IGEA SAT demonstrated that an adequate mix of pervasive technology, education and training is a powerful tool in a new system of delivery of care.
Best Practice data have shown that chronic patients that are included into well planned and well managed disease management programs (DMP) are complying well to prescriptions with only one quarter “behaving” fairly and almost a quarter behaving “very good” while approx 50% of patients have a good compliance. These programs, where implemented, are an asset for the public health but they are only seldom conducted due to the extensive need of human resources (health professionals) and dedicated clinic space.
The performance of patients in IGEA SAT exceeds the data reported from best practices in Disease Management Programs (DMP) with good and very good compliance (being 30% and 58% respectively) with a satisfactory performance of 88% (IGEA-SAT) vs. 76% (DMP). Moreover, the most important result is the improvement in compliance not only as the total of “good” and “very good” but the shift of patients towards the best performance.
These data support the concept that IGEA-SAT (and IT based health programs) can fulfil the needs for better care and self-care and could well be an alternative to standard clinic based DMPs and, in most cases, the only applicable means of implementation of current health policies.
Patient satisfaction has been good with respect to the provided services: 60% of the participants in the pilot gave the maximum score (5) to the overall service; 88% considered the services useful for the management of their disease; 79% considered the service usability easy enough; 83% considered the service fruition through the television very comfortable; 62% considered the monitoring data representation in a table format simpler to read than in a graphical format (38%); the electrocardiograph is the device most difficult to use (57%) as compared to the other devices. These latter were considered very easy to use in complete autonomy (100%).
76% of the sample were declared to be serene, 17,5% declared to be moderately anxious and only 6% declared to be depressed. In evaluating their own healthcare status, 53% of people reported a stability in their healthcare status, 35% an improvement and only the 12% a worsening of their healthcare status in the last 12 months. Despite the low number of patients included in the study, citizens and healthcare professionals involved in the pilot operations very much appreciated the services and their potential: the possibility to have a Service Centre support 24 hours was promoting a peace of mind for the patients that, eventually, gained a central role in the whole process of the service provision.
Physicians, nurses and physiotherapists well accepted their involvement in a new organizational context even if the implementation of these types of services requires a change of both the hospital and the territorial healthcare services organization that not always has been well accepted by the parties in place.
In IGEA SAT, for example, two clinical centres in Lombardia, initially committed to participate to the project, withdrew their adhesion when they faced this problem; in the Elba island only after several months from the start of the operations, the USL (local health administrative authority) that administers the territorial services through the GPs formalised the availability of a territorial nurse for IGEA SAT, and most importantly, the inclusion of the IGEA SAT services among the ADI (Assistenza Domiciliare Integrata-Iintegrated Home-care Assistance) services. This is an important result of the project that opens a new pattern of opportunities for the adoption of telemedicine to support the delivery of primary care.
In general, an organizational change is a long term process that needs time for the initial roll-out and its complete implementation. The IGEA SAT success stands on both the used technological platform and on the cooperation among healthcare professionals made possible thanks to the sharing of protocols, procedures and methods. In any case the impact of technology on this type of services needs to be reconsidered by proposing solutions that shall be simple to use by patients and that, when this component (technological) is relevant, can be proposed to patients with a critical pattern profile for which a cost-benefits return can be relevant.
The project wasn't able to perform an economical analysis of the services aiming to define possible remuneration proposals. Nevertheless, Lombardia Region health administration defined a fixed rate reimbursement for the hospitals participating to the project for the actuation of the CPOD rehabilitation pathway through IGEA SAT.