1
P. ANGELIDIS¹ ,G. DAFOULAS², S. STAMATOPOULOU³, M.PSYMARNOU², A. KOUTROUMBAS4, S. PAPASPYROPOULOS5
1.UNIVERSITY OF WESTERN MACEDONIA, GREECE2.VIDAVO HEALTH TELEMATICS SA, GREECE3.VODAFONE - PANAFON HELLENIC TELECOMMUNICATIONS COMPANY S.A., GREECE 4.ATHENS MEDICAL CENTER, GREECE5.INTER MUNICIPALITY HEALTH & WELFARE NETWORK, GREECE
EVALUATION OF A TELECARE NETWORK IMPLEMENTATION FOR THE EFFECTIVE HEALTH MONITORING OF PATIENTS WITH CHRONIC DISEASES
IN REMOTE RURAL AREAS OF GREECE
2
The Challenges of the Health Services in Rural Areas
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.
3
The Challenges of the Health Services in Rural Areas – Consequences
As a result patients in rural areas have to wait for weeks for
an appointment with specialized doctors, at the urban-
central hospital and have to travel long distances.
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.
The Challenges of the Health Services in Rural Areas – The aging population
5
“aging, health care and long-term care expenditures appear to be highly related at first sight …” EPC/ECFIN/630-EN final
6
Challenges faced in rural areas in Greece
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.
7
Information and Communications Technologies (ICT) improve the delivery of health services to rural areas
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.
8
e-health services and chronic diseases management – Needs and trends
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
9
Pilot Telemetry Network in Greece
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.
10
Aim and objectives of the Pilot Telemetry Network
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.
11
Current status of the Network (May 2009)
Aliveri, Evia
Evergetoula, Lesvos
Dimitsana, Arkadia
Gavdos, Crete
Kirou, Pella
Kamirou, Rhodes
Therapnon, Lakonia
Kormistas, Serres
Lampia, Ilia
Plati, Imathia
Sidirochori, Rodopi
Stavroupoli, Xanthi
Arkadi, Rethimno
Palini, Attiki
Ampelonas, Larisa
Pogoni, Ioannina
The following 16 health units, one in each local municipality participate in the project:
12
Implementation scenario
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.
13
System flow
Equipment used14
ECG Recorder
Spirometer
Oxymeter
Blood pressure & glucose monitor
PDA
PDA Application Welcome Screen
15
Project Partners
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)
16
Evaluation of the Project
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”.
17
“WONCA Policy Paper on ICT to Improve Rural Health Care”.
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
18
Project start - training session
19
System use per location3/3/2008 – 31/3/2009
CLINIC POPULATION LOT NUMBERLOG-IN
NUMBERECG SPIROMETER GLUCOSE
BLOOD PRESSURE
SPO2
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
20
System use per location3/3/2008 – 31/3/2009
CLINIC POPULATIONLOT
NUMBERLOG-IN
NUMBERECG 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
DRYMALIA, NAXOS5585
413 0 0 0 0 0
STAVROUPOLI, XANTHI 278518 162 6 17 16 18 17
PLATI, HMATHIA 10504 041 0 0 0 0 0
ΑRKADI, RETHIMNO 5557 047 0 0 0 0 0
DIMITSANA, ARKADIA 901 053 0 0 0 0 0
21
% of tests performed
Medical consultations22
23
System use per month
24
Benefits
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.
25
Results
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.
26
Conclusions
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.