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Description
Improving access and prevention services regarding idiopathic pulmonary fibrosis and broncho-pulmonary cancer for 500 people from vulnerable communities, from the counties of Bucharest-Ilfov, Prahova, Giurgiu, Dâmbovița, Călăraşi, Slobozia.The specific objectives of the project are:1) Facilitating the access of people from the category of vulnerable groups to medical services for the detection of pulmonary fibrosis and broncho-pulmonary cancer2) Increase by 50% the skills and knowledge of the medical staff regarding the identification of signs and symptoms in order to detect idiopathic pulmonary fibrosis and broncho-pulmonary cancer.3) Awareness of citizens in general and vulnerable groups in particular, regarding the medical assistance provided within the project as well as the visibility of the support of Ireland, Lichtenstein and Norway to address challenges in public health 2. Expected results:a) 500 people consulted, 500 risk charts carried out, Medical register developed for the target group, 200 people identified with pulmonary anomalies that required additional investigationsb) 200 people investigated through specialized consultation, 120 LDCT or Rx investigations, 50 people with microbiological examination for BK (tuberculosis test)c) Medical training of 30 family doctors on signs, symptoms, diagnosis and management of patients with lung diseases.e) Web and FB page, electronic and printed promotional materials3. Project activities:A.1. Project managementA.2. Identification and selection of people suspected of the disease as well as those at risk, based on specific symptoms or the riskogramA.3. Diagnosis of patients with possible lung abnormalitiesA.4. Assistance in accessing treatment servicesA.5. Medical training programs for family doctors on signs, symptoms, diagnosis and management of patients with lung diseasesA.6. Project and Program visibility and promotion campaign
Summary of project results
The EEA Financial Mechanism proposed to reduce the economic and social discrepancies in the European Economic Area, through measures aimed at social inclusion, employment and poverty reduction, measures that converge towards the achievement of the general objective of "improving prevention and reducing inequalities in the field of health ".
The analysis of the degree of equity of the health system in Romania highlighted inequalities regarding service coverage and health status by income level. These data indicated that the contributors to the high rates of preventable and treatable mortality are those with low and very low incomes. The underfunding of the health system also contributes to this whole situation (Romania ranks fourth in Europe, with the lowest rate of spending on prevention (1.4%) - Eurostat 18.01.2021), reduced access to basic medical services, but also the limited offer of preventive services from the basic package. The poor population is systematically deprived of those interventions that can save or change lives.
After cardio and cerebro-vascular diseases, respiratory diseases represent the third cause of mortality in the European Union. Chronic diseases of the lower respiratory tract followed by pneumonia are the conditions with the highest death rate among respiratory diseases. According to the latest WHO (World Health Organization) estimates, there are 65 million people suffering from moderate to severe chronic lung diseases (WHO 2017), predicted to be the third leading cause of mortality by 2030. In Romania, 8.3% of the population over 40 suffer from chronic lung diseases.
In general, patients with chronic lung disease are more prone to cardiovascular disease, osteoporosis, diabetes, lung cancer, and bronchiectasis, which in turn increase the chances of hospitalization and/or death. Chronic lung diseases such as idiopathic pulmonary fibrosis are associated with permanent architectural distortion and irreversible lung dysfunction. There is sufficient evidence that patients with idiopathic pulmonary fibrosis are at the highest risk of developing lung cancer, and its early diagnosis is essential for early treatment and possible improvement of long-term clinical outcome in this progressive disease and in last resort, fatal.
The evidence regarding the risk factors favoring the development of pulmonary fibrosis mentions the infection with the COVID-19 virus, in addition to those already known: active and passive smoking, exposure to radiation (radon) or other toxic substances (arsenic, asbestos), organic dust or inorganic, drug use and chronic alcoholism as well as hereditary factors.
In Romania, 808,040 covid cases were registered until February 2021, and current tobacco consumption in 2018 reached 30.7%, i.e. 5.63 million. Romanians over the age of 15 smoke.
Regarding alcohol consumption, Romania ranks 3rd in the EU according to the amount of alcohol consumed and 2nd among the countries with the most harmful consumption pattern.
A major risk that statistically places respiratory diseases as the third cause of mortality in the EU, is represented by broncho-pulmonary cancers. Romania ranks 7th in terms of mortality due to respiratory diseases in the EU and 5th in terms of mortality due to broncho-pulmonary cancer. According to the GLOBOCAN 2020 statistical data for Romania, lung cancer is in third place in terms of incidence in both sexes, and in first place in terms of incidence in men, with 16.8% of all cases, in 2020. in terms of mortality, this type of cancer ranks first, with a dominant percentage of 19.8% of all cancer deaths, also holding the record for the number of new cases annually (12.3%)
Against the background of the high circulation of the SARS COV-19 virus and the high prevalence of high-risk behaviors (smoking, alcohol consumption), the incidence of lung cancer in the national population is very high - the third highest rate in Europe for men according to the ECDC.
There is growing evidence that COPD is a physical condition with social consequences of stigmatization and marginalization. At the same time, more and more studies find a strong relationship between mortality due to respiratory diseases and social position, measured as indicators of education, income, housing and occupation.
Poverty is a major risk factor in the development of respiratory diseases and lung cancer, because socially disadvantaged populations are exposed to several vulnerability factors: behavioral risk factors (smoking, alcohol, poor nutrition), polluting factors - life associations where they usually live (noxes from abandoned buildings and degraded land, from landfills, from waste burning, mold, etc.) and social factors (marginalization, lack of health insurance, improper living conditions).
Broncho-lung cancer is often diagnosed late, which means fewer treatment options for people diagnosed at an advanced stage. This makes the number of people who die each year from lung cancer equal to the number of newly diagnosed ones.
First, patients are not aware that their symptoms are serious and that they need to see their family doctor. Sometimes they neglect the symptoms or deny that the symptoms they are experiencing may be serious and decide to postpone the check-up with the doctor for various reasons.
Second, it is possible that some family doctors do not pay much attention to the active identification of patients in risk groups and therefore do not refer patients for further investigations in a timely manner. Often the symptoms that patients present with are not specific to lung cancer, but can be specific to other diseases as well.
Thirdly, patients'' accessibility to specialized services and investigations (other than those offered by the family doctor) is difficult in many areas of the country. Because of this, GPs may not always identify patients in higher risk groups and they may not benefit from the necessary investigations to confirm or rule out fibrosis or lung cancer.
By implementing this project at the level of a target group of 500 vulnerable people, we intend to:
- Ensuring access to diagnostic and treatment services for patients at risk of idiopathic pulmonary fibrosis and broncho-pulmonary cancer
- Information and awareness of the population regarding the importance of prevention in health
- Increasing the skills of health personnel (family doctors) to recognize the symptoms, diagnosis and treatment of idiopathic pulmonary fibrosis and broncho-pulmonary cancer.
The main results were achieved through the following activities:
Activity 1: Project Management:
It consisted in mobilizing the project personnel, in meetings with the project partners, establishing the implementation plan and the mechanisms for collaboration and project management, the procurement process.
As results, we mention that 718 people were recruited, of which 71 were Roma.
Activity 2 Identification and selection of people suspected of the disease as well as those at risk, based on the specific symptomatology or the riskogram:
2.1 Designing the questionnaire and risk chart
Questionnaires and risk charts for target group interviews and patient selection were developed. They were elaborated
- Social questionnaire (including GDPR statements and acceptance statement for project consultation)
- Risk chart and risk questionnaire
- Patient management protocol
- Patient consent
- Partnership agreement Family Doctors
- Partnership agreement with local authorities
- Medical service providers partnership agreement
- Expert privacy statement
2.2 Realization of the screening program registration platform
The screening program registration platform was created and loaded with data from 718 social questionnaires and 607 riskograms with 170 pulmonologist consultations.
2.3 Interviewing and consulting disadvantaged categories at risk.
718 vulnerable people were interviewed, of which 607 people benefited from specialist advice.
Results:
Social questionnaire for the selection of the target group Riskogram and risk questionnaire
Elaborated patient management protocol
Electronic platform - loaded
Of the 718 vulnerable people enrolled in the project, 607 people benefited from consultations, of which 311 people were high risk and medium risk.
Activity 3: Diagnosis of patients with possible lung abnormalities:
During this activity, 213 patients benefited from consultations with a pneumophthisiology specialist and specialized investigations, in which the following pathologies were identified:
Results:
37 patients with lung nodules (with high suspicion of malignancy), of which 10 with bronchopulmonary cancer in various stages (of which 2 died with very advanced cancer)
10 patients with axillary and mediastinal adenopathies,
5 patients with fibrous lesions,
25 patients with COPD-chronic obstructive pulmonary disease
16 patients with bronchitis
10 patients with pulmonary fibrosis
8 patients with pachypleuresis
5 patients with pulmonary emphysema
10 patients with asthma
10 patients with TB + sequelae
As well as smoking, gastric tumors, sleep apnea, venous dilations, breast and liver tumors
Activity 4: Assistance with access to treatment services:
At the Call-center, the Coordinating Navigator handled incoming and outgoing calls to and from citizens and/or the target group enrolled in the project, listened to their needs or problems and provided useful solutions.
Results:
Navigation and counseling of over 300 people, through the Call-center (also from outside the target counties of the project)
Activity 5: Medical training programs for family doctors on signs, symptoms, diagnosis and management of patients with lung diseases:
3 training sessions were held for family doctors with a specialist pneumology lecturer with expertise in bronchoscopy and a scientific researcher at the Marius Nasta Institute of Pneumophisiology.
Results:
3 training sessions
30 medical personnel benefited from the training
Activity 6: Project and Program visibility and promotion campaign:
The logo of the project and the design of the website and the poster were finalized, as well as the slogan of the project - "Breathe easily" for which they received approval.
The project was launched through a press conference on 04/03/2023 at the Capitol Hotel, Bucharest, with the FABC president, the IOB manager, the Manager of the Institute of Pneumoftisiology Marius Nasta as guest speakers. The conference was attended by 22 invited medical people, the media, the project team.
The website content and FB page were defined
200 posters and 30 agendas were printed and distributed
30 certificates of participation in project training seminars were printed and distributed
Results:
Website creation: https://respiriusor.fabc.ro/
Create Facebook page: Breathe Easy | Facebook
Total number of visitors from the Facebook page who accessed the page for the most relevant articles: 16,370 and 6,890 impressions.
Production of promotional materials: 200 posters, 1 roll-up, 1 press release)
Project launch conference 04/03/2023
Press release - 04/05/2023
The final conference – 28.02.2024
The results of this project contribute to the achievement of outcome 2.5, namely the number of vulnerable people who have benefited from medical services and was obtained by combining Activity A2 - A2. Identification and selection of people suspected of disease as well as those at risk, based on The specific symptomatology or the riskogram.As part of the screening for lung diseases, they distributed questionnaires and ristrograms to 718 patients, of whom 604 benefited from special pneumophthisiology medical services, consultations and specialized investigations.