Focus on COPD: Improving quality of life in the Highlands

COPD – Supporting patients to take personal responsibility

You may have previously read the inspirational report published by NHS Highland providing a comprehensive analysis of Flo’s impact across a number of services throughout the Highlands region, including hypertension, asthma, low FODMAP diet and weight loss.

Feedback around NHS Highland’s COPD pathway has been fantastic. 

Patients interacted with Flo and as a result felt supported to take personal responsibility for their health, which in turn improved their quality of life through better self-management.  We would therefore like to share a more in-depth focus on this area with you.

NHS Highlands developed a local COPD pathway towards the end of 2016 incorporating Flo, which was specifically developed to help improve their patients motivation and confidence to self-manage.  Flo interacts with patients with support and advice, whilst providing the opportunity for them to participate in remote monitoring of their COPD by bringing their electronic action plan to life.

When patients report readings to Flo, her responses are based on the Chest, Heart and Stroke Scotland (CHSS) COPD Traffic Lights.  For example, if a patient who uses Flo reports that they are currently within a ‘red traffic light’ based on their SATS and symptoms readings, Flo will prompt the patient to take their rescue medication and to confirm that the action has been taken.  As the patient confirms via Flo, a notification will be sent to the clinician informing them that the patient has initiated their treatment.

A number of anticipated outcomes were identified at the start of the project, including:

  • Increased personal responsibility
  • Patients will see the link between worsening clinical signs and symptoms and learn to take action at the right time
  • Increased confidence in patients
  • Reduced exacerbations
  • Fewer hospital admissions
  • Fewer clinic appointments

It was also acknowledged that achieving these outcomes would contribute significantly to improved cost effectiveness, access to services and staff engagement, as well as reduced waiting times for patients. 

Feedback gathered by NHS Highlands was overwhelmingly positive, from both clinicians and patients alike.


“Florence has helped patients self-manage their COPD. Patients have said that they understand their condition more now.

“Some of my patient’s spouses really like Florence. They see it as a ‘back-up’ and an ‘extra-nag’, it gives them the confidence to care for their partners.

“I see that a patient has started taking some medication, I ask them if they would have done that without Florence prompting them to do so – they say no, they would have left it another few days. Patients who come to the end of using Florence say they are now in the habit of checking their stats every day. It embeds something into their daily routine. They feel connected, well cared for and not so isolated.

“I’m increasingly confident that Flo supports patients with COPD and their families by reinforcing the messages we give around early recognition of worsening symptoms in exacerbations. Also, Flo reminds them of the techniques which help keep them well, such as pacing their activity and using their breathing control methods in their daily activities”


“I liked the fact that Florence could alert me to a possible level drop in my oxygen and let me know before a negative outcome! I would welcome the idea of having Florence on a long-term basis”

“Florence always texts at the same time and gives me advice on what I should do depending on my SATs. It’s like having a doctor on call when I’m not sure whether to take antibiotics and steroids”

“It has helped me to understand and control my condition a lot more with positive results, as I haven’t had to rescue medication for months”

“Florence made me feel safe – someone was keeping an eye on me”

In addition to these comments, NHS Highland also utilised Flo and traditional paper questionnaires to collect evaluation data at the end of the protocol, finding that:

  • 87% of patients agreed that Flo helped them to understand and manage their own health.
  • 71% of patients would recommend Flo to other people in their circumstances.
  • 100% of patients who responded agreed that the COPD Flo protocol was encouraging and motivating and helped them manage their own health.
  • 83% of patients agreed that Florence helped them remember health information and advice and to comply with health advice.


As well as producing their own evaluation of Flo services, NHS Highlands approach was also included in Service Evaluation by Dr Maria Wolters, Edinburgh University, which focused on telehealth use for COPD, Asthma & Heart Failure. The evaluation found evidence that the COPD pathway integrating Flo:
Reduced the number of hospital admissions. Reduced the total number of bed days. Reduced GP appointments. Reduced clinic appointments.

If you would like to take an in-depth look at Dr Wolter’s Service Evaluation, then click here.

Case study:

Mrs Smith is 60 years old and has a confirmed diagnosis of COPD.  Before being introduced to Flo, she contacted the respiratory department on a regular basis, as she was very anxious about her condition.

When she was enrolled on Flo, Mrs Smith initially had increased contact with clinical staff. However, as her understanding of Flo grew, so too did her understanding of her COPD.  Mrs Smith became more confident in her ability to self-manage her condition, and the contact with clinical staff became less frequent.

By the final third of the protocol Mrs Smith was contacting the clinical team far less frequently than before her introduction to Flo, and since being on Flo she is willing to submit sputum samples, which previously she was uncomfortable doing.

Mrs Smith is now less anxious about her COPD, and Flo has made her feel reassured that she has the support she needs to manage her own health.

Furthermore, this feeling of improved confidence has continued beyond the end of the protocol, demonstrating that Flo’s proven psychology can help to effect long term health behaviours.

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