Implementing telemonitoring in the Portuguese National Health System Miguel Castelo Branco MD PhD On behalf of the Grupo de Trabalho da Telemedicina da Comissão de Informatização Clinica do Ministério da Saúde
GTT members that contributed to this presentation M. Castelo Branco 1, F. Gomes da Costa 2, C. Ribeiro 3, A. Pina 4, A. Belo 5, L.Gonçalves 6,H.M. Martins 7 1 Centro Hospitalar Cova da Beira, mcbrancocs@gmail.com Alameda Pero da Covilhã, 6200 251 Covilhã, Portugal 2 Administração Regional de Saúde do Centro, fgcosta@arscentro.min saude.pt Alameda Júlio Henriques, Apartado 1087, 3001 553 Coimbra, Portugal 3 Administração Regional de Saúde do Norte, cribeiro@arsnorte.min saude.pt Rua de Santa Catarina, 1288 4000 447 Porto, Portugal 4 Administração Regional de Saúde do Algarve, apina@arsalgarve.min saude.pt R. Brites de Almeida, nº 6, 2º Esq., 8000 234 Faro, Portugal 5 Administração Central do Sistema de Saúde, abelo@acss.min saude pt Av. João Crisóstomo nº 14 1000 179 Lisboa, Portugal 6 Serviços Partilhados do Ministério da Saúde, luisgoncalves45@gmail.com Av. João Crisóstomo nº 9 1000 162 Lisboa, Portugal 7 Serviços Partilhados do Ministério da Saúde, henrique.m.martins@spms.min saude.pt Av. João Crisóstomo nº 9 1000 162 Lisboa, Portugal
In 2011 The Portuguese Ministry of Health decided to increase the use of Telemedicine and Telemonitoring in the Portuguese National Health System
A working group (GTT Grupo de Trabalho da Telemedicina/ Telemedicine Working Group) was created under the Commission for Clinical Informatics that advises the Health Secretary of State
On March 2013, the government decree 3571/2013 was published on the Portuguese official journal regarding telemedicine adoption. A Chronic Obstructive Pulmonary Disease telemonitoring project was defined Dermatology and cardiology where also identified as targets in the program
COPD Telemonitoring Program Portalegre 5 Hospitals (ULSAM, CHUC; CHCB, ULSAA, CHAL) 5 Companies (Altran, Hope Care, Linde Portugal, Tunstall Iberica, Vitalmobile Health) Same rules Funded program
Contracts contracts were centrally developed and runned by SPMS. (Health Minister Shared Services)
COPD telemonitoring project aims i)raise the quality of services provided to citizens, making them feel continuously monitored in their illness; ii) Reduce at least 2 annual admissions for health degradation of the patient; iii) Reduce 3 episodes of exacerbation with visit to the Emergency Room (ER) per patient in the program; iv) to follow continuously patient conditions allowing timely reaction to postpone/prevent the possible clinical deterioration
Patient selection criteria Fifteen patients were selected in each hospital by the attending physician, on the basis of the previous COPD history. Followed for during the preceding year Severe disease: At least 3 admissions to the ED or one admission to the ward
Suppliers responsability monitoring devices maintenance and replacement process to gather information and to transfer it to the health team
Devices supplied to each patient Blood pressure measuring device, pulse oximeter, thermometer, pedometer, heart rate monitoring device, Mobile phone.
Hospital team involvement Patients follow up Education about the use of the monitoring devices Monitoring of data generated by equipment installed at the patient homes and parameterized in a personalized way Daily analysis of the data and timely response to the device generated alerts Telephone contact with the patient Priority routing for external consultation or emergency whenever needed.
Patients satisfaction (56 answers) 22-04-2015 14 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Sample charecteristics 6 5 4 3 2 1 0 Hospital Answers CHAL 15 CHUC 15 ULSAM 15 ULSNA 11 Total Geral 56 Age 48 51 54 55 56 57 58 60 61 62 63 65 66 67 68 69 70 71 72 73 74 75 76 78 81 83 89 (em branco) Question Quem responde? Answers Family/Career 8 Patient 48 22-04-2015 15 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt Gender Female 10 Male 46 Married 47 Divorced 4 Batchelor 5 Studies Basic 34 High School 10 Superior Studies 8 No 4 Home Small Village 15 City 9 Village 32
Qualidade do serviço prestado Answers % Quality Bad 0 0 Very Good/Excelent 34 60,7 Pleased/Good 22 39,3 Concept Bad 0 0 Very Good/Excelent 30 53,6 Pleased/Good 26 46,4 Used to use IT 22-04-2015 16 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Quality of service provided Quality Bad Very Pleased/ Good/excelent good Supplier 0 67,9 32,1 Team 0 80,4 19,6 Information 0 62,5 37,5 Devices 1,8 60,7 37,5 Profissionalismo 0 83,9 16,1 22-04-2015 17 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Healt Professionals and Suppliers Satisfaction Surveil (14 Answers) 22-04-2015 18 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Sample characteristics Hospital Nº CHAL 8 CHC Beira 3 ULSAM 1 ULSNA 1 (em branco) 1 Total Geral 14 Company Nº ALTRAN 3 LINDE 1 TUNSTALL 4 VITALMOBILE 1? 5 Total Geral 14 Who Answers? Nº Both 1 Company 2 Hospital 11 Total 14 22-04-2015 19 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Telemonitoring quality Quality of telemonitoring Concept Nº Bad 0 Good 6 Very Good/Excelent 8 Total 14 Did you noticed that patients felt more confident Nº No 1 Yeas 13 Total 14 Health Care Access Decrease? 22-04-2015 20 SPMS - Serviços Partilhados do Ministério da Saúde, E.P.E. www.spms.min-saude.pt
Although defined for one year duration the Health Minister decided to go for one more year
Home telemonitoring appears to have a positive effect in reducing respiratory exacerbations and hospitalisations and improving quality of life in COPD patients.
Thank You