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Description
The main objective of the project is to reduce social inequalities in health by providing remote access to health services through a personalised care system for patients with chronic obstructive pulmonary disease (COPD). The system will include remote monitoring and telerehabilitation using methods based on Artificial Intelligence. The implementation of the project will enable to continue the treatment of patients after their return from hospital to their place of residence. It will be possible to start the treatment for patients from excluded groups. Moreover, PHC physicians and pulmonologists who admit patients on an outpatient basis will gain real opportunities to refer patients for remote rehabilitation without the need for hospitalisation.
Summary of project results
Chronic obstructive pulmonary disease (COPD) is the leading cause of morbidity and mortality worldwide due to chronic respiratory diseases. The need to implement the project also resulted from the high and growing prevalence of COPD in the world''s population, regardless of the wealth of society, as well as the impact that this disease, when untreated, has on the length and quality of life of patients. The aging of societies entails an increase in the incidence of chronic diseases, which is visible in the triangle: age, comorbidities and multimorbidity. In Poland, according to estimates, such a diagnosis can be made in over 2 million citizens. By 2050, the population of Poland will be getting older. In parallel to the projected decline in population by 4.3 million by 2050, a steady increase in the number of senior citizens is expected. Among urban residents, the share of senior citizens will increase from 27.8% in 2020 to 42.4% in 2050, and the share of senior citizens in the population of Polish villages will increase from 22.3% to 37.8%.
Taking this into account, the main objective of the project was to reduce social inequalities in health by providing remote access to health services using a personalized care system for patients with COPD. The system included remote monitoring and tele-rehabilitation based on Artificial Intelligence methods. The project has been provisionally named PulmoRehab.
The PulmoRehab project successfully developed and piloted an advanced telemedicine system to support patients with chronic respiratory diseases such as COPD (Chronic Obstructive Pulmonary Disease). The project included a wide range of activities carried out in collaboration with project partners to achieve its objectives and ensure sustainability and dissemination of results. It was based on an AI-based system for measuring patients'' basic vital signs. The innovation involves the use of various sensors to collect biological data, which is then analysed using AI algorithms in the telerehabilitation of pulmonary patients.
Project was led by John Paul II hospital in Głuchołazy togeter with Polish partners and the Norwegian partner - University of South-Eastern Norway, Faculty of Health and Social Sciences, Department of Nursing and Health Sciences (Borre, Norway). A thorough needs assessment and feasibility study was carried out, including detailed analysis of the requirements for the telehealth system, consultation with healthcare professionals and patients, and evaluation of existing solutions to identify gaps. The system was customised with project-specific algorithms and exercises on a user-friendly platform, incorporating real-time patient monitoring, tailored rehabilitation programmes and video consultations, while ensuring compliance with data protection regulations.
Pilot testing was conducted in a controlled environment with selected patient groups to gather feedback and iteratively improve the system based on the pilot results. Training and capacity building was provided through training sessions for healthcare providers and the development of comprehensive user guides and support materials for patients and clinicians. The project involved a beneficiary responsible for overall coordination, communication and implementation; a technology partner for telemedicine support, platform customisation and remote monitoring; general practitioner partners for clinical validation, patient recruitment and medical oversight; and a Norwegian partner providing support, comments and participation in meetings.
A final evaluation assessed the achievement of project objectives, including improved access to pulmonary rehabilitation, increased efficiency in the management of chronic respiratory diseases, and improved patient compliance and engagement. The project encountered challenges such as patient recruitment and technical issues, but ultimately achieved a high level of success, with positive feedback from both patients and medical personnel. The document emphasizes the benefits of telemedicine in improving access to care, especially for patients in remote areas, and highlights the potential for cost reduction and improved health outcomes.
The following promotional activities were carried out within the project budget:
a) development and printing of brochures for patients,
b) production of instructional videos (e.g. https://drive.google.com/file/d/1Jpk3gpCgYMDQUo2-1d2eQNERsyMSnp_h/view),
c) organization of two conferences (initial on 27-30.06.2023 and final on 14-15.12.2023),
d) stationary educational meeting,
e) purchase of conference materials,
f) publication of articles promoting the project
As part of the task related to patient health education, a pilot was carried out, covering people active in the project and those who resigned, to determine the most important psycho-social challenges related to the implementation of the project, including proposing a model of support for patients also in the field of health education in chronic diseases. A motivational interview model and regular follow-up were proposed as a method of educational implementation, taking into account social factors influencing adherence in COPD patients.
In total 418 of patients were recruited to the project. Verification of improvement was based on the Final Qualification, in which the patient performed the 6-minute test again, the simplified Fullerton test, an assessment of dyspnea was performed and a symptomatic survey was conducted. At the end, patients complete a survey assessing the satisfaction of using the application as well as an assessment of the entire remote rehabilitation concept. Data obtained from in-depth interviews with project participants were prepared and will be used for further analysis and to create an action strategy.
During the implementation period the Project Promoter purchased remote patient monitoring equipment (full biofeedback with 14 vital signs), diagnostic spirometers, smartphones. A system for qualification, management and supervision of remote rehabilitation was launched, comments and proposals for changes were collected and implemented on an ongoing basis.
During the project, ongoing repair and replacement of equipment and adaptation of the system to the needs of users.
The project contributed to achieving the program''s result by providing a pilot program to a group of patients diversified in terms of gender and place of residence with a telemonitoring and telerehabilitation system that will imitate the methods and procedures of hospital supervision and rehabilitation of COPD patients, routinely used in the Applicant''s medical practice.
By implementing of the project, it was possible to continue the treatment of patients after they return from the hospital to their place of residence, it was possible to start treatment for patients from excluded groups. Also primary care physicians and pulmonologists seeing patients on an outpatient basis had real opportunities to refer patients to remote rehabilitation without the need for their hospitalization, which is in line with global trends and the latest literature.
The PulmoRehab system has demonstrated improved access to rehabilitation services for patients in remote locations, with some exceptions for patients with limited e-health literacy. However, it has shown improved patient outcomes for disabled patients and those from small towns/villages (but with internet access), as evidenced by feedback from pilot participants. Recruitment was completed at 82%. However, the patient satisfaction index and the proportion of hard-to-reach communities were well above plan. Analysis showed that in the group of 386 patients will all necessary primary and secondary points, a statistically significant improvement in somatic health was observed. The usability of the system received a score of 67 points, indicating a high level of user satisfaction. There was good acceptance and usability by healthcare providers (mainly nurses and physiotherapists) and patients. Despite challenges like recruitment difficulties due to shortened period out of our control, and unequal proportions of tasks and salaries in the pilot plans preprend by experts being cardiologist (with not pulmonary background), the project successfully increased awareness of telemedicine, improved access to care for patients in remote areas and those with disabilities, and achieved high patient satisfaction.
In primary healthcare facilities, benefits such as improved access to care, ongoing monitoring of health status and the possibility of individually adapting the rehabilitation program were observed. It can be added that telemedicine minimizes the need for stationary visits, which is particularly important for people with COPD who may have difficulty moving.
Summary of bilateral results
The project fostered collaboration with a Norwegian partner to exchange knowledge and expertise in the field of telemedicine. Detailed reports were produced summarising findings, lessons learned and recommendations for future initiatives. Bilateral collaboration with the Norwegian partner facilitated knowledge transfer, adaptation of Norwegian solutions to the Polish context, and development of a telerehabilitation model potentially suitable for implementation in Norway, demonstrating the significant benefits of international cooperation in the field of telemedicine. The project also identified areas of further studies and provided input to National authorities for further potential scaling up of the telerehabilitation.Bilateral cooperation with the Norwegian partner was aimed at exchanging experiences and know-how in the field of telemedicine and telerehabilitation. The partner''s representative showed the employees of the University of Southeast Norway the system and equipment (physically and remotely) and made annotations as to what could be changed. The Norwegian partner also helped in discussions with other Norwegian stakeholders and showed how similar systems work on site. Benefits from such cooperation could include, among others adaptation of Norwegian solutions to Polish conditions and increasing the innovativeness of the project.