Transcript Document 7740400

EVALUATION OF A TELECARE NETWORK IMPLEMENTATION FOR THE
EFFECTIVE HEALTH MONITORING OF PATIENTS WITH CHRONIC DISEASES
IN REMOTE RURAL
AREAS OF GREECE
1
P. A N G E L I D I S ¹ , G . D A F O U L A S ² , S . S T A M A T O P O U L O U ³ , M . P S Y M A R N O U ² , A .
K O U T R O U M B A S 4, S . PA PA S P Y R O P O U L O S 5
1.UNIVERSITY OF WESTERN MACEDONIA, GREECE
2 . V I D AV O H E A LT H T E L E M AT I C S S A , G R E E C E
3 . V O D A F O N E - PA N A F O N H E L L E N I C T E L E C O M M U N I C AT I O N S C O M PA N Y S . A . , G R E E C E
4 . AT H E N S M E D I C A L C E N T E R , G R E E C E
5 . I N T E R M U N I C I PA L I T Y H E A LT H & W E L FA R E N E T W O R K , G R E E C E
The Challenges of the Health Services in Rural Areas
2
 One of the most critical issues in rural health around the
world has been the lack of access of rural communities
to the same level of health services enjoyed by urban
communities, due to:
1. lack of health workers prepared to work in these areas
2. distance from the location of health services
3. lack of adequate resources.
The Challenges of the Health Services in Rural Areas –
Consequences
3
 As a result patients in rural areas have to wait for weeks for
an appointment with specialized doctors, at the urbancentral hospital and have to travel long distances.
The Challenges of the Health Services in Rural Areas –
The aging population
4
 The problem becomes more complicated due to the
increased percentage of elderly residents in rural areas
who suffer from chronic diseases that increase the
financial burden for the healthcare systems.
“aging, health care and long-term care expenditures appear to be
highly related at first sight …” EPC/ECFIN/630-EN final
5
Challenges faced in rural areas in Greece
6
 Greece faces important
challenges in the management
of chronic diseases in rural
areas due to the special
geographical characteristics.
 Chronic patients in remote rural
areas of Greece, have limited
access to specialized
healthcare compared with
the care provided to residents
of urban communities.
Information and Communications Technologies (ICT)
improve the delivery of health services to rural areas
7
 If the tools and services of ICT are used appropriately,
then will provide a better and a more efficient healthcare
services for all.
 Examples: health information networks,
electronic health records, telemedicine services,
wearable and portable systems, health portals, and many
other ICT-based tools assisting disease prevention,
diagnosis, treatment, health monitoring and lifestyle
management.
e-health services and chronic diseases management –
Needs and trends
8
Emphasis on:
 Remote monitoring and care continuity of care/health services outside
hospitals.
 Efficient disease management:
1.monitor patients over extensive periodsof time (at home)
2.avoid costly treatments
3.reducing healthcare costs
 Prevention and Prediction of diseases
 Enhanced Quality of Life
 Individual citizen with stronger role in healthcare process
Pilot Telemetry Network in Greece
9
 A pilot telemetry network was established in 2008 in 17
remote and isolated rural municipalities of Greece,
10 of them located in islands initially.
 The implementation of the pilot network aims at the effective
health monitoring of patients with chronic diseases in remote
areas.
 The network allows the constant communication between the
specialised physician and the regional health unit's general
physician.
Aim and objectives of the Pilot Telemetry Network
10
Aim:
 Improve public access to healthcare services.
Objectives:
 Preventive medicine.
 Provision of specialist healthcare services, independently of geographic
limitations.
 Medical personnel facilitation and more efficient human resource
management.
 Diffusion of specialized knowledge.
Current status of the Network (May 2009)
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The following 16 health units, one in each local municipality
participate in the project:
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Aliveri, Evia
Evergetoula, Lesvos
Dimitsana, Arkadia
Gavdos, Crete
Kirou, Pella
Kamirou, Rhodes
Therapnon, Lakonia
Kormistas, Serres
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Lampia, Ilia
Plati, Imathia
Sidirochori, Rodopi
Stavroupoli, Xanthi
Arkadi, Rethimno
Palini, Attiki
Ampelonas, Larisa
Pogoni, Ioannina
Implementation scenario
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 The local primary health units are equipped with vital signs
telemonitoring devices.
 At these points the family physicians record the vital signs of
the patients with chronic diseases (cardiovascular and
respiratory diseases).
 The data is transmitted via Vodafone Greece GPRS to a
central web server.
 Specialized physicians in Athens Medical Center consult the
recorded tests and provide advisory diagnosis to the local
physicians.
System flow
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Equipment used
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PDA Application
Welcome Screen
ECG Recorder
Oxymeter
PDA
Spirometer
Blood pressure &
glucose monitor
Project Partners
15
The implementation of the network is organised by:
 Intermunicipality Health and Welfare Network
 Vidavo S.A. (technical support)
 Vodafone Greece (sponsor)
 Athens Medical Center (medical expertise)
Evaluation of the Project
16
 The objective of this study is to assess the performance of the
development of this new telecare service for rural areas of
Greece.
 A retrospective evaluation study was designed in order to
evaluate the 6 months of full operational working period of the
telesales network.
 Evaluation criteria measuring the adoption and the outcomes of
the implementation of the specific telecare service were based
on the recommendations of the “WONCA Policy Paper on ICT
to Improve Rural Health Care”.
“WONCA Policy Paper on ICT to Improve Rural
Health Care”.
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Recommendations for Rural Information and Communications Technology
Community Partnership
Security and Confidentiality
Local issues
Implementation
Local, Regional and Global Issues
Regulatory Issues
Reimbursement Issues
Ongoing Funding
Staff Training
Evaluation
Impact on Rural Health Services
Access to Services and Service Delivery
Recruitment and Retention
Continuing Education
Project start - training session
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System use per location
3/3/2008 – 31/3/2009
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LOT
NUMBER
LOG-IN
NUMBER
ECG
SPIROMETER
GLUCOSE
BLOOD
PRESSURE
SPO2
POPULATION
ΚΟRMISTA, SERRES
3043
75
459
52
27
36
54
60
THERAPNON, LAKONIA
2814
154
1025
138
79
2
119
120
PALINI, ATTIKI
17232
66
395
0
65
0
44
51
SIDIROCHORI, RODOPI
3454
137
554
125
30
70
120
56
POROS, ATTIKI
4282
48
374
14
41
11
15
16
ALIVERI, EVIA
5686
51
242
2
49
1
1
41
LΑMPIA, ILIA
1013
23
206
10
16
5
9
16
ΜAKEDONIDOS, HMATHIA
1979
18
161
13
7
2
10
18
KIROU, PELLA
7509
31
239
20
12
3
20
11
PALIKI, KEFALONIA
7386
5
90
2
3
1
1
1
ΑLYZIA, AITOLOAKARNANIA
3759
4
83
4
1
0
3
1
EVERGETOULA, LESVOS
3242
11
97
6
6
1
5
8
ΝISIROS, DODEKANISA
928
3
23
2
2
1
1
1
POGONI, IOANNINA
1398
3
23
1
1
0
1
1
ALYKES, ZAKYNTHOS
4852
2
19
2
2
2
2
2
CLINIC
System use per location
3/3/2008 – 31/3/2009
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POPULATION
LOT
NUMBER
LOG-IN
NUMBER
ECG
SPIROMETER
GLUCOSE
BLOOD
PRESSURE
SPO2
GAVDOS, CRETE
81
2
10
2
1
1
1
2
ΚALLONI, LESVOS
8073
2
17
2
2
1
0
2
IDROUSA, ANDROS
3057
2
12
1
2
1
1
1
ΑΜPELONAS, LARISA
8463
29
105
1
29
1
1
1
ΑVLONOS, ΕVIA
4707
1
16
0
0
0
0
0
ΤILOS, DODEKANISA
521
1
12
1
1
1
1
1
ΜΑRGARITI, THESPROTIA
2819
0
20
0
0
0
0
0
SKALA, LAKONIA
5801
0
3
0
0
0
0
0
13
0
0
0
0
0
162
6
17
16
18
17
41
0
0
0
0
0
47
0
0
0
0
0
53
0
0
0
0
0
CLINIC
DRYMALIA, NAXOS
5585
4
STAVROUPOLI, XANTHI
2785
PLATI, HMATHIA
10504
0
5557
0
ΑRKADI, RETHIMNO
DIMITSANA, ARKADIA
18
901
0
% of tests performed
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ECG
spirometer
Glucose
Blood pressure
24%
23%
23%
8%
22%
oxymeter
Medical consultations
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8.02%
Not able to analyse the data received
26.50%
Further tests are required
High risk patient
Expert consultation is not needed
28.65%
Additional info was not received
0.86%
0.29%
2.58%
2.15%
0.29%
0.43%
30.23%
Proceed to further tests as scheduled
Resend lot
No problem
Patient to be followed
Not answered
System use per month
23
Benefits
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Patients/public:
 Preventive medicine.
 Ubiquitous communication with specialized doctors.
 Increased feeling of safety by accessing specialists.
 Overcame geographical limitations.
Doctors:
 Advanced healthcare services provision.
 More effective patient management.
 Service provision in rural areas.
 Scientific collaboration.
Results
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 During the operation of the project 3 local health units
abandoned the project and 4 were replaced by others.
 In total 777 different tele-consultations took place and 2,206
logins in the online patients’ health records database, with the
level of adoption of the telecare services by the local health
professionals in everyday practice to vary significantly.
 A cost effective analysis should also be performed.
Conclusions
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 The introduction of telecare services for remote communities
cannot automatically be a benefit for rural health workers
and the communities that they serve. Ongoing support and
commitment from all engaged partners is crucial in order to
maximise the potential for successful and sustainable
telecare services to rural communities.