Steps for Creating a Titration Programme
The steps below is applicable only when "Monitoring+Titration" is selected for "Validated Treatment Programmes".
- Enter the medical history.
- Viso uses the medical history information of a patient to recommend the medication titration plan, if it can be recommended, based on validated national patient management protocols. The recommended plan varies depending on the medical history and current co-morbidities of the patient.
- In certain cases, Viso cannot automatically recommend a treatment plan due to the complex management pathways for the patient. Viso can still be used to manage these patients remotely, however treatment plans must be inputted manually by the clinician (see "More About Creating a Titration Plan").
- Mark any applicable conditions by selecting "Yes" in the radio button next to that condition. When completed, click [Next].
Note
- Click
next to the condition to view a more specific definition of the condition.
- Enter the basic health information.
- In certain cases, Viso may require additional health information to generate a recommendation plan. For example, Viso uses the NICE recommendations for treatment of hypertension which varies depending on the blood pressure level. If a patient is not currently under hypertensive treatment, their latest blood pressure will be used to in determining the recommendation.
- If there is an incomplete MW action card for this patient, the results of this MW will be displayed here. If you believe that these blood pressure values are not valid, first clear the action card and indicate that the values should not be written to the EMR.
- Enter the information into the designated fields and click [Next].
- Enter drug allergies and intolerance.
- Viso takes into account allergies and intolerances when creating treatment plan recommendations. Intolerances can be identified at a 'class' level (for example ACE inhibitor) or at a drug 'active' level (e.g. captopril, ramipril). When a drug has been selected and moved to the "Patient's Drug Intolerances" list, it will automatically be marked with a maximum tolerated dose of 0 mg to indicate the patient is completely intolerant/allergic to this drug.
If the patient can tolerate a certain level of medication, add it to the "Patient's Drug Intolerances" list and indicate the maximum dose they can tolerate.
- Viso will prefill this information from the EMR as much as possible.
Note
- When reviewing a medication plan, always confirm that the plan is suitable for patients based on their known medication intolerances.
- The medication intolerance list for registered patients can always be accessed and edited from the patient settings screen in the dashboard (see "Edit Patient Information" page).
- Set targets.
- Target values for the indices monitored with the Validated Treatment Programme may be recommended by Viso. For example, Viso generates a target blood pressure recommendation based on NICE guidelines for Hypertension Plus programme patients. The target can be edited.
- You can also set the Alert Threshold for the indices monitored for the programme on this page. Different Alert Thresholds can be set for each patient.
- Review the treatment recommendation.
- Viso will display a treatment recommendation based on validated national patient management protocols using the patient data added during registration.
- Notifications from action cards in the last three months will be shown here, e.g. if a new medical condition for this patient was detected in the EMR.
- The recommendation will also indicate whether Viso can automatically generate a treatment plan based on the patient profile. Treatment plans can be created and edited in the following screens.
- Click [Next] to create, edit and review the plan.
Note
- There are some cases that the Viso cannot generate treatment recommendation. Read the explanation on the screen for details. If such a case occurs, you need to create a custom treatment plan.
- For the hypertension programme, the recommendation displayed in Viso exactly reflects the wording used by NICE. For explanation on the meaning of the recommendation please refer to the NICE Guideline Hypertension in Adults: Diagnosis and Management (NG136).
- Click to see the rationale for the treatment recommendation.
- Enter the current medications (if applicable).
- When enrolling patients that are already under treatment, Viso takes into account their current medication in order to generate a treatment plan recommendation. The new treatment plan will automatically start from the next titration step.
- Viso will prefill this information from the EMR as much as possible.
- During the enrolment period, only hypertensive medication should be added. Non-hypertensive medications may also be added after enrolment; however, these will not be applicable to the Validated Treatment Plan. These medications will be visible to the patient in the Viso app where they can set medication reminders and on the clinician dashboard.
- Select the option “No antihypertensive medication” if a patient is not currently on any Hypertension medication. Select “Has antihypertensive medication” otherwise.
- Press the “Recommend plan” button when done, to make Viso recommend a treatment plan based on the Nice guidelines.
- Create treatment plans.
- The Hypertension Plus Programme generates recommended treatment plans for the majority of patients based on their profile and medical history. When Viso cannot generate a recommended plan, a custom medication plan can be created.
- Hypertension Plus uses a 3-step medication plan as the basis for remote management and titration of patients.
- To use a patient’s current medication as Step 1 in the treatment plan, click the [Copy Current Medication] button.
- Click [Next] to go to the confirmation screen. After confirmation, click [Next] again.
Class | The type of medication that will be prescribed, for example Calcium Channel Blocker, ACE Inhibitor, ARB, Beta-Blocker etc. |
Medication Level | Titration plans are created based on incremental increases in medication within each NICE treatment guidelines step. For the majority of medications there are 4 steps within a medication class: Low, Medium, High and Maximum, defined based on the British National Formulary dosage guidance. Certain medications (For example Amlodipine) have a lower number of standard steps. |
Active | The active ingredient of the medication. |
Brand | Either branded or generic medication can be selected. |
Form | Tablet, Capsule etc. |
Dose | Dose per sitting of that active (for example if a patient is taking 5 mg Amlodipine 2 times per day, the dose would be 5mg). Note: "Medication Level" is linked to an active’s total daily dosage which is the Dose multiplied by Times per day. Selecting the level of medication will automatically return the corresponding Dose per sitting and Times per day. Other available doses can be selected via the drop-down list. |
Times per day | The number of times per day that patient should take the medication. In the example of Amlodipine above, this would be "2". |
Note
- The Hypertension Plus treatment plan recommendations are based on the NICE Guideline, Hypertension in Adults: Diagnosis and Management (NG136), dosage levels and frequency are derived from guidance in the British National Formulary.
- Clinical actions and data shared in the Viso platform will be written into the patient's medical record and SNOMED coded.
- You can always select a dosage of an adult or an elderly from the drop down list. By checking "Use medication recommendation for Elderly", the recommended dosage will be decreased (the flag will be displayed when you select the recommended dosage for elderly).
- You can add up to 10 medications within a single step.
- For more information on the treatment plan interface, see "More About Creating a Titration Plan".
- Set the frequency of the lab tests.
- For certain programmes, Viso shows the recommended period for the patient to undergo their bloods and/or urine review on this page. You can edit the start date and the frequency of receiving a reminder for the routine review of the bloods and/or urine of the patient.
- Click [Approve] to finish the enrolment.
Note
- If the patient is to be enrolled to another programme, Viso will move to the enrolment screens of the next programmes. If not, the enrolment is complete.