Momentum telemedicine service descriptions
Telehealth Trikala (GR)
Objectives, expected outcomes, main beneficiaries
The full title of the service is Telehealth Service of the Municipality of Trikala. Trikala, located in central Greece, has designed a long-term strategic plan for the transformation of the local society, based on the opportunities created by the information society era. To this end, several e-services are planned and are being implemented in the areas of e-government, e-health, and e-education, for example. Part of this strategic plan is the establishment of a telehealth and telecare centre offering advanced health and social care services to citizens with chronic diseases.
Telehomecare functions as an alternative and complementary social service that is able to provide value-added healthcare to patients with chronic diseases. The expected outcomes include the reduction of costs for the health and social care system, and improvement of the quality of life of the chronic patients. The main beneficiaries are patients and society.
Targeted population, number of patients
The target population is people with chronic conditions (e.g. who receive long-term monitoring or coaching).
From ten to 50 people receive the service each month.
Type of telemedicine service
This is a monitoring service. The relationship between key actors in the service is patient to secondary care.
Set-up that was being replaced
The Greek national health service care is not predominantly oriented towards the primary health care sector, but maintains a large network of secondary care hospitals which provide primary care through their outpatient departments. Therefore, there are often long waiting lists for patients in primary care. Patients from rural settings, such as from Trikala, often have to travel a long distance to visit their physicians in the secondary hospital so they can consult with a specialised doctor. Due to these difficulties, in the event of health deterioration, patients usually visit the hospitals’ emergency departments.
The aim of this telemonitoring service is to replace some of the regular visits and face-to-face meetings of the patient with the specialist or primary care physician every time a medication modification is made or a medical examination is needed.
Outcomes and results expected after introduction
During the first year of operation of the telehealth services, two scientific studies were conducted: one in cooperation with the Medical School of the Aristotle University of Thessaloniki, Greece, and with the Department of Business Administration, University of Macedonia, Thessaloniki, Greece; the other with the Department of Physical Education & Sport Science of the University of Thessaly in Trikala. Their purpose was to evaluate the efficiency of the telecare services compared with the traditional services.
The outcomes of the studies show that chronic disease management with telehomecare can lead to cost savings and improve quality of life and prognosis. At the same time, the citizens receive advanced, personalised health and community services. As a result, the establishment of a telehealth centre constitutes an efficient channel for the provision of patient-centric services. These two studies are reported below. More specifically:
1. The e-Trikala Telecardiology project: Cost utility and effects of home telemonitoring on hospitalisations, functional capacity and quality of life in elderly patients with chronic heart failure. Α prospective, six-month, randomised trial was designed to compare the effectiveness of HTM versus usual care (UC) in elderly patients with CHF (NYHA class III and IV) and left ventricular ejection fraction (LVEF)<40%, receiving optimal treatment and counselling.
Results: The mean duration of the follow-up was similar for the two groups (146.29± 28.56 days, P>0.05). There was a non-statistically significant reduction in hospital readmissions (-0.304 admissions; 95% CI, -0.773 to 0.164; P>0.05) and in hospitalisation days (-1.130 days; 95% CI, -3.205 to 0.944; P>0.05) for HTM group. However, there was a significant improvement in the Quality of Life, as measured with the disease-specific Minnesota CHF questionnaire (-6.24±4.05, P<0.001) and the generic health-related EQ-5D questionnaire (10.00±7.24, P<0.001). There was also a significant improvement in the exercise capacity as measured with the Specific Activity Questionnaire score (SAQ questionnaire: -0.62±1.10, P=0.001) but not in the NYHA functional class. There was a trend for lower heart failure resource use in the intervention group.
HTM was associated with a significant improvement in the QoL and the exercise capacity, but a small incremental gain of 0.13±0.24 quality-adjusted-life-years (QALYs) over UC. The analysis showed that the average incremental cost of HTM was 12,909±53,313 Euros/QALY gained.
Conclusions: This project demonstrates that home telemonitoring in elderly chronic heart failure outpatients could improve Quality of Life and exercise capacity and reduce hospitalisations in the Greek health-care setting (Stafylas et al, 2008).
2. Hypertension Management through the telecare service of the Municipality of Trikala: Α prospective, six-month, randomised trial was designed to compare the effectiveness of hypertension management through telecare versus usual care.
Results: The results of the study suggest that telecare management of hypertension is more effective than usual care (Tsounis et al, 2008).
Telemonitoring services are provided to individual citizens with chronic heart failure, chronic asthma or chronic obstructive pulmonary disease (COPD), arrhythmias and hypertension. Individual citizens are equipped with light-weight handheld devices. They record their vital signs at home which are then transferred (via the telehealth centre) to the municipal hospital over the Internet or GPRS for review and feedback by the doctors. The service is implemented as a Card-Guard system which provides a web-based personal health record called PMP4 for both patient and clinician access. The medical devices used are designed to interface with the PMP4 system (this is the trade name of the electronic medical record and telemonitoring data management system of Card-Guard). Therefore, from an interoperability standpoint, this is a closed system provided by one vendor.
The service allows enhanced interaction between patients and primary care settings (i.e., General Practitioners) as well as secondary care settings (hospitals and/or specialists).
The service is operational, and is part of the mainstream healthcare service.