the challenges of the health services in rural areas

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.