The Challenges of the Health Services in Rural Areas

1. EVALUATION OF A TELECARE NETWORK IMPLEMENTATION FOR THE EFFECTIVE HEALTH MONITORING OF PATIENTS WITH CHRONIC DISEASES IN REMOTE RURAL AREAS OF GREECE P. ANGELIDIS¹ ,G. DAFOULAS², S. STAMATOPOULOU³, M.PSYMARNOU², A. KOUTROUMBAS4, S. PAPASPYROPOULOS5 1.UNIVERSITY OF WESTERN MACEDONIA, GREECE 2.VIDAVO HEALTH TELEMATICS SA, GREECE 3.VODAFONE - PANAFON HELLENIC TELECOMMUNICATIONS COMPANY S.A., GREECE 4.ATHENS MEDICAL CENTER, GREECE 5.INTER MUNICIPALITY HEALTH & WELFARE NETWORK, 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: • lack of health workers prepared to work in these areas • distance from the location of health services • 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 weeksfor an appointment with specialized doctors, at the urban-central hospital and have to travel long distances.

4. The Challenges of the Health Services in Rural Areas – The aging population • 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.

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 efficienthealthcare 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: • monitor patients over extensive periodsof time (at home) • avoid costly treatments • 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

14. Equipment used PDA Application Welcome Screen ECG Recorder Oxymeter PDA Spirometer Blood pressure & glucose monitor

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

20. System use per location3/3/2008 – 31/3/2009

21. % of tests performed

22. Medical consultations

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.