More information
Description
The main goal of the project is to improve prevention and to reduce health inequalities which will be achieved through the implementation of the programme result, i.e. reducing social inequalities in health, including improving access to health care services in the field of telemedicine and e-health. The target group in the project will be patients from the age of 18 diagnosed with heart failure, regardless of etiology, age, gender, sexual orientation, national / ethnic origin or disability, who have given their consent to participate in the project.
Summary of project results
"Telemonitoring of patients with heart failure. Pilot project of a telemedicine model in cardiology. implemented by SPZOZ MSWiA in Rzeszów together with the University of Rzeszów (research partner) and 12 entities providing primary care services. Project implementation period: March 2023 - January 2024.
The aim of the project was to reduce social inequalities in access to medical care, implement innovative solutions in the field of telemedicine, shorten the waiting time for specialized medical assistance, improve the quality of services, ensure continuity of care, and acquire new experience in the field of telemedicine by medical staff.
The use of the telemedicine model was aimed at optimizing treatment in a group of recruited patients with heart failure by improving cooperation between primary care physicians and cardiologists, increasing the availability of specialized treatment in smaller towns and conducting medical interventions aimed at preventing exacerbations of chronic heart failure
The described project recruited a sample of 439 patients with heart failure treated in 5 Polish voivodeships, mainly from the Podkarpackie Voivodeship (52.7% of the sample). The Podkarpackie Voivodeship, located in the south-eastern part of Poland, was selected mainly for the pilot study due to its relatively lower level of industrialization and poorer access to specialized outpatient cardiac care compared to more developed regions of Poland. Patients with heart failure treated in primary care offices were included in the study. On the day of recruitment, a cardiologist present at the recruitment site confirmed the presence and severity of heart failure. For a period of approximately 3 months, these patients were monitored daily in real time (via the GMS network) for body weight and blood pressure using an electronic scale and an electronic blood pressure monitor (measurements twice a day and each time on request). In the event of abnormal weight gain or high or low blood pressure values, defined as unusual compared to baseline values, telephone intervention, often combined with pharmacological modification, was carried out through the selected monitoring center (paramedic/specialist physician) immediately after the detection of any irregularities. Telemonitoring was also accompanied by a series of video or teleconsultations. The project also used 14-day Event Holter Kits or 7-day Holter ECG.
Telemedical equipment was purchased:
- scales with a tele-transmission function via an application or communication module (hub);
- blood pressure monitors with a tele-transmission function via an application or communication module (hub);
- tablets for 10% of patients
There was an information and registration desk at each primary care unit (which was a Project Partner), where the patient could immediately register his/her participation, learn about his/her rights in relation to telemedicine services within the Project, rights concerning personal data processed by the Applicant and Project Partners, give necessary consents, collect the telemedicine kit and fill in forms/questionnaires necessary to conduct patient satisfaction assessment and disease knowledge tests.
Another action was to carry out the implementation of telemedicine services, including the installation of telemedicine systems together with the test of test transmission from the patient''s kit to the telemedicine platform, training of doctors and nurses in telemedicine devices and telemedicine systems, including training in ICT security related to the provision of health services with the use of modern technology and standards for the provision of telemedicine services.
This was followed by the implementation of telemedicine services for the cardiologists coordinating patients (consulting) and the scientific, content and telemedicine coordinator.
Doctors and Nurses conducted the visits and televisits assumed in the model: a recruitment visit, one follow-up visit after the first month of patient participation in the Project and a final visit. A cardiologist, conducted the so-called inclusion visit, which was carried out in the same month as the recruitment visit.
A helpline for Project patients was launched, available 12h a day, seven days a week. The task of the helpline was to provide ongoing support to the patient in the performance of tests and to monitor the regularity of the tests, to conduct activation conversations, and to corodinate relaisonships with the primary care physician, nurse practitioner and cardiologist.
The Measure implemented telemonitoring of reported ECG, blood pressure and weight tests and ran a patient support centre for disease exacerbation and increased risk of loss of health and life. This included checking alerts or notifying the GP of the need for urgent consultation. The centre allowed response to ongoing emergency events. In parallel, tele-consultations of the primary care practitioners with the cardiologist took place to discuss recommendations and procedures for the primary care practitioner (initial consultation) and to summarise the effects (final consultation).
The project implemented actions related to the promotion of the Programme and the Project with the use of Norwegian Funds and presentation of the areas of support in the form of:
- 11 speeches in front of patients as part of organised medical events;
- 11 letters to authorities of local self-government units where Partner GPs are located;
- 11 advertisements and information in social media promoting the pilot project;
- 2 sponsored articles with nationwide coverage;
- 2 conferences: opening and closing of the project;
- a dedicated website for programme promotion and patient education;
- 3 types of leaflets (30000 pcs);
- posters (300 pieces);
- 2 advertising spots
- 2 instructional videos ‘how the programme works’ (1min) and ‘equipment instructions’ (1min).
- 1 educational video about the disease (4-5 min).
Made:
- boxes for the device kits, branded with the Project logos (600 pieces);
- Programme paper instructions;
- joint instructions for the devices;
- heart failure education booklet (700 pcs.).
Webinars were conducted to raise awareness and qualifications among medical staff on the importance of the issues addressed by the Project and the role of the Norwegian Funds available to registered participants - doctors.
An audio-video recording of the events was made and presented at a local press conference with the authorities of the municipalities from which the Partner HCPs were recruited.
All event materials were posted on dedicated websites, social profiles.
Pages of SPZOZ MSWiA in Rzeszów https://szpitalmsw.rzeszow.pl/sp-zoz-mswia-w-rzeszowie-realizuje-projekt-pn-telemonitoring-pacjentow-z-niewydolnoscia-serca-projekt-pilotazowy-modelu-telemedycznego-w-kardiologii-projekt-telemonitoring-pacjentow-z-niew/https://szpitalmsw.rzeszow.pl/telemonitoring-pacjentow-z-niewydolnoscia-serca-projekt-pilotazowy-modelu-telemedycznego-w-kardiologii/https://szpitalmsw.rzeszow.pl/niewydolnosc-serca-nie-musi-kontrolowac-twojego-zycia/https://szpitalmsw.rzeszow.pl/zaproszenie-do-udzialu-w-pikniku-zdrowia/https://www.facebook.com/photo/?fbid=150725814742229&set=a.119847674496710&locale=pl_PL
Project website:https://niewydolnoscserca.rzeszow.pl/https://www.facebook.com/profile.php?id=100094144325247&locale=pl_PLhttps://www.facebook.com/100094144325247/videos/300013262498874?locale=pl_PL
UR:https://www.ur.edu.pl/pl/kolegia/kolegium-nauk-medycznych/kolegium/dzialalnosc-naukowa/projekty-badawcze/inne/realizowane-2022-r/projekt-norweski---telemonitoring-pacjentow-z-niew
media:
https://nowiny24.pl/piknik-zdrowia-w-niechobrzu-zobaczcie-wideo-z-tego-projektu/ar/c14-17675797?fbclid=IwY2xjawHOTd9leHRuA2FlbQIxMQABHUVooiYrJiqq2E6aBYxGz3N5QAo4NunBCWBkdOhU_yopZXtVuazad2OEdw_aem_a-dLswPS39HAViXc39N1MAhttps://www.termedia.pl/poz/Telemonitoring-pacjentow-z-niewydolnoscia-serca,52822.html#disqus_thread
During the program, a total of over 100,000 telemedicine examinations were carried out in the form of measurement of body weight, heart rate, blood pressure and 7-day or 14-day Holter assessment. During this study, the coordinating medical staff ordered 570 changes in the patient''s pharmacotherapy, confirming a positive impact on the quality of life in the study group.
As part of the medical intervention in the form of the use of a telemedicine model among patients with heart failure, significant results were achieved:
• A significant result of the effectiveness of the program is the number of hospitalizations 3 months before joining the program and during 3 months of participation in the program. Before joining, this rate was 41 hospitalizations, while during the accession one patient was hospitalized due to heart failure and three due to acute coronary syndrome. Reduction of hospitalizations by approximately 90%.
• There was one death of a program participant, which is much lower than that observed in the patient population in the Podkarpackie Voivodeship. An estimate of the number of theoretically avoided deaths in the patient sample will be made once additional data are available.
• During the project, there was a significant improvement in the classification of patients according to the NYHA scale. 48.0% of participants whose NYHA categorization was known at the beginning and end of the study period corrected it (representing 33.8% of the total sample).
• In addition to the NYHA categorization, indicators such as body weight, systolic and diastolic blood pressure have improved. They decreased on average in the study population (for people whose initial and final examination was known) by 1.3 kg, 4.3 mmHg and 5.6 mmHg, respectively.
• Modifications of pharmacotherapy occurred as many as 570 times. The majority of patients, i.e. 59.8%, had at least one modification of pharmacotherapy. Most people had two modifications (20.5%). 20.0% of all patients had their pharmacotherapy modified only once.
• Holter tests were carried out during the project. In 8.5% of cases, indications for coronography were found. Non-sustained ventricular tachycardia was found in 9.8% of cases. There was also a need for oral anticoagulant administration, angioplasty, indications for ablation, ICD implantation, pacemaker implantation, and diagnosis of atrial flutter/fibrillation.
In addition to the clinical condition, the quality of life and health of patients improved:
• Particular improvement was observed in the ability to move. The percentage of people reporting complete inability or serious mobility problems decreased from 20.3% to 6.7%. In the case of self-service and the ability to perform everyday activities (such as work, study, family activities, etc.), the percentage of people reporting the lack of ability or serious problems decreased by 2.9 percentage points, respectively. and 3.2 p.p.
• Improvement in patients'' health also affected mental health and discomfort. The percentage of people reporting extreme or severe pain or discomfort dropped from 15.6% to only 2.2%. Only 1.0% of respondents felt extreme or severe anxiety or depression at the end of the project, compared to 6.3% at the beginning of the project.
• There was a visible improvement in the subjective assessment of health at the end of participation in the project compared to the initial assessment on a scale from 0 to 100. According to this scale, the average health status at the beginning of the study period was 59.8 and at the end 63.8.
• Extreme, very severe or significant shortness of breath at the end of the study period occurred much less frequently. The improvement ranged from 3.5 to 12.2 percentage points. and was most noticeable when walking, followed by emotions such as anger or sadness.
• Significant improvement as a result of participation in the program also concerned the feeling of negative emotions/the occurrence of negative states. The greatest decrease in percentage points concerned the state of low energy (11.9), feeling anxious, tense, nervous (9.2) and feeling frustrated and impatient (8.3).
The knowledge test about heart failure conducted among patients with this condition shows that the respondents have good knowledge of its causes, complementary treatment methods, appropriate heart rate, and the effects and risks of this disease. Unfortunately, the respondents have average knowledge about the appropriate diet accompanying pharmacological treatment and the most important parameters to be monitored during outpatient treatment.