to be able to either diagnose and subsequently treat her possible hypertension, or provide reassurance that it had been excluded before she travelled, Mrs JW’s clinician recommended that she accessed Nellie to help her to record daily blood pressure readings. At the end of the period, Mrs JW’s GP was able to review the daily submitted readings and confidently confirm that she did not have hypertension, and she was able to go on holiday with the reassurance she needed.
The experience with Nellie was stress free for the patient as there was no requirement to schedule additional appointments for Mrs JW’s blood pressure readings at the practice, or to have to learn how to download and use an app during the short amount of time before her holiday. In addition, Mrs JW was able to send more accurate readings as she was in a more relaxed and familiar environment. Her GP was not involved during those two weeks as they were confident that Nellie would advise the patient to get in touch with the practice if it was appropriate to do so. Mrs JW’s blood pressure readings were simply reviewed by the practice at the end of the two weeks and an informed exclusion of hypertension was able to be made.
You can watch this video of Dr Geoff Campbell explaining this story here.
Case 2: Helping to take back control with a simple medication reminder
Ms DM is a 64 year-old woman with a history of acquired brain injury (ABI) following four cerebrovascular accidents in 2014 which affects her short term memory. She also has type 2 diabetes, hypertension and suffers from depression. Ms DM was a new patient to the general practice nurse-led clinic and presented with uncontrolled BP ranging from 150/90 -168/98 and a HbA1c of 8.6%.
To help Ms DM remember her medication and take control of her hypertension, Nellie was introduced to her at her care planning session, and she was happy to take up the opportunity for daily prompts to take her morning medication as prescribed. Ms DM was on this program for several weeks and with Nellie’s help, only missed her anti-hypertensive medications on two occasions! As a result, her BP had reduced to 130/85, and her fasting blood glucose levels were also beginning to reduce.
Case 3: Preventing cerebrovascular accidents by walking with Nellie
Mr CI is a 69 year-old man with a history of cerebrovascular accidents during the last 18 months. He had recovered well and attended a rehab program yet had found it difficult to maintain his motivation to keep active which was a key component of his recovery. With his weight and blood pressure creeping up, Mr CI was introduced to Nellie and really liked the idea of being accountable for his daily step measurements.
On a daily basis for 3 months, Nellie provided Mr Cl with motivational messages to get him moving more and also helped to track his daily step count to maximize his motivation. As a result, Mr Cl was able to maintain his increased activity at a level of 5-6,000 steps a day and consistently demonstrating such positive sustained behavior change, Mr CI no longer needed Nellie to motivate and prompt him so has been able to be discharged from the program.
Case 4: Walking with Nellie helped to save life
Mr and Mrs S are a retired couple and both have chronic health conditions. Mrs S had undergone a knee replacement 3 years ago and has experienced painful knees ever since, which has limited her capacity for physical activity.
Mr S was diagnosed with Type 2 diabetes 40 years ago which unfortunately has led to partial blindness. In order to help manage his diabetes, Mr S was treated with 30 units of insulin/d and also has a pacemaker.
In a care planning appointment both Mr and Mrs S identified weight loss as a goal for them both and decided to sign up to a walking protocol with Nellie in January 2018.
Nellie provided daily motivational messages aimed at encouraging exercise whilst also keeping track of their daily walking.
After 3 months of starting with Nellie:
- Mrs S lost 7kg and is now walking pain-free. Her glucose has reduced by 4.2
- Mr S weight reduced by 10KG, HbA1c 4.3%, BP 180/95 > 120/65, Insulin dose 30 u/d > 5 u/d with a significant reduction in the frequency of hypos.
- Mr S continues to walk most days and tracks his daily step count via his own pedometer, with occasional motivation messages from Nell.
Simple Shared Healthcare were lucky enough to meet with Mr and Mrs S’s GP in 2019. Their GP said in plain terms that if it hadn’t been for this behavior change towards walking regularly, Mr S would not be here today.
You can watch the video about their story here
Case 5: Informed decision making to reduce BP
Ms M is a 70 year-old female with Type 1 diabetes, which was diagnosed at the age of 30. She had presented with microvascular complications and more specifically, deteriorating retinopathy. She spoke to her diabetes educator, and her main concern was the potential for losing her eyesight. Her glycaemic control was excellent (reduced to a HbA1c of 6.5% from 8.0% 12 months previously), but she also had a history of hypertension and was on anti-hypertensive medication.
At the time of her consultation her blood pressure was 145/85 mmH and her goal was to reduce microvascular risk factors, so she chose to focus on optimizing her blood pressure control. It was not clear whether her raised blood pressure was related to suboptimal control or white coat syndrome, so the patient commenced on Nellie with a hypertension protocol. Over the following 4 weeks she measured her BP at home and submitted the results via Nellie. Nellie responded to her raised blood pressure readings to reinforce the target blood pressure range and due to more accurate readings, her GP was able to make a more informed decision to titrate her anti-hypertensive medication and increased her dosage, which resulted in her systolic BP consistently being less than 130mmHg.
Nellie’s interactions have helped Ms M to understand how to manage her BP better to reduce the risk of further deterioration of her retinopathy (as well as other vascular risk factors), and has provided her with reassurance that she can continue to control her conditions in future.
Case 6: Nellie supporting patients in more than one way
After the recent loss of her husband, Mrs J was finding it difficult to motivate herself to go out and exercise. Recognizing this, in October her clinician introduced her to Nellie as a friendly nudge towards becoming more active. Nellie first encouraged Mrs J to walk every Monday to Friday, but Mrs J felt that she missed Nellie’s messages at the weekends. Therefore after talking to her clinician about this, her clinician was able to personalize Nellie’s program for her to provide support 7 days a week.
After 1 month, Mrs J had lost 4 kilos and was “over the moon” with Nellie.
for supporting her to get out and be more active, which left her feeling a lot happier within herself. By December, Mrs J had lost 12 kilos!
Although this protocol with Nellie was designed just to motivate people to walk more, because of Nellie’s unique persona and supportive messages, it has meant a lot more for Mrs J.
Her clinician also commented, saying that “it’s been lovely to see Mrs J become happier during this difficult time.”
Case 7: Personalization of messages instrumental to BP management
A patient with multiple chronic conditions identified a lack of motivation to check his blood pressure due to a stressful and demanding job, explaining that he didn’t have the time or mental capacity to remember to check his blood pressure throughout the day. He acknowledged the impact his uncontrolled blood pressure was having on his recently diagnosed Type 2 diabetes, which had also become uncontrolled.
After speaking to his clinician, they were able to personalize Nellie’s interactions so that he received them at a time that suited him during his busy day. As the patient knew Nellie would prompt him at a convenient time, he didn’t have added stress about remembering to take his blood pressure readings, and due to these timely prompts, over the next four weeks his blood pressure testing became routine, resulting in his blood pressure being more controlled and feeling empowered to deal with his diabetes.
Case 8: Simple inhaler reminder helped patient control and understand their asthma
A 24 year old female patient with chronic asthma often forgot to take her preventer inhaler because of long working hours, which led to frequent exacerbations and the use of her Ventolin (reliever) inhaler almost daily. Due to this, she was suffering from an increased amount of chest infections which understandably was impacting on both her mental and physical health and wellbeing.
The patient joined Nellie with a medication reminder protocol, where she received daily prompts to remind her to take her preventer inhaler. The reminder was tailored to her time schedule and specifically told her which inhaler to use, this not only helped her to take her medication but also began to build her health literacy around the treatment of her asthma.
Although the patient had only been receiving messages from Nellie for a short amount of time, during the first week healthy habits began to form and she remembered to take her preventer every day and hadn’t needed to use her reliever once, which was a huge improvement.
Case 9: Exercising with Nellie and… Dr Who!
DA, an overweight 65 year old man with chronic pain and raised blood pressure, struggled to motivate himself to exercise regularly. DA’s Chronic Disease Coordinator suggested introducing Nellie alongside a health coaching program to enhance DA’s motivation to walk, and provide welcome encouragement when he achieved his goal.
While walking, DA likes to watch episodes of his favorite TV show, Doctor Who. He even came up with the idea of setting his message tone to the Doctor Who theme when Nellie messaged him. For DA, this linked walking, something that he previously found laborious and boring, with something he truly enjoyed, flipping the negative association to positive.
After four months of encouragement from Nellie, DA established a daily routine of waking up in the morning and getting straight on the treadmill. He lost over 7kg of weight and 12cm around his waist by steadily increasing the time he spent on his treadmill, and now has no need for Nellie’s prompts.
Over this time, his goal developed from 20 minutes of slow paced walking to over an hour of brisk walking at an incline! He has also committed to an overhaul of his diet, and said “my wife has stopped cooking with salt”. DA now aims to lose another 8kgs over the next 6 months and further improve his diet, limiting less healthy treats to once a week.
We’ve been told his wife is relieved he’s now built the habit because she no longer hears that ringtone!
Case 10: Nellie as a self-help support for improving mental health
Ms S is a 47 year-old woman with a history of Post Traumatic Stress Disorder, fibromyalgia, depression and a few other chronic medical conditions. Her Care Coordinator saw her to review her care plan back in June 2018 and talked about Nellie. Ms S was going to consider Nellie, then rang her Care Coordinator about a month later and decided that she was ready to start.
Ms S commenced with Nellie’s mental health protocol and interacted with her each day to self-rate her mood and energy levels in real time. She“ totally loved it “ and ended up staying on it for 3 protocol cycles as she was able to re-start the protocol. Ms S even showed her Psychologist her interactions with Nellie on her phone and started sharing her progress with them. She told her Care Coordinator about the story of her grandmother who was called Nellie, so she affectionately named her Granny Nellie.
Ms S was living at home with her mom and was quite withdrawn, socially, and really looked forward to receiving Nellie’s messages every morning, and was happy to follow the instructions and suggestions that Nellie provided in response to her self reported mood and energy scores.
She created a diary, which she purchased at one of the later sessions, where she was able to show her Care Coordinator that she’d been documenting all the little activities that she’d been doing as suggested by Nellie, such as making a present for someone, contacting people, writing a letter, listing things she had enjoyed. She loved it and it had really improved her mood over that time.
She was on Nellie until December 2018, with a couple of breaks. At the end Ms S was self-rating her energy levels at a 7/10 and her mood at 6/10 and she did start off quite low, at 1’s and 2’s, so she went up and down, but she definitely loved it and having Nellie for support made a big difference.
