Pilot projects descriptions

The Proactive Health Journey Digital Designer is a digital solution for efficient communication between patients and primary healthcare centers in planning, monitoring, and supporting treatment. It's a secure communication and collaboration application for both family doctors and patients, including functionalities to maintain and enhance patient motivation.

The aim of the project was to provide patients with a supportive self-management environment to (1) follow their health plans, (2) proactively change their health behavior, (3) achieve better treatment outcomes, and (4) thereby prevent the onset and progression of chronic diseases.

The project aimed to provide family doctor centers with a user-friendly tool for effectively creating and monitoring health plans for patients with chronic diseases and health risks (including clear summaries of patient input and progress) and for providing comprehensive and effective support to patients through process automation.

The primary care center, in collaboration with the patient, created a personalized health or treatment plan through motivational interviews, including the patient's goals and activities. The role of the family doctor and their team was to empower patients to manage their health, involving other health center team members if necessary (physiotherapist, clinical psychologist, mental health nurse, midwife). An agreement was made with high-risk patients, specifying exact tasks, metrics, regular meetings, and communication channels.

The pilot solution was based on evidence-based health technologies and utilized decision support capabilities in treatment guidelines. The methodology for developing health/treatment plans was developed in conjunction with a risk patient management project.

Nearly 400 patients were recruited for the impact assessment study and equally randomized into intervention and control groups.

The remote service "OnKontakt - E-support for Cancer Patients" was a collaborative model aimed at patients receiving oncological treatment, allowing patients who were receiving treatment to report treatment-related side effects to the cancer center using the Kaiku Health online platform. Patients could fill out a structured symptom questionnaire at their convenience. Based on the questionnaire responses, artificial intelligence automatically provided feedback to patients on how to improve their well-being. In addition, the Kaiku platform allowed communication with the treatment team via a chat window. Information inserted by the patient reached the treatment team's workstation, and support for patients was provided as needed.

Reporting side effects early allows early treatment of side effects. If the proportion of serious and potentially life-threatening side effects decreases it helps to reduce unnecessary hospitalizations. Through the remote service model, systematic data can be collected and analyzed for use in making further treatment decisions for patients (both at the cancer center and at the primary care level).

The impact assessment study, conducted in partnership with Tallinn University of Technology, aimed to assess the impact of the service on patients, healthcare workers, and society. Over nine months, a total of 177 patients diagnosed with breast or colorectal cancer were recruited, equally randomized into intervention and control groups. The project also involved a partner hospital, Pärnu Hospital, to test the coordinated action of the patient, cancer center, and partner hospital treatment team in handling treatment side effects and advising the patient at their local hospital. 

One of the results was that, on the third month of participation in the study, the OnKontakt remote service helped to maintain the quality of life for patients in the intervention group. Meanwhile, the quality of life in the control group decreased. Patients and staff rated the usability of the Kaiku platform highly, and at the end of the study, 77% of patients responded that the IT solution helped them cope independently with treatment-related issues.

Psoriasis is a chronic, inflammatory, autoimmune, non-infectious skin disease that patients must live with for their entire lives. Psoriasis increases the risk of many other diseases. Although psoriasis cannot be cured completely, continuous treatment can significantly improve quality of life, including increasing periods free of flare-ups and early detection of comorbidities.

The Psoriasis Remote Monitoring Pilot Project aimed to improve the treatment of psoriasis at several stages of the treatment journey. It is important that when the disease worsens, the patient can contact the healthcare facility, and the doctor can assess the progress of the treatment based on continuous monitoring information. A new service model was created where the doctor gets a better overview of the patient's condition using the Dermtest Image Viewer software. The patient can send relevant monitoring information and photos of the skin condition remotely. The software allows the collection of patient-reported outcome measures of quality of life, symptoms, and risk factors and the use of asynchronous teledermatology functionality. 

A total of 106 patients were recruited in the intervention group and 52 patients in the control group for the impact assessment study. The aim was to assess whether remote monitoring of psoriasis is equivalent to conventional treatment and whether patients benefit from it. A cost-effectiveness analysis was conducted, which showed that the new psoriasis remote monitoring service model is feasible in the Estonian context and is not inferior to standard treatment.

The study showed that remote monitoring can achieve similar improvements in quality of life compared to standard treatment - equivalence was demonstrated in terms of improving quality of life between the intervention group (new treatment journey) and the control group (standard treatment) (+/-3.12; 90%, α=0.05). In addition, 87% of individuals expressed satisfaction with the service model, and 85% would recommend or rather recommend the service to loved ones. 68% of patients expressed a desire to continue remote monitoring in the future. The software is user-friendly for both healthcare workers and patients.

The study also looked at psoriasis treatment insurance costs in the control and intervention groups and found that the average insurance costs for moderate to severe psoriasis patients in the intervention group were lower than in the control group, indicating that the new treatment journey potentially saves costs in this subgroup. Patients are empowered, feel cared for, and can be confident that timely information reaches healthcare workers if the disease worsens.

Pre-visit was a service consisting of the patient filling out a symptom questionnaire and triage being carried out in family doctor centers based on health tickets, using an IT solution called Pre-visit. It was a service that complemented the work processes of family doctor centers to create a more comprehensive and accessible primary care service.

The journey began with the patient describing the problem (health ticket), for which the most suitable treatment path was found at the family doctor center. The solution was available 24/7, with the central part being the triage module with a self-anamnesis, symptom questionnaire, and health analyst's workstation. This allowed patients to receive feedback quickly and determine the urgency of the next service based on the results. Firstly, after reaching out to their primary care center, the patient received a message that (1) their problem was received; (2) it is being dealt with, and (3) information on when they would be contacted. The solution allowed bookings for various services based on triage category (family doctor, specialist, etc.) and conducting video consultations. This means that patients can receive faster solutions to simple problems due to the improved workflow at family doctor centers and technological solutions, and patients are more involved in solving their health problems.

As part of the project, the use of health tickets allowed increasing the role of nurses, as 80% of tickets were directed to be solved by nurses. In 2022, patients involved in the study made 32,071 contacts through MinuDoc, including filling out 10,441 symptom questionnaires for new health problems. This means an average of one contact per patient per year and 0.37 times completing a symptom questionnaire.

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