The goal of the project "Improving Access to Healthcare Services in Telemedicine and eHealth - Telemonitoring of Heart Failure Patients" was to increase the level of health security and improve the quality of life of heart failure patients by providing coordinated traditional and telemedicine care and educational activities. The project tested a model of telemedicine care for heart failure patients, using a dedicated online platform. Funding for the project comes from the Health Program under the Norwegian Financial Mechanism 2014 - 2021 (85%) and the state budget (15%). Its total value is PLN 2,557,720.00.
During the event, the pilot was summarized, its strengths and weaknesses were discussed, and preliminary results of a survey assessing patient satisfaction with participation in the project were presented. The project leader, the National Institute of Cardiology, and representatives of the partners participating in the pilot (Lomza Medical Center, BaltiMed Outpatient Clinic in Gdansk, Medical and Diagnostic Center in Siedlce) also exchanged insights gained during the implementation of the project.
The meeting was opened by Professor Maciej Sterlinski, MD, Deputy Director for Clinical Affairs. As he emphasized in his speech, the National Institute of Cardiology is heavily involved in all kinds of modern solutions that support and improve patient care, which translates into an improved patient prognosis. - From our perspective, we are seeing an increase in the number of patients with heart failure. The progression of this disease is becoming a significant social problem, so the introduction of solutions such as telemonitoring allows us to provide better care for this group of patients," Prof. Sterlinski stressed.
The keynote lecture on telemedicine solutions in the care of patients with heart failure was delivered by Col. Prof. Dr. med. and n. o zdr. Pawel Krzesinski from the Military Medical Institute - National Research Institute.
A preliminary summary of the course of the pilot project at the National Institute of Cardiology was discussed by Anna Drohomirecka, MD, coordinator of the Medical Affairs Team. During her speech, she summarized the activities carried out so far in the project. A total of 424 heart failure patients with an average age of 65 took part in the pilot, with the oldest patient being 93 years old. A major success was the coverage of a large group of elderly patients. As part of the monitoring, the patients took more than 142,000 measurements of blood pressure, heart rate and body weight, of which just over 30,000 were outside the established limits of the norm for a given patient and required analysis by the monitoring medical team.
In the following part of the conference, the implementation of the pilot in each partner center was summarized, as well as the advantages and disadvantages of the tested solution from the point of view of medical and administrative staff and the patient. Representatives of all the centers spoke (Dr. Andrzej Zapaśnik and Maria Koszałka from the BaltiMed Clinic in Gdansk, Dr. Bartosz Pędziński and Dr. Tomasz Janczarski from the Lomża Medical Center, Dr. Paweł Żuk from the Medical and Diagnostic Center in Siedlce.
All speakers emphasized the need for a strong commitment to this type of care by the medical team and the significant role of nursing and support staff, such as medical coordinators. Since the NIKard pilot used smartphones to transmit vital signs measurements, ongoing technical support was necessary, particularly for patients who were less experienced in using this type of phone. A major challenge was to train patients to take blood pressure, heart rate and weight measurements correctly, and to learn how to recognize worrisome symptoms that may arise in the course of the disease, to respond to them correctly.
In turn, Anna Malek, project manager, presented the advantages and disadvantages of the logistical side of the pilot implemented at the National Institute of Cardiology, emphasizing how challenging it is logistically to organize a well-functioning telecare system based on the cooperation of many centers. On the other hand, Dariusz Trzmielak, Ph.D., Prof. of the University of Lodz, Deputy Director for Science, shared his insights arising from the implementation of the pilot at the Polish Mother's Memorial Health Center Institute in Lodz.
Later in the meeting, Dr. Anna Drohomirecka, Medical Affairs Team Coordinator, presented the preliminary results of a survey assessing patient satisfaction with participation in the project. As she pointed out, 96% of patients who completed the survey are satisfied with the solutions proposed in the project (half of them rated the proposed solution very highly). 83% of patients rated the need for daily vital signs measurements very highly. In contrast, 55% of the respondents said they would continue to take measurements themselves in the future.
During the conference summarizing the pilot of the program, preliminary results of the implementation of the project entitled: "Reducing social inequalities in health through the use of telemedicine and e-health solutions" in the field of cardiology were also discussed by medical managers in the other units that are beneficiaries of the program: Polish Mother's Memorial Health Institute in Lodz (Prof. Agata Bielecka-Dabrowa, MD), Upper Silesian Medical Center in Katowice (Prof. Rafał Młynarski, MD), SP ZOZ of the Ministry of Internal Affairs and Administration in Rzeszów (Dr. Mateusz Wiśniowski). The meeting was summarized by Prof. Tomasz Zieliński, head of the NIKard Heart Failure and Transplantation Clinic and member of the steering committee. All unanimously argued the advisability of introducing telemedicine solutions into everyday clinical practice, based on the experience gained during the pilot.
Patient under the constant care of a doctor
Recruitment for the project: "Telemonitoring of patients with heart failure" took place among patients with heart failure treated in primary care facilities and in cardiology clinics implementing the project in partnership. A total of 424 patients were enrolled in the pilot with no more than three months of monitoring. During this time, they independently took daily measurements of their weight, blood pressure and heart rate using dedicated devices: a scale and a blood pressure monitor, which, thanks to a smartphone paired with them with an installed app, automatically transmitted the results of the measurements to a dedicated telemedicine platform. In turn, the analysis of these results was handled by specialists at the National Institute of Cardiology. If the measurements exceeded predefined limits, they were flagged as alarming measurements. In justified cases, the monitoring team contacted the patient. At the same time, information was sent to the primary care clinic under whose care the patient is.
Patient involved in the treatment process and health education
Telemonitoring required greater patient involvement in the treatment process, in which self-observation and the ability to respond to worrisome symptoms were crucial. Intensely involving patients in the treatment process, increased their sense of responsibility for their health. In addition, the telemedicine solutions proposed in the project reduced the burden on patients of traveling to medical facilities, while equalizing the chances of accessing medical care for those who were less physically able or lived in excluded areas. This approach, however, did not limit direct contact with a doctor. Patients benefited from scheduled regular monthly visits and teleconsultations by a doctor or nurse, and traditional inpatient medical or nursing consultations were arranged as needed.
- Through the implementation of this pilot, we have developed mechanisms, some of which will be able to be implemented in the routine care of heart failure patients. We are also committed to further activating patients and involving them in the treatment process, so we have spent a lot of time training and educating them - said Anna Drohomirecka, MD, medical affairs team coordinator at the National Institute of Cardiology.
Cooperation with partners
The project is being implemented by the National Institute of Cardiology in partnership with 11 POZ facilities (CMD Sp. z o.o., clinics in: Siedlce, Minsk Mazowiecki, Łuków, Wielgoles, Sterdynia, Nura, Żelechów, Holubia and Domanice; Łomżyńskie Centrum Medyczne Sp. z o.o. and Baltimed Clinic Sp. z o.o., Sp. k. in Gdańsk) and the Professor Zbigniew Religa Heart Transplant Association.
Source: press mat.
