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Description
The main objective of the project is to increase access of 520 individuals (including at least 260 women) meeting the inclusion criteria, including at least 52 individuals (at least 10%) from excluded areas (from districts with an average income per capita below the national average, including those using primary care located in a rural area away from major cities), to health services, mainly telemedicine, in accordance with the assumptions of the model “2 GERIATRICS”. It is expected to be possible to cover at least 520 individuals with screening, and in those diagnosed with malnutrition, sarcopenia and frailty syndrome, we expect an improvement (in 80% of them) of prognosis in the period of piloting, counteracting the development of disability and limiting the risk of dependence on the help of other persons in performing ADLs, as well as limiting the risk of hospitalisation, exacerbation of chronic coexisting diseases and limiting the risk of death, in the course of activity of the Partners in Lower Silesian Voivodeship.
Target group: age 60+;
Summary of project results
The project aimed to increase access (and reduce inequalities in access) to healthcare services, including telemedicine, for people over 60 years old, particularly those from excluded areas. This was in line with the assumptions of the ""Geriatrics"" model, which also included conducting screening tests to improve prognosis by detecting malnutrition, sarcopenia, and frailty syndrome.
Specific objectives for patients:
- Increasing their awareness and gaining access to reliable knowledge about therapy and rehabilitation options through adequate care and health education focused on lifestyle changes. This was especially beneficial for individuals with multiple overlapping health conditions, who previously lacked access to multi-specialist care, which ensured continuous coordinated care, supported by the involvement of the primary care physician (POZ).
- Access to reliable information enhanced independence and the sense of health security in the 60+ population
An organizational challenge in the project was the implementation of non-standard solutions to ensure project completion with the highest possible performance indicators.
MAIN OBJECTIVE: Increase access of 520 persons (including min. 260 women) meeting the inclusion criteria (e.g. age >= 60 years, who gave written informed consent to participate in the project), including at least 52 persons (min. 10%) from excluded areas (from districts with average income per capita below the national average, including users of GPs located in rural areas away from large cities), to mainly telemedical health services according to the assumptions of the GERIATRIA model, including enabling coverage of min. 520 persons with screening tests, and among those in whom malnutrition, sarcopenia and frailty syndrome will be detected, improvement (in 80% of them) of prognosis during the period of coverage by the pilot, counteracting the development of disability during this time and reducing the risk of dependence on the assistance of others in performing the duties of daily life, as well as reducing the risk of hospitalisation, exacerbation of chronic comorbidities and reducing the risk of death
he MAIN RESULTS were to reduce social inequalities in health by reducing the residence and income factor in access to screening and medical services through the use of telemedicine, which overcomes geographical limitations in access to outpatient specialist care (in centres far from the supply of specialists, e.g. in villages and small towns far from large agglomerations) and incorporates the GPs'' clinic (with a nurse) into care close to the patient - using remote contact with the specialist.
The project was based on technologies that are easily scalable and IT-consistent with the solutions implemented by the Ministry of Health, facilitating its implementation at national level. Partners and the Leader represent entities from different municipalities and districts with different sizes and characteristics of health services, strongly differentiated also in terms of income, which will ensure the representativeness of the target group and the effectiveness of the organisational solutions developed.
The main objective, was realised by achieving SPECIFIC OBJECTIVES:
1) To increase independence and a sense of health security in the 60+ population,including in patients with malnutrition, sarcopenia and frailty syndrome - regardless of income and place of residence and access to AOS (geriatric specialist) nearby;
2) Verification of the effectiveness of the model studied as a tool to carry out effective screening in the population, including the typing of patients with malnutrition, sarcopenia and frailty syndrome and the improvement of their health status, in collaboration between the Hospital, the GP and specialist outpatient care and using the assumed telemedicine tools;
3) Optimisation of health services for people over 60 years of age, which will make it possible to increase the emphasis on screening, secondary prevention and health education activities, to involve patients with malnutrition, sarcopenia and frailty syndrome first of all the general practitioner and only when necessary the specialist, and to involve the patient (and/or, hypothetically, their formal or informal carer) more broadly in taking care of their own health and in the process of rehabilitation and treatment, through the use of telemedicine solutions.
The project had a pilot character in order to verify clinically through the introduction (implementation) of a new method and accompanying organisational and technological solutions (platform, devices) in an area where current models and schemes of therapeutic and diagnostic support were insufficient. The project made it possible to check whether the planned measures were having the desired effect in terms of treating effects in old age.
Action – Preventive and Promotional Activities in the Field of Public Health
1) The project was supported by preventive and promotional activities, carried out both by the Project Leader and by the Partners, addressed to the group of patients receiving support.
2) In consultation with the Lead Geriatrician, leaflets and posters were developed and distributed to the patients. According to the schedule of informational-educational meetings, workshops on the use of the telemedicine platform for patients were organized at the Leader''s office, along with a conference.
3) Radio spots were created and broadcasted, with their airing adjusted to recruitment opportunities to achieve the best possible effect.
4) A project website was created, along with a promotional panel.
5) The Communication and Recruitment Plan included activities aimed at increasing the public''s awareness about the existence of Norwegian and EEA Funds, their goals, bilateral cooperation with entities from Norway, as well as their implementation, results, and the impact of these projects.
6) A communication system was developed for partners, patients, contractors, and the Leader''s accounting department. This system focused on cost accounting, expenditure descriptions, making transfers, analyzing cost eligibility, financial reporting, liquidity management of the project, and accounting for partner expenses.
7) The risk management communication framework was developed by the Evaluation Specialist, responsible for conducting the program feasibility assessment (based on patient surveys), ongoing verification of project indicators, and creating guidelines for public dissemination of the results (publications, webinars, conferences, and the project website).
8) The Coordinator developed reporting guidelines to the Steering Committee on the progress of the project, including the achievement of milestones. Throughout the project period, meetings, conferences, and other events were organized to inform and educate about the project''s assumptions.
Activities carried out in the project:
1.Opening Conference of the Project combined with a Health Picnic 26.07.2023, Number of participants (on-site and remote via teleconference): 73, 23 representatives from the medical and scientific communities, about 50 patient representatives
2. Telemedicine Workshops for Patients, Date: 22.06.2023, Number of participants (on-site and remote via teleconference): 33, about 23 representatives from the medical and scientific communities, about 10 patient representatives
3. Closing Conference of the Project, Date: 21.12.2023, Number of participants (on-site and remote via teleconference): 50
4.Field Conference at the University of Drammen, Date: 14-17.01.2024, Number of participants: 18,
5.Telemedicine during Polish Armed Forces Day, Date: 15.08.2023, Number of participants: 34
6.White Saturday at Magnolia Shopping Center – Wrocław Health Promotion Days, Date: 09.09.2023, Number of participants: 28,
7.White Saturday for Seniors at the "Dobrzyńska" Medical Center, Date: 07.10.2023, Number of participants: 19
8.Telemedicine at the Third Age University, Date: 19.10.2023, Number of participants: 48,
9.White Week for the beneficiaries of the Municipal Social Services Center, 159 participants
During the closing conference, promotional materials about the project''s indicators and results were presented. These materials, created during the project, were translated into English for distribution during the conference trip to Norway, where an exchange of experiences took place with Norwegian telemedicine program participants and technology providers for telemedicine tools.
The visit to Norway took place from 14-17.01.2024, including a visit to the Norwegian Partner''s headquarters, covering the scope of the completed project. Promotional materials, indicators, and results were presented.
Three publications were created based on the project''s results:
1. Mercurius Officinal, 2023; LI,6:665-673, DOI: 10.36740/Merkur202306114
2.Medical Science Pulse, 2024 (18) 2, DOI: 10.5604/01.3001.0054.6663
3. Medical News, 2024; 77(7):1505-1513. doi: 10.36740/WLek202407128
Links: https://wroclaw.tvp.pl/70751524/22062023-1830
https://pubmed.ncbi.nlm.nih.gov/38207070/
https://medicalsciencepulse.com/article/01.3001.0054.6663/en
https://pubmed.ncbi.nlm.nih.gov/39241153/
norweskie.4wsk.pl
Action – Testing of Model Solutions in Partnership with Primary Healthcare System
1) The applicant, along with the partners, carried out a pilot of telemedicine solutions, in accordance with model geriatrics.
2) In the pilot, the technology partner rented and adapted a telemedicine platform for the purposes of the project, enabling patients—participants in the project—to remotely complete surveys.
3) The technology partner provided the telemedicine platform, ensuring that it could be integrated in the future with the Ministry of Health''s platform.
4) The internet platform used in the project allowed the collection and management of medical data as well as the provision of services (including scheduling appointments, consultations, and remote monitoring).
5) The platform meets the following conditions:
a. It is available at the specified web address.
b. It operates as a website that can be accessed on a PC (or MacOS) and mobile devices (smartphones/tablets with Android/iOS operating systems).
Patient recruitment was carried out through:
• Phone contact – information about the project;
• Scheduling an initial "zero" visit upon the recommendation of the primary healthcare doctor;
• Scheduling an initial "zero" visit upon the patient''s request.
Project Partners'' Contributions:
The partners involved in the project allowed for the expansion of activities in the Lower Silesian Voivodeship and beyond its borders.
They verified the effectiveness of the applied technologies and tools for primary care physicians (POZ), delivered information to patients to include them in the project. They faced the challenge of reluctance towards telemedicine due to experiences from the Covid-19 pandemic era. They dealt with the skepticism of older people who associated internet and phone contacts with scams, such as the "grandchild scam method. These factors influenced the ability to verify the effectiveness of the studied model as an efficient screening tool.
Action – Purchase of Equipment for Testing Model Solutions
As part of the task, equipment and devices were purchased, which will enable the implementation of the project and subsequent testing of model solutions. The following equipment was purchased to facilitate the execution of the project, including: Purchase of tablets with mobile internet access, which will be loaned to patients who do not have such devices. During the process, we encountered configuration issues with some of the equipment and with integrating our systems with the Partner''s system. All these issues were resolved, and the operations continued smoothly. We maintained a Help Desk service, which allowed us to quickly respond to any emerging technical problems.
Achievements
• The organizational know-how and medical experience gained will yield results in the future.
• The possibility of ordering laboratory tests – attractive for patients – should be expanded in the future.
• Access to geriatric consultation, often needed for reasons other than those planned in the project.
• Activation of recruited seniors.
• Material for further reflections and work in the future.
• 500 individuals were examined. Cooperation with Partners, including the Norwegian Partner, brought many benefits and the exchange of practices in the healthcare and telemedicine sectors.""
To conduct the pilot, a telemedicine platform was leased and adapted for the purposes of implementing the ""Geriatrics"" model. This allowed for increased access (reducing inequalities in access) for people over 60 years old, including those from excluded areas, to healthcare services, including telemedicine, in accordance with the assumptions of the ""Geriatrics"" model. It also involved providing them with screening tests to improve prognosis by detecting malnutrition, sarcopenia, and frailty syndrome.
As a result of the project implementation, patients benefited from:
• Increased awareness and access to reliable knowledge about therapy and rehabilitation options through adequate care and health education focused on lifestyle changes, especially for individuals with overlapping health conditions. These individuals had previously been without multi-specialist care, which now ensured continuous coordinated care, strengthened by the involvement of the primary care physician (POZ). Access to reliable information enhanced independence and the sense of health security in the 60+ population. The leasing of the telemedicine platform and its effectiveness verification with the involvement of a patient organization also influenced the ability to verify the effectiveness of the studied model as an efficient screening tool. The goals has achieved."
Achievement of indicators:
1. number of beneficiaries (women) for whom services are provided or improved (using the diagnosis/treatment with the assistance of telemedicine) - 294
2. number of beneficiaries (men) to whom services are provided or improved (using the diagnosis/treatment with the assistance of telemedicine) - 206
3. number of persons declaring satisfaction with the services received with the help of new e-health methods according to the implemented model - 500
4. number of people declaring satisfaction with services received with the help of new e-health methods according to the implemented model (women) - 294
5. number of people covered by the telemedicine service - 500
6. number of health care services provided using the purchased modern equipment - 1299
7. number of PCUs covered by telemedicine services - 9
8 Number of organisations (POZ, foreign partners, patient organisations, national partners) which cooperate with the Leader in conducting and validating the project - 12
9. territorial scope of the project: number of counties from which residents participate in the project - 4
10. experience of the applicant and partners: Number of entities which have experience in implementation of at least one project in the field of e-health or telemedicine - 5
11 Information and promotion Number of information and education campaigns carried out among patients - 1
12. bilateral cooperation: Number of partnerships established with a Norwegian entity (bilateral cooperation) - 1
13. increased level of knowledge on the use of on-line medical services among project participants - 105
14. increased level of knowledge of geriatric diseases among project participants -105
15. number of patients diagnosed with geriatric diseases: sarcopenia, malnutrition, frailty syndrome based on on-line consultation -12
Summary of bilateral results
Cooperation with the Norwegian Partner was carried out through consulting on project activities during meetings of the Steering Committee. This provided support in the substantive aspects of the project. The experience of the Norwegian Partner was utilized in preparing the platform, documents, and project procedures, as outlined in the Project''s Regulations. 19 meetings with the Norwegian Partner were a result of the course of the project and its participation in the Project Steering Committee. The bilateral cooperation was assessed so positively that the Norwegian Partner decided to participate with us in the Final Conference of the Health Program, which took place at the Ministry of Health, in order to discuss the possibility of carrying out further projects in collaboration.