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Description
The general objective of the project is to increase the access of the vulnerable population, including the Roma, to telemedicine services at nearby centers for primary diagnosis in order to prevent and treat non-communicable diseases through the development and implementation of an integrated platform for diagnosis and monitoring, including post-Covid, at to have direct access or through facilitators to the vulnerable communities in the NE Region.
The project contributes to the achievement of the general objective of the RO20 Health program, namely the improvement of prevention and the reduction of inequalities in the field of health, resulting in a decrease in the number of illnesses (cardiovascular diseases, cancer, diabetes, respiratory diseases, nutrition) and post-Covid rehabilitation for a number of at least 500 people from vulnerable groups, including Roma, from the NE Region.
Summary of project results
The project aims to prevent late identification and worsening of non-communicable diseases such as respiratory diseases, cardiovascular diseases, cancer, diabetes, nutritional, including post-Covid rehabilitation issues among vulnerable people by improving their access to telemedicine services in the North East Region, a region considered the least developed at national level.
The overall objective of the project is to increase access of the vulnerable population, including Roma, to telemedicine services at nearby centers for primary diagnosis in order to prevent and treat non-communicable diseases by developing and implementing an integrated diagnostic and monitoring platform, including post-Covid, to which they have direct access through facilitators for vulnerable communities in the North East Region.
The project contributes to achieving the general objective of the RO20 Health program, namely by improving prevention and reducing inequalities in the field of health, resulting in a decrease in the number of illnesses (cardiovascular diseases, cancer, respiratory diseases, nutrition) and post-Covid rehabilitation for a minimum of 500 people from vulnerable groups, including Roma.
The main activity of the project is the initiation of telemedicine services in the vicinity of marginalized areas and with vulnerable people, monitoring and evaluating the proposed system for validation in order to replicate it throughout the region. The E-NE-Health platform will include a database with patients benefiting from telemedicine services and will be connected to another relevant database with diagnosed pathologies. And it will be made available to public health authorities for centralization and interpretation of data.
The partnership established within the project formed by a cluster NGO active in the field of cardiovascular and oncological diseases as Promotpr having as partners 2 of the 6 County Directorates of Public Health - Iași and Suceava, together with 3 ATUs from marginalized areas (Crostești, Cosula - Botoșani county and Văleni - Neamț county) is representative and creates the premises for the continuation and expansion of the services proposed by the project at the level of the North-East region, but also at the national level.
The project aims to support the target group, people belonging to vulnerable groups, including Roma who will benefit from telemedicine services carried out in the proximity of the area where they live, by teams of medical professionals, doctors and nurses, social workers and facilitators who ensure access to the use of IT facilities in order to participate in diagnosis and treatment, in adapted and necessary medical services.
The innovative nature of the project is given by the initiation of telemedicine services, services regulated at national level at the end of 2020, with a high degree of novelty at international level considering the evolution of technologies, including in the medical field. In addition, the application of telemedicine in rural areas, and several marginalized areas and dedicated to vulnerable people presents a high degree of novelty. The proposed telemedicine services respond to the country recommendations made to Romania, as well as the specific objectives of the Program, namely improving access to healthcare for people in rural areas and vulnerable groups for disease prevention, as well as the efficiency of the health sector in terms of costs, including by transferring the center of gravity of hospital services to outpatient services, but also telemedicine services. The project aims to establish 30 telemedicine centers and a target group of diagnosed patients of at least 500 people, of whom 100 are Roma. This target group is also supplemented by indirect beneficiaries from among the target group''s family members, medical and social personnel, central and local authority personnel and places of worship as facilitators of the implementation of telemedicine services. Increasing the diagnostic and treatment capacity through telemedicine services will improve access to medical services for the county''s population in general, contributing to achieving the objective of the EEA Grants 2014-2021 Public Health Challenges Program.
The main challenges addressed at the project level are related to the problems and needs identified at the community level. The current project is implemented at the level of the North-East Region, a poor area with a great lack of services. Among the main problems, but also challenges identified, we list:
- Low level of development of basic infrastructure
- Low accessibility and mobility
- Low access to public education and health services
- Risk of poverty or social exclusion
The requested funding is a means to demonstrate the feasibility of introducing telemedicine services in isolated/marginalized areas.
A1. Project Management
Within the A1 activity, the Project Manager maintained permanent communication with the partners, including by traveling to the project area. The main issues discussed were: allocation of human, financial and material resources, planning of activities, identification of possible locations for establishing telemedicine centers
Also, meetings of the implementation team were organized in order to monitor and evaluate the implementation of the project as well as to plan future activities, in parallel with participating in the actual development of the project activities.
Results obtained
- 40 CIMs, included in the Financial Report
- Updated UIP Decision no. 25/01.03.2024, included in the Financial Report
30 consignment contracts for telemedicine centers, including minutes of handover-receipt/reception of equipment and consumables
A2. Recruitment of target group and telemedicine service facilitators
Results obtained
• GT Recruitment and Selection Methodology, revision 2
• 764 people informed for recruitment as GT
• 16 GT information and recruitment sessions
Report on Information and Recruitment Campaign
A3. Implementation of the E-NE-Health platform
Following the meetings of the project implementation team, as well as the information - awareness and recruitment campaigns of facilitators, the situations encountered in the field, the health assessment questionnaires on non-communicable diseases pathologies targeted within the project were updated and sent to the developer of the telemedicine platform contracted in March 2024. The questionnaires thus designed formed the basis of the data that were included in the E-NE Health platform.
The project implementation team developed the database with people belonging to the GT by integrating the questionnaires on the telemedicine services platform, which became functional at the end of March and was populated by the end of the project implementation period, and subsequently, an activity that will continue during the sustainability period.
The design and development of the telemedicine platform was developed based on the previously established database structure and the acquisition of IT services was started immediately after the approval of the Additional Act No. 1.
The beta version of the platform was available in the second half of March, in the first half of April it was launched and populated with members of the target group.
A report on the functionality of the platform and the degree of user satisfaction is attached to this report.
With the completion of the platform in order to create an organizational framework for the flow of telemedicine services, the Procedures Manual for the implementation of telemedicine services was developed.
Results obtained
• Procedures Manual for the implementation of telemedicine services,
• Functional telemedicine platform populated with data
• Contract no. 101/01.03.2024, procurement file, included as an annex to the Financial Report
• Final acceptance report for the telemedicine platform, included as an annex to the Financial Report
Report on the functionality of the platform
A4. Training programs for the implementation of e-health services
4.1. GT and related training sessions
During the reported period, respectively between 04.03-26.04.2024, 34 training sessions of the target group were organized, in which a no. of 1139 people. The sessions were supported by the implementation team of the Promoter AngioNET Cluster Association, together with the DSP partners from the project implementation area, with the aim of presenting the telemedicine platform created within the project and the benefits of telemedicine services offered through the platform. The data of the identified target group were taken over for inclusion on the telemedicine services platform, as it became functional
Results obtained
- 34 training sessions of the target group
- 1139 GT members trained
- 6 facilitator training sessions + EKG workshop
- 2 online sessions (webinar)
- 29 + 10 + 9 facilitators, doctors and project staff trained in telemedicine services.
- Facilitator and doctor training session report
- Target group training session report
A5. Equipping the centers with medical equipment for the implementation of telemedicine services, including purchases necessary for the implementation of the project
During the reporting period, the following service contracts were concluded:
- IT services for the implementation of the E-NE Health platform
- addendum no. 1 to the contract for the development of information and advertising materials
- advertising support services related to the Final Conference
logistics services accommodation and meals training sessions and final conference
- transport services, travel to project implementation locations.
The following equipment was purchased:
29 laptops
30 multifunction printers
30 electrocardiographs
30 glucometers
30 pcs. measuring strips
30 pcs. thermometers
30 pcs. blood pressure monitors
30 pcs. scales.
The following medical supplies were purchased:
30 sets of FLOWFLEX PROFESSIONAL COVID-19 RAPID TEST
consumables related to glucometers (60 test boxes + 120 boxes of needles)
The following protective materials were purchased:
1500 medical masks 3 layers filtration >98% Type II R
30 boxes x 100 pcs. Powder-free nitrile gloves
60 x 1 L Hand sanitizer solution
The following office supplies were purchased:
- 50 A4 xerox paper tops
- Toner cartridges
30 telemedicine centers were equipped and operationalized and the quantitative and qualitative handover-reception Minutes were concluded, accompanied by tripartite consignment contracts - AngioNet Cluster Association - UAT from the localities where the telemedicine center is established - The facilitator responsible for the telemedicine center.
A6 Telemedicine services
Questionnaires and documents were completed along with the identification and training of the target group from the 34 locations and were included in the telemedicine platform in March-April 2024.
During the reporting period, consultation appointments were started and completed.
A number of 879 patients included in the platform were registered in the platform, of which 559 with complete medical data who benefited from telemedicine services through the coordinating physician, 260 being redirected for specialized consultations in cardiovascular diseases, diabetes, pneumology, internal medicine.
Even if medical data were not included according to the specific fields in the platform, the consultations took place by completing the narrative in the fields "Medical history" and "Symptoms reported by the patient" and transmitted to the Telemedicine Coordinator who acts as a triage doctor, who further directs, if necessary, to specialist doctors.
Of the total of 879 patients, 137 fall into the Roma category.
During the reporting period, the follow-up methods were established and included in the validated structure of the platform. The 260 patients who were redirected for specialist consultations in cardiovascular diseases, diabetes, pneumology, internal medicine returned for follow-up to the coordinating doctor. Monitoring periods were established for all patients, depending on the severity of the conditions for which they were treated.
For the analysis and processing of the obtained data, 4 people were hired by the Promoter as public health experts, so as to cover all 6 counties in the NE Region. The experts worked together with the telemedicine services coordinator, with the specialist doctors, with the project manager to monitor the functioning of the services through the platform, to establish the stage conclusions and the final conclusions so that the continuity of the services could be ensured during the sustainability period of the project.
Results obtained
Telemedicine platform populated with data: 879 patients included in the platform, of which 559 with complete medical data, of which 137 Roma
Platform data analysis
A7. Awareness campaign. Project information and publicity
A total of 879 participants were registered in the 6 sessions of the information - awareness campaign, to which other representatives of the targeted target groups will be added by the end of the project, within the target group recruitment campaign, as well as through the use of social media, in accordance with the communication plan.
As a conclusion, the awareness campaign was carried out in accordance with the Communication Plan, an integral part of the project application that is the subject of the financing contract and achieved its goal, namely:
- increasing the level of information on prevention methods and cardiovascular diseases, cancer, diabetes, respiratory diseases, nutrition and physical education in Romania
- increasing awareness of the implementation of the project and the role of the EEA Financial Mechanism in financing the project
On 29.04.2024, the final conference of the project was organized and held, a conference at which the results obtained within the project were presented and which was preceded by the transmission of the press release https://www.agerpres.ro/ots/2024/04/29/servicii-de-telemedicina-pentru-grupuri-defavorizate-cu-afectiuni-cronice-in-zonele-izolate-din-ne-romaniei-acronim-e-ne-sanatate--653702
Results
Communication strategy and plan
- employment contracts were concluded for the 29 facilitators from the 6 counties of the N-E Region
- the health assessment questionnaires on non-communicable diseases pathologies targeted within the project were updated and sent to the developer of the telemedicine platform contracted in March 2024. The questionnaires thus designed formed the basis of the data that were included in the E-NE Health platform.
- developed the database with people belonging to the GT by integrating the questionnaires on the telemedicine services platform, which became functional at the end of March and was populated until the end of the project implementation period, and subsequently, an activity that will continue during the sustainability period.
- the design and development of the telemedicine platform was developed based on the previously established structure for the database and the acquisition of IT services was started
- 34 training sessions of the target group were organized, attended by a no. of 1139 people
- the Procedures Manual for the implementation of telemedicine services was developed.
- 6 facilitator/doctor training sessions took place + 2 webinars supported by trainers and members of the project implementation team, to which an ECG usage workshop was added
- a Final Conference was organized and attended by a total of 48 people
- specialized medical personnel were hired (4 specialist doctors + 1 medical trainer) and medical personnel training sessions were organized together with on-site facilitator sessions
- the following service contracts were concluded: IT services for the development of the E-NE Health platform, advertising support services related to the Final Conference, logistics services, accommodation and meals for training sessions and the final conference, transport services, travel to project implementation locations.
- 30 telemedicine centers were equipped and operationalized
- questionnaires and documents were completed along with the identification and training of the target group from the 34 locations
- a number of 879 patients (137 Roma) included in the platform were registered, of which 559 with complete medical data who benefited from telemedicine services through the coordinating physician, 260 being redirected for specialized consultation in cardiovascular diseases, diabetes, pneumology, internal medicine.
- a number of 6 sessions were held in the information campaign
- a no. was registered total 879 participants in the 6 sessions of the information campaign - awareness
- the project launch conference was organized on 31.03.2023 within the 2nd edition of the Regional Multidisciplinary Symposium on Minimally Invasive Techniques
- the press release was published on 30.05.2023, https://www.viata-medicala.ro/comunicat-de-presa-privind-lansarea-proiectului-servicii-de-telemedicina-pentru-grupuri-defavorizate-cu-afectiuni-cronice-in-zonele-izolate-din-ne-romaniei-acronim-e-ne-sanatate-32582
- the content of the information flyers on different categories of chronic pathologies was finalized, including the layout and printing of the 5000 pieces. (10 x 500 pcs) which were distributed within the GT recruitment information campaign and subsequently at the final conference
- the AngioNet Cluster website was updated with information related to the progress made within the project, as well as the results obtained at the end of the project;
- elements related to the objectives and results of the project were included on the E-NE Health platform, https://e-ne-sanatate.angionet.ro/
- the social media campaign, respectively on the AngioNet Cluster Facebook account, was carried out during March-April 2024 on the occasion of the operationalization of the telemedicine centers;