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Ferrara PilotPresentation of

AUSL Ferrara – Matias de la Calle

Final Conference, Vienna16th May 2014

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The Ferrara Pilot – respiratory failure

The pilot aims to provide patients suffering from breathing

problems with a system that can remotely monitor their health

status, enabling a more efficient use of medical aids and a

more efficient organization of the healthcare service.

The pilot also aims to guarantee provision of telemedicine to

all health care users, providing user-friendly technology

solutions to elders.

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Target

1. Affected by chronic respiratory failure, requiring long-term

oxygen therapy and non-invasive mechanical ventilation.

2. Already followed by pneumologists in AUSL Ferrara for

periodical clinical controls.

3. Enrolled over two districts in the province of Ferrara and not

within the town.

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Target group average age: 75 years

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Ferrara: Ageing Index

Aziende USL indiceAzienda USL di Piacenza 190.7Azienda USL di Parma 174.9Azienda USL di Reggio Emilia 130.8Azienda USL di Modena 147.8Azienda USL di Bologna 189.2Azienda USL di Imola 163.0Azienda USL di Ferrara 236.3Azienda USL di Ravenna 187.4Azienda USL di Forlì 182.8Azienda USL di Cesena 155.0Azienda USL di Rimini 149.7

MEDIA REGIONALE 170.2

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Ferrara: Population Density

Low population density in Ferrara Province(136,5 inhabitants/square km vs. 198,7 in Emilia-Romagna Region)

results in additional costs for health care offer.

 DistrettoCentro Nord

Distretto Sud Est

Distretto Ovest

Azienda USL

Emilia-Romagna

Inhabitants 178.001 102.921 78.044 358.966 4.395.606Surface (kmq) 887 1.330 413 2.630 22.123

Density(ab/kmq) 200,7 77,4 189,0 136,5 198,7

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Ferrara Province

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Better support for elderly people living at home

Speeded up diagnosis and therapeutic care

Reduced mobility of patients and physicians

Easier procedures for better services provision

Easier management of health risks prevention and control

independently from location of the patient

Aims

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Patients involved Drop out Cause Active

29 12 5 deceased 17

2 therapy suspended

1 No compliance

1 No Internet

3 H admitted25 Patients enrolled

Patients involved

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ACER Iconia W501 + ADSL

Oximeter Nonin 9560 with Bluetooth

Devices – Home setting

Spirometer

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Data collection and transmission os blood O2 saturation.

Questionnaire on Quality of Health perception and respiratory conditions.Everyday, every 3 days, once a week.

Tablet

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Measurement of oxigen blood saturation

And heart rate.

Pulsi-oximeter

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Portable Spirometer Spirodoc

Patients already involved in the pilot were selected, on clinical basis, to be monitored also through the spirometer, in order to measure altered respiratory functions.

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The flow obstruction allows us to:

1. Evaluate how patient is responding to the therapy,2.Detect immediately worsening of patient health condition.

Parameter: flow obstruction

16 months

25 patients in O2 therapy

BUONGIORNO !BUONGIORNO !IIAnswer the Answer the questtionnairequesttionnaire

first pilot 8 months second pilot 8 months

second pilot

+

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Functionalities

For Users:

Medical measurements: take and view data

Medical questionnaires: compile and view

E-mail messages: send and receive

Video conference – Skype

Agenda

For Professionals:

View medical measurements, medical questionnaires

Add information about the patients

Set of alarms (for clinical parameters)

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Active Feedback specialist - patient

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Respiratory parameters and clinical questionnaires outcome allow real time monitoring.This allows us planning ambulatory check up in a rational and timely way.

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Messaging using the SPES allows human interaction and improves patient motivation by receiving feedback on health and data production.

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Results

Qualitative assesment on end users’ perception

Tools

1.WHOQOL questionnaire

2.Focus Groups Patients+doctors

Patients

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Quality of Life Assesment – WHOQOL BREF

DOMAINS:Physical Health – Psychological - Social relationship - Environment

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Target

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Target

Average: 75 years

Minimum: 49 years

Maximum: 92

Age

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Target

Average age: 75 years

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Target

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Target

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Results

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Results

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Results

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Results

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Results

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Results

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Results

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Results

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Results

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Results

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RESULTS - FOCUS GROUPS

Courtesy of FISTAT

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SPECIALIST Mantovani:“Telemedicine amplifies the amount of time needed to relate with the patient: this implies that the professional needs more time. So specific and structured organization spaces are needed or dedicated personnel.”

PATIENT Bariani:“I’m satisfied because I have the chance to monitor my health by myself by answering to the questionnaires and measuring my blood saturation.”

PATIENT Moro:“ I find very positive to self-monitor my health. It makes me feel more self-confident. I’d like to keep using the oximeter and the tablet. If I can’t keep it I’ll buy it myself.

RESULTS FOCUS GROUPS

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1. A high percentage of the patients (more than 80%) has performed the assigned duties and activities and has reported the lesson learnt with the use of the system.

2. The patients have appreciated the possibility to visualize and store their clinical data measured with the provided device in a very easily manner.

3. The possibility to write mails has been very little used. The patients have reported that they prefer direct contact or at least phone/video calls.

RESULTS - CONCLUSIONS

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Both patients and clinical professionals are satisfied with the Both patients and clinical professionals are satisfied with the SPES telemedicine opportunitySPES telemedicine opportunity

Patients

Refer to feel more self confident, mainly for two reasons.

1.patients feel safer and serene because they perceive that the specialist

constantly monitors his or her health conditions. Perception that health

conditions are daily monitored by the specialist.

RESULTS - CONCLUSIONS

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Patients

The patients refer to be better able to self monitor their health parameters.

They feel safer by reading answers to questionnaires.

Patients feel to have more control on their lives by having their

health parameters and health perception monitored by clinicians and

feeling empowered by the opportunity to be self monitored at home.

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Clinicians

Refer to be satisfied of the SPES platform because:

1.They are able to remotely and constantly monitor patients’ parameters.

2.They are satisfied because patient empowerment is enhanced by self

monitoring.

3.They are more capable to define the medical follow-up agenda

according with health conditions priorities.

4.All patients refer they are willing to continue monitoring with SPES

technology.

PERSPECTIVES

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SPES Tech infrastructureSPES Tech infrastructure

Bluetooth/serial

HUB

DB

WS

Web

in

terf

ace

SOLESOLE

Devices

Physician

practitioner

EHR

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Thanks!