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Description
The planned project is a pilot project and assumes the possibility of testing in real conditions the telemedicine model and carrying out preventive actions in the field of obstetrics and providing support for pregnant women, women after childbirth, postpartum and medical staff.
MAIN ACTIVITIES:
1) implementation of preventive and promotional activities in the field of public health and conducting informational and promotional actions related to the activities under the project and the model tested under the pilot;
2) testing of model solutions in partnership with Primary Health Care (PHC) entities and purchase of equipment necessary for testing;
3) creation and sharing a telemedicine platform to support the area of care during pregnancy;
4) rental of CTG machines and making them accessible to pregnant women in line with the model.
The model will be implemented in the area of operation of PHC midwife clinics and gynaecological-obstetrics outpatient clinics of the project partners (CMD and CMJ in 6 facilities located in towns distant from large cities. These will be clinics located in places where patients have poor access to 24-hour prenatal care (distance criterion). As part of the project, the Applicant plans to provide support to 320 adult women of reproductive age who are pregnant, including women from excluded areas. It is also important to include in the project midwives and gynaecologists-obstetricians who will be able to perform teleconsultations with specialists from the reference centre in the case of suspected pregnancy or health disorders of the pregnant woman.
Summary of project results
The need to implement the project resulted from the existing and constantly growing health inequalities in Poland. Resources, access to which is determined by social position, have a very significant impact not only on life chances, but also on health chances of a person. People with a low social position encounter many barriers that make it difficult or even impossible to take proper care of their health, e.g. more often than people with a high social position, they have worse housing conditions, lower income or finally problems with access to health services. The problem of health inequalities also includes access to gynecological and obstetric care in Poland.
The aim of the project entitled "Hello Mama! – pilot telemedicine care for pregnant women” was to test a telemedicine model in obstetrics and reduce social inequalities in health by improving access of 320 adult women from Poland to healthcare services in the field of telemedicine and e-health and increasing their level of education in the field of preparation for childbirth, postpartum period, breastfeeding and parenthood in the period from 01.07.2022 to 31.01.2024.
The project was planned for:
1) implementation of preventive and promotional activities in the field of public health and conduction of information and promotional campaigns related to the activities of the project and the model tested as part of the pilot;
2) testing the model solutions in partnership with Primary Health Care entities and purchasing equipment necessary for testing;
3) creating and providing a telemedicine platform supporting the area of care during pregnancy;
4) rentaal of CTG devices and making them available to pregnant women in accordance with the assumptions of the model.
The project was implemented in the area of operation of PHC midwife clinics and gynaecological-obstetrics outpatient clinics of the project partners in Poland. These clinics were located in places where patients have poor access to 24-hour prenatal care (distance criterion). As part of the project it was aimed to provide support to 320 adult women of reproductive age who are pregnant, including women from excluded areas. It was also important to include in the project midwives and gynaecologists-obstetricians who were able to perform teleconsultations with specialists from the reference centre in the case of suspected pregnancy or health disorders of the pregnant woman.
The project promoter together with its partners developed a training and working version of the Virtual Card of a Pregnant Woman application, and then a production version was designed. To be able to collect personal medical data the necessay documents were developed:
* regulations of participation, declarations of participation, information clauses and others, operational processes related to recruitment, training, course of care and contact with patients during the pilot project, consultations and medical coordination of the medical partner/promoter, which are used routinely,
* Data Security Policy and Risk Prevention Policy in the project and agreements were made with the Partners regarding the applicability of the data security policy and risk prevention policy.
The preventive and promotional activities carried out by the project promoter were aimed at raising health awareness, both among medical personnel and patients and their family members on health prevention during pregnancy, including issues related to a healthy lifestyle, appropriate health behaviors and prevention of emotional disorders during pregnancy. Educational and promotional materials (leaflets, posters) were developed, which contained content related to health promotion and prevention for pregnant women, talking about the need to take care of proper health during this period and the prenatal development of the child. The priority was to promote behaviors beneficial to health, including: optimal nutrition (both in terms of quantity and quality and regularity of meals); elimination of known teratogenic factors with a brief explanation of their impact on pregnancy development and indication of ways to avoid them (in the workplace, in the environment), risk factors for the occurrence and severity of depression symptoms (in accordance with current recommendations and medical knowledge, e.g. using the Edinburgh Postnatal Depression Scale), quitting addictions (smoking, drinking alcohol, drugs, overused medications, psychoactive substances); beneficial effects of sleep and rest on the body; principles of body and oral hygiene (including dental check-ups) during pregnancy; physical activity adapted to the health condition of the woman (walks, physical exercises).
As part of the model testing, the midwives and gynecologists-obstetricians of the promoter and partners received encrypted access to the "Halo Mama" system and were trained in using applications, including the Virtual Account of a Pregnant Woman, planning care for pregnant women. The equipment and technological tools necessary to equip the clinic were purchased i.e.: mobile workstations with software to operate the Virtual Account of a Pregnant Woman, telephones for people taking care of pregnant women and for pregnant women, cards with mobile data, blood pressure monitors. The implementation of the required functionalities and their use took place under the supervision of the project management staff (including weekly assessment of patients'' medical data, assessment in terms of the course of pregnancy, possible implementation of a specific procedure).
Intensive recruitment of patients was conducted and as a result 322 patients were recruited. Preventive services, health promotion activities, diagnostic tests and medical consultations for pregnant women were carried out, in accordance with the guidelines of the Organizational Standard of perinatal care. The person managing the pregnancy informed the woman about the possibility of using the application for pregnant women. Teleconsultations and teleeducation for pregnant patients were carried out. Midwives performed 42 cycles of education, consisting of a total of 575 meetings.
On May 29, 2023, a conference was held to open the project entitled Hello Mama! - pilot telemedicine care for pregnant women, the aim of which was to present the main assumptions of the project, pilot project objectives and planned results, as well as to share experiences in the field of telemedicine and e-health. The conference was attended by a representative of the Department of Investment Assessment of the Ministry of Health, project initiators, partners, coordinators, members, as well as other persons interested in the subject of the project, a total of 47 people.
On January 11, 2024, a final conference was held devoted to summarizing the project, issues of telemedicine, e-health, trends and possible areas of development. The conference was attended by representatives of the management of the Department of Investment Assessment and the Department of Innovation of the Ministry of Health, representatives of the medical community for obstetrics, project initiators, partners, coordinators, members, as well as other persons interested in the subject of the undertaking, a total of 42 people.
Short films summarizing the conferences and reports were prepared. Photographic documentation of the event was made, live streaming. Information was published on an ongoing basis on a dedicated website for the pilot project in social media.
Information and promotional materials were purchased for the needs of both conferences, i.e. leaflets, posters, billboards, catering and remuneration for speakers were also provided.
A high rate of patient recruitment for the pilot project was achieved, which contributed to achieving the assumed indicator, i.e. recruiting 322 patients. The patient application and the portal for medical staff were complete and enabled medical care to be provided together with supervision by the Promoter during the pregnancy. The medical staff had a convenient insight into the full medical history of the patients, along with the most important parameters available on the main card.
The benefits for patients from the perspective of the medical staff, in particular the person managing the pregnancy, were:
* Supervision by the doctor at every stage and quick interventions through contact with an additionally created consultation group and set algorithms significantly reduced the risk of making an error;
* The necessity and practice of collecting data on the patient''s health condition in the pilot project (based on the application) contributed to the organization and systematization of medical documentation in primary care;
* The solution supported the transfer of the best medical practices and the latest available medical knowledge;
* Constant access to specialist knowledge and treatment options at the Promoter''s discretion.
An undoubted benefit was the awareness that the course of the pregnancy was supervised by a team of experts from a center with a 3rd reference level - the Clinic of Obstetrics and Gynecology of the Institute of Mother and Child. Of great importance to the patients was the fact that medical documentation and the course of care for the pregnant woman was supervised by specialist staff from the Institute and the medical database was properly secured. A very important element of the pilot project was the possibility of stationary consultations with specialists from the Institute in Warsaw, in the event of an increased risk, which allowed for quick intervention, radically increasing the safety of the woman and child.
The partner primary care providers saw in the implemented solution an opportunity to improve the quality of obstetric care and pregnant care in general at the level of primary care, with the use of telemedicine tools and facilitation of accessibility both at the technical and organizational level.
An undoubted advantage was the ability to monitor the child''s well-being using the remote CTG measurement device, which also included constant supervision of the heart rate recording along with the response of the staff in alarm situations and in the event of the need to repeat the measurement for technical reasons. This gave the patient a sense of security and comfort (no need to travel to the nearest clinic/hospital). This was a very attractive addition, which was greatly appreciated by the women who used the device. Patients joined the pilot project at various stages of pregnancy, which affected the scope of care received. Of the patients who were offered access to remote CTG measurement, approximately 2/3 took advantage of this option (46/71), which means that some patients, despite initiating the procedure for providing the device, decided not to complete it; in a few cases, there were refusals to use this form of examination. In general, the percentage of pregnant women who responded positively to the possibility of using this type of telemedicine service seems to be high - especially considering the possible perception of patients'' participation in the pilot project as a prototype event.