Feasibility of Advanced Practice Nurse - Led Telehealth Service in Patients with Myeloproliferative Neoplasm in the Community: A Singapore Single-Centre Report

Introduction Telehealth is fast becoming a promising alternative service for face-to-face consultation in healthcare to improve access to healthcare in a cost effective manner. An academic medical centre (AMC) piloted a tele-consultation program for patients with myeloproliferative neoplasm (MPN), a disease with an abnormal mutation in the bone marrow leading to overproduction of any combination of white cells, red cells and platelets. The program aimed to demonstrate the feasibility and safety of the use of telehealth in managing patients with MPN. Methods For this program only patients with Essential Thrombocytosis (ET) and Polycythemia Vera (PV) who met the criteria were recruited and enrolled into the program. Workflows, logistics and education materials were developed and briefed to stakeholders prior to the commencement of the program. The program utilised the Advanced Practice Nurses' (APNs) expertise in the haematology unit to support the service. APNs were provided addition training on both clinical practice knowledge and the appropriate use of the telehealth equipment. Data was collected between January and July 2020. Prospective outcome indicators measured were i) correct treatment prescribed according to guidelines; ii) number of emergency visits due to events related to MPN and its complications, iii) deterioration in cardiovascular health (namely hypertension, diabetes mellitus and hyperlipidermia) iv) number of patient visits right-sited to the community and v) barriers and facilitators for the uptake of the program. Results A total of 21 patients with 44 tele-consults over 7 months was captured. Average age of the patients were 70.1 years. Thirteen patients were diagnosed with ET and 8 patients have PV. Only 1 patient was on a combination of hydroxyurea and anagrelide, the rest of the patients were on hydroxyurea. A total of 14 dosage adjustments were made based on patients' complete blood count, and all of patients' blood countsremained stable during the following review. Two venesections were prescribed for patients with PV. None of the patients required ED visit or admission due to events related to MPN and its complications. One patient was referred back to physician earlier due to non-compliance to telehealth review. All patients had their blood pressure reviewed within 1 year. Sixteen patients had fasting glucose/HbA1c within 2 years, and 14 patients had fasting lipid within 2 years. None of the patients required cardiovascular medica