A collaboration between community leaders, GPs, NHS commissioners, researchers and the Oxford AHSN supported groups at greater risk from Covid-19. Pulse oximeters were made freely available at a foodbank, mosque and a homeless shelter linked to a GP practice. This initiative supports equity of access and complements wider research into the remote monitoring of patients with coronavirus symptoms. Engaging with trusted figures, tapping into existing community support systems and utilising word-of-mouth spread could all help to empower vulnerable communities. The lessons learned from this initiative are being applied to disseminating health education through other community networks.
What’s the challenge and solution?
It is known that patients with serious coronavirus symptoms often do not go to hospital early enough, and this can have a negative impact on outcomes. Promoting general public knowledge of monitoring with pulse oximeters can mean people whose health is deteriorating rapidly but without visible signs are more likely to be identified and can get the help they need as quickly as possible.
Some populations are at much higher risk of developing Covid-19 and its complications. These include:
- people aged over 65
- those with comorbidities (e.g. diabetes, lung disease, heart disease)
- people from minority ethnic groups
- poorer people.
Individuals falling into more than one of these groups are at even greater risk.
Early oxygen therapy improves outcomes in acute Covid-19, but many people who need it have ‘silent hypoxia’ (i.e. no symptoms). Pulse oximeters help to detect this. These simple devices measure oxygen levels and heart rate. They can give early warning that someone is unwell with Covid-19 or another health condition.
In healthcare, oximeters are a bread-and-butter tool for monitoring oxygen levels – the equivalent of a thermometer for measuring temperature. However, unlike thermometers, oximeters had not found a home in most households – until the pandemic when many more people brought one into their homes. This practice is far from universal though with the vulnerable populations listed above less likely to have access to a pulse oximeter. Challenges to pulse oximetry use include technological literacy and access, language barriers, interpreting results and access to healthcare.
What did we do?
After being approached by Oxfordshire Clinical Commissioning Group (CCG), the Oxford AHSN brought together the National Institute for Health Research Applied Research Collaboration Oxford and Thames Valley and a University of Oxford research team led by Professor Trish Greenhalgh. The Oxford AHSN had already enjoyed success with the national COVID Oximetry @home (CO@h) initiative which supported people with risk factors and suspected acute Covid-19 at home where their oxygen levels were monitored using pulse oximeters.
Pulse oximeters were made freely available to three vulnerable communities in Oxford – via a foodbank, mosque and a homeless shelter linked to a GP practice. They were given to 15 people at each venue along with supporting information. These people were subsequently contacted as part of a research study.
Key themes that emerged included:
- initial lack of knowledge around what an oximeter is and what it can be used for
- willingness to learn how to use a pulse oximeter and take regular readings at home
- enthusiasm and positivity around the device’s ease of use
- lack of preventive education around Covid-19 and viruses in general in vulnerable communities
- community platforms as potential route to raise awareness on the benefits of pulse oximetry.
Equity of access to pulse oximetry was improved. Community leaders—trusted and well-respected figures in minority groups have the capacity to influence healthcare promotion and engagement on a communal scale. Engaging with trusted figures, tapping into existing community support systems and utilising word-of-mouth spread could all help to enfranchise vulnerable communities. The lessons learned from this initiative are being applied to disseminating health education through other community networks. Recommendations were provided to Oxfordshire CCG on how to improve the update of pulse oximeters in deprived groups. The Oxford AHSN shared learning from this initiative regionally and nationally through AHSN and NHS networks.
Oxfordshire CCG continues to explore opportunities to access vulnerable communities to offer pulse oximeters, including people with long-term conditions that affect the heart and/or lungs, where measuring oxygen levels could be helpful. The University of Oxford research team is considering further research based on the themes identified in this exploratory qualitative study.
Sarah Brown, Programme and Implementation Manager email@example.com