Telecare Talk Pilot Evaluation

The Telecare Talk pilot program, a proactive telehealth initiative run by Leeds City Council in conjunction with NHS partners, used telephone calls to support service users in improving their health and well-being. The program targeted a small cohort of 200 service users between April and September 2018, with a total of 40 clients receiving calls. The demographic of these clients was predominantly female (70%, n=28) with ages ranging from 30 to 83 years old. The majority of calls focused on the clients' first self-management goal (with a maximum of three per client). The program incorporated personalized care planning and a health coaching approach where referring staff and service users collaborated to identify support needs, set goals, and monitor progress. A key finding was that the service proved more effective with clients who possessed specific and readily achievable goals, evidenced by the success rate observed within the Falls Prevention Team's exercise program.

Opinions on charging for the Telecare Talk service were divided. Some viewed charging as a viable option, while others considered it a barrier to recruitment. This suggests a need to carefully consider pricing strategies to balance revenue generation with accessibility. The evaluation further revealed that the service's suitability varied across different client groups. Clients with specific and well-defined goals, such as those referred by the Falls Prevention Team (for exercise class attendance), benefited more from the program. Conversely, clients with complex needs, such as those with mental health issues or dementia, were perceived as less suitable for a solely telephone-based support model. This indicates the program may not be universally beneficial and requires further development or targeting towards more homogenous groups with clearly defined health goals.

The program's effectiveness was also considered in relation to pre-existing telecare services in Leeds. Some referrers felt the service duplicated their own work, suggesting a need for better integration with existing infrastructure to avoid redundancy. The evaluation team also investigated Tunstall Televida, a similar telecare service operating in Spain. While both services shared similarities, a key difference was the more proactive approach in Spain, where a larger proportion of calls (60%) focused on wellbeing checks, reminders, and health information. This more proactive methodology yielded positive outcomes, with 92.3% of users in the Spanish model reporting decreased loneliness and 35% fewer calls made to emergency services. This comparison highlighted a potential area for improvement in the Leeds Telecare Talk pilot. The results indicate that a more proactive and comprehensive approach might improve the program's overall effectiveness and impact.

Only 13% of clients achieved their first self-management goal during the pilot. While call handlers reported an improvement in client health, service users had difficulty articulating concrete health improvements resulting from the program. This suggests a gap between perceived and actual benefits. The evaluation also uncovered several significant challenges in delivering the pilot program. These included staff time constraints (due to concurrent emergency response duties), incomplete referral forms leading to difficulties in understanding client needs, and insufficient training for call handlers, particularly in dealing with clients with mental health issues. The limited number of trained staff and managers exacerbated these time constraints. These findings highlight crucial areas for improvement in resource allocation, training, and program design.

Feedback from service users and referrers provided valuable insights into the program's strengths and weaknesses. Some service users appreciated the support, especially when it complemented other services like the Falls Prevention program. However, others highlighted the need for more information, longer initial calls, and clearer explanations of the service's purpose. The name 'Telecare Talk' also caused confusion, being mistaken for telemarketing. Referrer feedback was diverse, ranging from positive experiences (good communication, helpful videos) to concerns about service duplication and its suitability for clients with complex needs. The overall perception was that the service was more effective for clients with straightforward, specific goals. This underscores the importance of clear communication, user-centered design, and potentially a name change to avoid confusion.

The evaluation prioritized a holistic approach, centering on the perspectives of project staff, partners, stakeholders, and service users. To maintain methodological rigor, a Theory of Change (TOC) framework (Judge and Bauld, 2001) was employed. This framework helped to explicitly define the connections between the project's objectives and the context of its implementation. The researchers' previous work underscored the importance of understanding the contextual factors influencing program success or failure (South et al., 2012). This contextual awareness was crucial in interpreting the collected data and drawing meaningful conclusions about the pilot program's effectiveness. The use of a TOC framework ensured that the evaluation was not only data-driven but also considered the complex interplay of factors influencing the Telecare Talk program's overall impact.

The Telecare Talk referral process received mixed reviews. While some referrers found the paperwork straightforward and clear, others described it as too long and confusing. This disparity suggests a need for streamlining the process to improve user experience and encourage higher referral rates. Technical issues also emerged, with some referrers encountering computer system incompatibilities, forcing them to resort to postal referrals. One referrer explicitly preferred the postal method, highlighting potential problems with the digital interface. The contrasting experiences highlight the need for a more user-friendly and robust referral system, ensuring compatibility across different organizational platforms and offering alternative methods for submission to cater to individual preferences and technical capabilities.

A significant challenge encountered was the low number of referrals to the Telecare Talk program. Many interviewees, whether they had made referrals or not, believed the service didn't meet the needs of their clients. Concerns were raised about the suitability of telephone support for clients with mental health issues or dementia. The lack of understanding of the service’s offer among potential clients was also identified as a barrier. In addition, some referrers expressed uncertainty about the service and its integration with their existing workflows. The inflexibility of scheduling calls also proved to be a deterrent for some potential referrals. The inability to schedule calls at specific times (e.g., 30 minutes before an appointment) prevented the service from being a suitable option for some clients, particularly those who require structured reminders tied to specific events or appointments. These insights indicate significant areas for improvement in the service design, client education, and communication.

In contrast to the low overall referral rates, the Falls Prevention team successfully integrated Telecare Talk into its 20-week exercise program. Using phone calls to remind participants about exercise classes, the team found the service to be a useful tool for behavior change. This success highlights the program's effectiveness when applied to clients with clearly defined and measurable goals. This experience contrasts sharply with the difficulties faced by referrers working with clients experiencing mental health issues or dementia. The differing outcomes underscore the importance of tailoring the service to clients with very specific needs and measurable goals, as well as addressing the need for more training and resources to effectively address the unique needs of diverse client populations, including those with more complex conditions. The Falls Prevention Team's success provides a valuable case study for refining the program's approach and expansion strategies.

Referrers' opinions on the Telecare Talk service varied significantly. Some viewed it as a valuable tool for reminding clients about appointments or medication, aligning with their existing roles. Others perceived the service as duplicating their existing work, particularly for clients with dementia, highlighting a potential need for better integration with existing healthcare services. Several referrers felt the service was most effective for clients with clearly defined goals, such as those participating in structured programs like the Falls Prevention exercise classes. This indicates a potential mismatch between the service's current design and the needs of clients with more complex or less structured care requirements. The mixed feedback highlights the need for a clearer understanding of the service's role within the broader healthcare ecosystem and its ability to complement rather than replicate existing services. Improving communication and demonstrating clear added value compared to pre-existing services would likely improve referral rates.

Service user feedback provided insights into the program's impact from the recipient's perspective. Some participants found the telephone support beneficial, particularly when combined with other forms of support, such as the Falls Prevention program. This synergistic effect suggests that the service might be more effective as a supplemental tool rather than a standalone intervention. However, the evaluation also revealed limitations. Some users reported a lack of significant health improvement, especially when calls were infrequent (e.g., monthly). Others felt the service lacked sufficient information and suggested longer initial calls to establish rapport and clarify expectations. The service name itself was criticized for its potential to be confused with telemarketing, suggesting a need for rebranding. These diverse perspectives indicate the importance of tailoring communication, frequency of contact, and program design to meet individual needs and expectations to enhance the overall user experience and perceived value of the program.

The possibility of charging for the Telecare Talk service generated conflicting opinions among referrers. Some believed that introducing charges would not improve the already low referral rates. Others were concerned that the introduction of charges would deter individuals from enrolling, given that the current free service already faced low participation. The free-service model appears to be a key factor in current enrolment. The differing views on charging reflect a complex interplay between financial sustainability, service accessibility, and the overall value proposition of the service. Further research may be required to understand the optimal pricing model for a similar telecare intervention, striking a balance between cost-recovery and maintaining access for vulnerable populations.