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Description
The main objective of the project is to improve the access of 510 people (including 255 women) meeting the inclusion criteria, among whom there are at least 51 people (minimum 10%) originating from excluded areas (counties where the mean per capita income is lower than the national average) to health care benefits, mostly via telemedicine, according to the assumptions of model no. 1 “Cardiology.”
The aim of the project will be to develop a proposal to change the model of telemedicine cardiological care for patients with heart failure. According to the assumptions the pilot project will be coordinated by the National Institute of Cardiology which will cooperate with primary health care.
Activities identified under the project:
1) Information and promotion activities of the project including educational activities aimed at patients;
2) Implementation and testing of the internet platform;
3) Conducting a pilot project and constant supervision over the correctness of recruitment and implementation of the pilot with particular emphasis on the observance of the principle of equality of access to services, including IT services and legal services;
4) Training meetings with the medical staff of the project partners in particular in the use of the internet platform;
5) Commencement of the patient recruitment process and treatment of patients with heart failure:
a) medical / nursing visits
b) training on the use of the internet platform with the recommendation to use it for educational purposes, goals and assumptions of the project
c) home vital signs monitoring
d) patient satisfaction assessment
6) meetings with Heart Transplant Association named after Professor Zbigniew Religa;
7) project management.
Summary of project results
Previous studies on the use of telemedicine monitoring systems for patients with heart failure have shown that they improve the prognosis of patients, reducing mortality and the frequency of hospitalizations. The proposed model of telemedicine cardiology care for patients with heart failure is an attempt to implement such a solution in Polish conditions. Moreover, which is very important, it places significant emphasis on the activation of primary care physicians in the treatment of this group of patients and increasing educational activities of patients. Currently there are about 1.5 million patients with heart failure in Poland. Therefore, the number of patients requiring care is significant. Moreover, the quality of life of this group of patients is significantly lower, and treatment is a huge challenge. According to specialists'' forecasts, with the aging of society and parallel progress in the treatment of patients with heart attack, this number will constantly increase.
The aim of the project was to implement and test the developed model of telemedical cardiology care for patients with heart failure, through a dedicated internet platform, while maintaining the principle of equal opportunities and non-discrimination, including accessibility for people with disabilities and the principle of equality between women and men. The implementation of the project ultimately contributed to reducing social inequalities in health through the implementation of tasks related to telemedicine and e-health policy. The aim of the project for the National Institute of Cardiology was also to verify the consistency of actions already taken, addressed to patients with heart failure, as part of a pilot patient care program within the cardiology network in Mazovia, taking into account the monitoring of patients with heart failure as part of the model of telemedical cardiology care proposed by the Ministry of Health. The model of telemedical cardiology care assumes comprehensive patient care with effective use of medical resources and is focused on the patient, around whom a group of specialists will work, in order to improve their prognosis and quality of life through the integration of hospital care, outpatient specialist care and primary care. Care was provided in particular through the use of an internet platform with a separate interface for the medical team and patients, which will also allow for the coordination of patient treatment and strengthening contact between representatives of the health care system (GPs, cardiologists and nurses) using modern solutions.
The implementation of the project started with the conclusion of partnership agreements with 11 centres with which the project was jointly implemented. During project implementation, management work focused on:
- modernising and adapting the project management strategy to the project implementation phase,
- detailing the competencies and responsibilities of the members of the various teams (medical, technical, administrative),
- preparation and implementation of competitions for health services in the project and organisation of webinars,
- procedure for changes in the material and financial schedule,
- monitoring the degree of project implementation in relation to the adopted assumptions,
- analysis of risks, and implementation of remedial actions in response to defined and disclosed risks.
The website https://telmed.ikard.pl was prepared and educational content for the website was developed: information boards and promotional materials (patient leaflets, posters). Training and educational materials for project participants were prepared and printed, including in particular:
- Instructions for logging into the platform,
- monitoring principles,
- nutritional guidelines,
- physical activity tips.
A publication was also prepared in the form of a brochure promoting a healthy lifestyle and information on the diagnosis and treatment of heart failure, with particular emphasis on the actions to be taken by patients with this condition. The brochure was distributed to the patients. The brochure was available both in front of doctors'' surgeries and handed out by doctors during office visits. The distribution of brochures and posters took place both at the Partners'' and Project Promoter''s premises, and the cooperating patient organisation was also involved in the promotion.
During the project implementation 3 events were organised during which the project assumptions were presented and the implemented activities were summarised, in which representatives of the project Partners, Patient Organisation and the Beneficiary participated:
1. On 20.01.2023, a project launch event was held in the auditorium of the National Institute of Cardiology. The invitation to the meeting was extended to the Partners, the Patient Organisation and representatives of the Programme Operator. The event was attended by 43 people. During the meeting, the assumptions of the project were presented, as well as the project team on the side of the National Institute of Cardiology, the Partners and the Patient Organisation.
2. On 4.07.2023, a mid-term meeting was held at the premises of the National Institute of Cardiology to summarise the activities and actions carried out under the project up to date. The invitation to the meeting was addressed, among others, to the Partners, the Patient Organisation and the Programme Operator. The meeting was attended by 34 people. The discussion revolved around the tasks already completed as well as the organisational challenges encountered. Representatives of the Partners involved in the project and the project leader exchanged their experiences, suggesting improvements in the further implementation of the project.
3. January 2024, information was published on https://telmed.ikard.pl regarding the Project Summary Conference, which took place on 11 January 2024 at the premises of the National Institute of Cardiology.
Also scripts were prepared for 2 webinars:
- Webinar for patients - How to live with heart failure? With the participation of experts from the National Institute of Cardiology;
- Webinar for medical personnel - ‘Treatment of heart failure - what every doctor should know’ - with participation of an expert from the NIKard.
Since the memento was broadcast in September 2023, there have been 2412 views on telmed.ikard.pl and the YouTube channel of the National Institute of Cardiology by the end of January 2024, of which the webinar for patients was viewed 1430 times, while the webinar for doctors was viewed 982 times.
The promotional and educational activities helped to raise patient awareness of cardiovascular diseases, including heart failure, as well as risk factors, and supported patient recruitment. The first patient was included in the project on 17.03.2023, and by 31.12.2023, 424 patients (144 women and 280 men) had been recruited. During the course of the project, parameters measured by patients at home were monitored by medical staff using a telemedicine platform, which allowed medical data to be captured via wirelessly communicating devices (scales, blood pressure monitor with heart rate measurement) and managed by PCPs, cardiologists and nurses and provided a tool for patient monitoring.
The project included both in-patient visits (inclusion visits) and teleportations, which helped to remove geographical barriers (even people living in an area without a specialised unit received professional care). A total of 2104 medical and nursing visits were carried out, including about 1404 in-patient visits and about 700 teleportations. Patient recruitment and visit management activities were carried out both at the National Institute of Cardiology and by the Partners named above.
The project included a representative of the Professor Zbigniew Religa Heart Transplantation Association representing a patient organisation, which provided substantive support by exchanging experience and sharing knowledge through consultations, meetings, participation in conferences, as well as by participating in the development of information and training materials, so that the activities in the project were oriented as much as possible towards the patient.
Representatives of the Professor Zbigniew Religa Heart Transplant Association took an active part in the ‘Healthy Life’ health prevention picnics. Press releases from the events were posted on the project website www.telmed.ikard.pl. During the picnics, a number of patient education meetings on health education and prevention were organised to raise knowledge and awareness of cardiovascular diseases.
A major success was the provision of care to a large group of elderly patients. As part of the monitoring, patients performed over 142,000 blood pressure, pulse and body weight measurements, of which slightly over 30,000 exceeded the established norm limits for a given patient and required analysis by the medical team supervising the monitoring.
Telemonitoring required the patient to be more involved in the treatment process, in which self-observation and the ability to respond to disturbing symptoms were of key importance. Intensive involvement of patients in the treatment process increased their sense of responsibility for their health. Additionally, the telemedicine solutions proposed in the project reduced the burden on patients associated with traveling to medical facilities, while equalizing the chances of access to medical care for people who were less able or living in excluded areas. However, this approach did not limit direct contact with a doctor. Patients took advantage of scheduled regular monthly visits and medical or nursing teleconsultations, and if necessary, traditional stationary medical or nursing consultations were arranged.
After conducting a survey assessing patient satisfaction with participation in the project, it turned out that 96% of patients who filled out the survey were satisfied with the solutions proposed in the project (half of them rated the proposed solution very highly). 83% of patients rated the necessity of daily measurements of vital signs very well. In turn, 55% of the respondents declared that they would continue to perform measurements independently in the future.