CEZAR provides support to patients with long-terms conditions – diabetes type 2 and/or heart failure, to better self-manage their disease at home.
In Slovenia, telemedicine service for patients with long-term care conditions is delivered by the Centre for Telehealth (CEZAR) at the General Hospital Slovenj Gradec (GH SG). The Centre and the services were developed form European R&D project UNITED4HEALTH. CEZAR offers support to patients with heart failure and/or diabetes mellitus type 2 in their home environment. The reason for using the telemedicine service is to support patients at their self-management to achieve the target values e,g, blood sugar level and to minimize risks for hospitalization. The most critical diabetic patients are selected for this additional treatment in parallel with the traditional one. Often patients with heart failure are enrolled after their discharge from a hospital. The patients perform daily measurements of their blood pressure, heart rate, body weight, and oxygenation or blood sugar following the recommendation of their specialist regarding the time and frequency of measurements. Data from measuring device are immediately automatically sent to the gateway (mobile phone) and then further to the TM server at the GH-SG. When deteriorated condition is confirmed, the patient is contacted by phone and the specialist decides on the action to be taken by the patient. Later the centre coordinator advises the patient on the doctor’s decision.
Stakeholders/beneficiaries: patients with chronic conditions, healthcare staff, relatives/carers, health insurance institute.
The service set-up 450.000 EUR support from the European Commission, UNITED4HEALTH project
1 project manager, 3 Medical specialists., 1 nurse, 2 informaticians, 1 technician
Capacities for 400 diabetic and 150 heart failure patients: 2 Medical specialists, 1 nurse, 1 informatician, 0,2 technician
Evidence of success
The service has proven to be effective in providing support to patients with heart failure and diabetes. In patients with heart failure number of hospitalisation per year was reduced by 70% and the average hospitalisation duration was reduced by 76%. Clinical results in patients with diabetes were significant. The team was awarded as the best innovation of the Carinthia region in 2016. The team obtained in 2017 a silver award for innovation from the Chamber of Commerce and Industry of Slovenia.
The critical issue for broader deployment is that the national insurance does not recognize the telemedicine services and does not reimburse the service to the hospital. Additionally, no financial support is available for the service scaling-up and dissemination on the national level.
Potential for learning or transfer
The good practice presents a pioneering activity that demonstrates how an EU project can transform in a regular service. It also indicates challenges and obstacles that public authorities need to address and overcome when introducing such services.
The success factors are the results this GP is showing: In patients with heart failure number of hospitalisation per year was reduced by 70% and the average hospitalisation duration was reduced by 76%. Clinical results in patients with diabetes were significant.
This is one of the first and still the largest evaluations of telemedicine services at home in Slovenia. In addition to the private company that provides the technology, the Slovenj Gradec General Hospital and the Ravne Health Center participate in it. As there are no completed evaluations at the national level in Slovenia, these policy outcomes are crucial in considering how to deploy eHealth services. The results are relevant to other regions that face similar challenges.