Patient inclusion in Diabetic and CHF Telemedicine Services United4Health project experiences in Slovenia

Transcription

1 Patient inclusion in Diabetic and CHF Telemedicine Services United4Health project experiences in Slovenia Drago Rudel1, C.Slemenik Pušnik2, M.Epšek Lenart2, S.Pušnik3, and J.Lavre2 1MKS Electronic Systems Ltd., Ljubljana, Slovenia 2General Hospital Slovenj Gradec, Slovenia 3Healthcare Centre Ravne, Slovenia

2 United4Health EU project Competitiveness and innovation framework programme ICT Policy Support Programme (ICT PSP) CIP ICTPSP Grant Agreement No.: Duration: 36 months ( ) Diabetes type2, Congestive Heart Failure (CHF), Chronic Obstructive Pulmunary Disease (COPD), Hypertension United4Health works on RENEWING HEALTH ( ) project results (model, evaluation)

3 U4H Consortium 34 partners from 15 EU MS 15 regions in 9 EU MS EU wide spread (UK, E, PL, GR) National/Regional Authorities with the budgetary responsibility for healthcare (14) Regional Healthcare providers (15) Health and welfare insurers (1) (AIM BE) End users and other stakeholder associations (1) (EWMA DK) Industry associations (4) (Continua, COCIR, EHTEL, GSMA)

4 15 Pilots, patients, 12 months monitoring Patholo gy Intervention New pilots funded by ICT PSP New pilots funded from other sources Existing RENEWING HEALTH partners Scotland (UK) Basque Country (ES) Wales (UK) Southern Norway (NO) Northwest Moravia (CZ) Slovenia (SL) Campania (IT) Sicilia (IT) Nord Pas De Calais (FR) Galicia (ES) Syddanmark North. Norway South Karelia Central Greece Berlin Total Diabetes COPD CHF Life long monitoring Short term follow up after hospital discharge Remote monitoring of Congestive Heart Failure Total

5 Diabetes and CHF pilots The interventions aims to promote self care and selfmanagement by encouraging use of self monitoring means Telehealth centre provides ongoing health coaching The telemonitoring SW allows: healthcare professionals to monitor and manage the data as locally agreed, including provision of a summary and access to the web based portal to monitor the patients health conditions at any time required.

6 Diabetes (6 countries, patients) Ongoing Health Coaching Patient s home Telehealth Centre 1 PATIENT TELEMONITORING DEVICE GATEWAY SERVER GENERAL PRACTITIONER DIABETOLOGISTS AT HOSPITAL OR LOCAL HEALTH DISTRICT 5 7 OTHER INVOLVED HEALTHCARE PROFESSIONALS 6 REGIONAL CENTRE S OPERATOR FAMILY DATA TRANSMISSION DATA ACCESS OPTIONAL CONTACT (DIRECT/INDIRECT) 6

7 Telemedical measurement of blood glucose Cignus Profiline Glucometer

8 CHF pilot (6 countries, patients) Ongoing Health Coaching Patient s home Telehealth Centre 1 PATIENT TELEMONITORING DEVICES GATEWAY SERVER GENERAL PRACTITIONER DIABETOLOGISTS AT HOSPITAL OR LOCAL HEALTH DISTRICT 5 7 OTHER INVOLVED HEALTHCARE PROFESSIONALS 6 REGIONAL CENTRE S OPERATOR FAMILY DATA TRANSMISSION DATA ACCESS OPTIONAL CONTACT (DIRECT/INDIRECT)

9 CHF patient devices for weight, blood pressure and oxygen saturation telemetry Nonin Onyx II 9560 Pulse Oxymeter Cignus TD Senior Line Blood Pressure Meter I.E.M Librograph Weight Scale

10 Challenges for the U4H Slovenian team No regular telemedicine (B2P) service in Slovenia Slovenian partners in United4Health pioneering in the area. Several tasks need to be addressed at once for setting up the telemedicine service: Telemonitoring technology Issues concerned with patient inclusion Changes in the treatment processes Organisation of workflows in the hospital (II level) and HC centre (I level).

11 Patient inclusion Agreed common inclusion and exclusion criteria for all 15 pilots sites for diabetes, CHF and COPB Intervention group 12 months health coaching period ( ) Control group same patients but retrospective collection of data for the same patients 12 months history period

12 Diabetes patient inclusion Criteria Diabetes mellitus type 2 Home monitoring of glucose already in place General conditions Mental, cognitive, social conditions for co operation Positive response to invitation Protocol once per week the whole profile measurement (pre/post breakfast, pre/post lunch, pri/post dinner)

13 CHF patient inclusion criteria 1. Confirmed diagnosis of CHF by a cardiologist 2. Hospitalization or emergency department visit due to decompensated HF in the previous six months (with a need and administration of diuretics) AND At least one of the following conditions: 1. LVEF < 45% (at least once during the last year or in the last echocardiogram if older) 2. LVEF > 45% but BNP > 400 (or plus NT probnp>1500) (at least once during the last year) Legend: LVEF Left Ventricular Extraction Fraction NT probnp B type natriuretic peptide General conditions Mental, cognitive, social conditions for co operation Positive response to invitation Protocol once per week the whole profile measurement

14 Patient identification DM2 patients Hospital Information System database used with over DM2 patients Selection team consisted of a diabetologist and a senior nurse Potential candidates identified CHF patients Registry of >700 CHF patients (specialized CHF unit at SB SG) Selection team consisted of a cardiologist and a senior nurse Patients identified and marked in the registry

15 Patient inclusion process 1. Personal address and invitation for participation at regular pre scheduled 6 months visits to the specialist 2. Formal written invitation given to the patient (project, role, potential benefits) 3. Invitation to a scheduled training on use of the telemedicine service 4. At the training final decision on participation. 5. If YES: signature of a written consent 6. Equipment passed to the patient for testing 7. Written instructions for home measurements provided (advice for potential emergency situations, user manuals for the equipment) 8. Individualised telemonitoring equipment passed to the patient 9. Telemedicine service is demonstrated and then tested individually 10. Each patient passes an initial interview (personal data collected).

16 Telemedicine service user satisfaction interview (1/2) Interviews with the patients in the intervention group planned at the end of the observed period to assess their perception of the telemedicine service The WSD questionnaire (UK Whole System Demonstrator for telecare and telehealth) on patient acceptability is used in the study to assess the perception of the telemedicine service of the patients in the intervention group.

17 Telemedicine service user satisfaction interview (2/2) The questionnaire includes 22 items regarding: Utility of the telemedicine measuring kit Effect of the service use on the patient s health status Effect on health care/social care system provision Privacy issues when using the service Suitability of the kit Patient s satisfaction with the kit

18 Interview at patient s rejection or pre term withdrowal A) Interviews with patients who were identified as suitable but declined to participate or were not enrolled for other reasons Reasons for withdrawal: Patient refusal for further participation (refuses to be monitored, to participate in an experiment, etc) Logistic/technical limitations (patient relocated, no network coverage ) Clinicians assessment (not meeting requirements for proper use ) B) The same questionaire used for patients from the intervention group who decided to withdraw prior the end of the intervention period

19 Patient web based portal (U4H Slovenia portal) Data on patient s Personal data Carers Specialist Primary care institution and GP Medical data Diagnose (type, date) Co morbidities Data for the assessment of social/medical benefits Economic indicators Import or manual entry of data

20 Telemedicine portal (HIS portal) Health Inside Systems GmbH telemedicine portal Personal data management Telemetric data Daily/weekly/Monthly reports Thresholds for alarms Equipment management Linking HIS telemedicine and the U4H Slovenia project portal Personal data

21 Patient s communication gateway in the telemedicine service Smart phone based app (Android 4.2) One way telemedicine data transfer Reception from the measurement equipment (BlueTooth) Sending data over mobile network (3G) Telemetric data presentation (history) Manual data input (DM2 pre/post meal) Localized interface (Slovenian language)

22 Screenshots from patient s phone Glucometer result Glocometer history Oxymeter result Oxymeter history

23 Healthcare service workflow and organisational changes affecting patients Major organisational changes, although potentially required, were put aside because the telemedicine service is a pilot and therefore not mainstreamed. The existing workflow process of patient treatment in SB SG hospital only minimally adjusted to integrate the new telemedicine service To support the project activities regular (6 months) visits to the healthcare specialists are maintained Patients retain the ability during such visits to report their experiences of the new service. An additional medical response scheme introduced that responds to requests for intervention generated by the telemedicine system and where requested by patients. A mobile team of field nurses is planned to visit those patients who are willing to cooperate but do not feel capable of managing the telemedicine devices by themselves.

24 Adjustment of the existing system of medical devices provision for DM2 patients Within the U4H project all the telemedical devices provided through the project at no charge for the patients Ambitions to involve the National Health Insurance Institute of Slovenia (NHIIS) to partially compensate glucometers and gluco stripes for DM2 patients Reimbursement of the costs for the glucometers and the strips at the NHIIS is made only for eligible patients. Need for by passing the traditional distribution route of glucometers and stripes through the pharmacy network.

25 Patients initiatives for promotion of the telemedicine service Patient organisations want to be involved Demonstration points planned at user s organisations Patients demonstrate telemedicine approach at their society social events/activities (rehabilitation week, demo in larger shopping centres ) Ready to go to other patients homes to support their society members in using telemedicine service.