CSR practices in a Telecomm Company: Information and communication technologies (ICTs) for elderly healthcare management in Portugal

The phenomenon of population aging is resulting in a global demographic change, a consequence of an unbalance relationship between life expectancy increase and low birth rates, where the United Nation Report positions Portugal as the 4th oldest country in the world by 2050. Living longer does not necessarily mean living better. The Portuguese Public Healthcare system is facing sustainability challenges to provide the necessary assistance to an increasingly older population, with unsustainable hospitalizations costs related to chronic uncommunicable diseases. Domiciliary health assistance is a viable solution for this, if an efficient health monitoring assistance is provided, hospitalizations would be prevented. Information and Communication Technologies (ICTs) applied in the healthcare sector as telemedicine can have an important role not only improving healthcare assistance but also allowing new forms of information sharing and communication through distance, reducing elderly isolation. This project was developed in partnership with Altice Portugal, as an in-company project, with the objective to provide improvement recommendations for the ICT solution that company is developing for elderly domiciliary healthcare management, that includes remote monitoring of vital signs. For that, a conceptual framework was developed in order to schematize the relationship between the variables that influence Elderly Use and Acceptance of Health ICTs, using a face-to-face questionnaire tool to a group of 142 participants. This research permits to understand the importance of Healthcare ICTs, identifying the existing innovations and future trends.O fenómeno do envelhecimento da população está a resultar numa mudança demográfica global, resultado de relação desequílibrada entre o aumento da esperança média de vida e baixa natalidade, onde o relatório das Nações Unidas positionou Portugal como o quarto país do mundo mais envelhecimento em 2050. Viver mais anos não significa necessariamente viver melhor. O Sistema de Nacional de Saúde Português (SNS) apresenta alguns desafios de forma a proporcionar a devida assistência a uma população cada vez mais envelhecida, registando custos de hospitalização insustentáveis associados a doenças crónicas relacionadas com o envelhecimento. Muitos destes casos de hospitalização podem ser prevenidos através de uma monitorização eficaz da saúde, sendo a assistência ao domicilio umas solução viável. A aplicação de tecnologias de informação e comunicação (TICs) no sector da saúde, como por exemplo a telemedicina, podem ter um papel importante, não apenas melhorando a assistência de saúde, bem como permitindo novas formas de partilha de informação e comunicação à distância, reduzindo o isolamento dos idosos. Este projecto foi desenvolvido em parceria com a Altice Portugal com o objectivo de dar recomedações de melhoria para a solução TIC que a empresa se encontra a desenvolver para melhorar o apoio domiciliário a idosos, incluindo o controlo remoto dos sinais vitais. Com esse intuito, um modelo conceptual foi desenvolvido de forma a esquematizar a relação entre as variáveis que podem influenciar o Uso e Aceitação das TICs na saúde por parte dos idosos, através de questionário presencial a um grupo de 142 participantes

Predictors of mortality among elderly dependent home care patients

BACKGROUND: The purpose of this study is to identify which variables –among those commonly available and used in the primary care setting– best predict mortality in a cohort of elderly dependent patients living at home (EDPLH) that were included in a home care program provided by Primary Care Teams (PCT). Additionally, we explored the risk of death among a sub-group of these patients that were admitted to hospital the year before they entered the home care program. METHODS: A one-year longitudinal cohort study of a sample of EDPLH patients included in a home care programme provided by 72 PCTs. Variables collected from each individual patient included health and social status, carer’s characteristics, carer’s burden of care, health and social services received. RESULTS: 1,001 patients completed the study (91.5%), 226 were admitted to hospital the year before inclusion. 290 (28.9%) died during the one-year follow-up period. In the logistic regression analysis women show a lower risk of death [OR= 0.67 (0.50-0.91)]. The risk of death increases with comorbidity [Charlson index OR= 1.14 (1,06-1.23)], the number of previous hospital admissions [OR= 1,16 (1.03-1.33)], and with the degree of pressure ulcers [ulcers degree 1–2 OR = 2.94 (1.92-4.52); ulcers degree 3–4 OR = 4.45 (1.90-10.92)]. The logistic predictive model of mortality for patients previously admitted to hospital identified male sex, comorbidity, degree of pressure ulcers, and having received home care rehabilitation as independent variables that predict death. CONCLUSIONS: Comorbidity, hospital admissions and pressure ulcers predict mortality in the following year in EDPLH patients. The subgroup of patients that entered home care programs with a previous record of hospital admission and a high score in our predictive model might be considered as candidates for palliative care

Mobile assistive technologies for the visually impaired

There are around 285 million visually impaired people worldwide, and around 370,000 people are registered as blind or partially sighted in the UK. Ongoing advances in information technology (IT) are increasing the scope for IT-based mobile assistive technologies to facilitate the independence, safety, and improved quality of life of the visually impaired. Research is being directed at making mobile phones and other handheld devices accessible via our haptic (touch) and audio sensory channels. We review research and innovation within the field of mobile assistive technology for the visually impaired and, in so doing, highlight the need for successful collaboration between clinical expertise, computer science, and domain users to realize fully the potential benefits of such technologies. We initially reflect on research that has been conducted to make mobile phones more accessible to people with vision loss. We then discuss innovative assistive applications designed for the visually impaired that are either delivered via mainstream devices and can be used while in motion (e.g., mobile phones) or are embedded within an environment that may be in motion (e.g., public transport) or within which the user may be in motion (e.g., smart homes)

Morbidity and medication consumption among users of home telecare services

[Abstract] Telecare is a healthcare resource based on new technologies that, through the services offered, attempt to help elderly people to continue living in their homes. In this sense, first-generation telecare services have quickly developed in Europe. The aim of this work was to define the profile, pattern of medication consumption and disease frequencies of elderly users of a telecare service. The cross-sectional study involved 742 Spanish community-dwelling elders (85.3% of the total users aged 65 years and over who used a telecare service before the end of the data collection period). Data were collected between March and September 2012. Subjects’ mean age was 83.3 (SD 6.6) years, and the majority lived alone (78.3%) and were female (85.8%). The mean Charlson comorbidity index score was 1.13 (SD 1.1), and the mean number of prescribed medications per day was 5.6 (SD 3.0). The most frequent diseases were hypertension (51.1%) and rheumatic disorders (44%); and the most consumed medications were those for the cardiovascular (75%) and nervous (65.2%) systems. For the total sample, the three main determinants of polymedication (five or more medications) were hypertension, anxiety-depressive symptoms and coronary heart disease. Regardless of the social elements contributing to the implementation of telecare services, specific health characteristics of potential users, such as morbidity and polypharmacy, should be carefully considered when implementing telecare services in the coming years

Telehealthcare for chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a disease of irreversible airways obstruction in which patients often suffer exacerbations. Sometimes these exacerbations need hospital care: telehealthcare has the potential to reduce admission to hospital when used to administer care to the pateint from within their own home. OBJECTIVES: To review the effectiveness of telehealthcare for COPD compared with usual face‐to‐face care. SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register, which is derived from systematic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; last searched January 2010. SELECTION CRITERIA: We selected randomised controlled trials which assessed telehealthcare, defined as follows: healthcare at a distance, involving the communication of data from the patient to the health carer, usually a doctor or nurse, who then processes the information and responds with feedback regarding the management of the illness. The primary outcomes considered were: number of exacerbations, quality of life as recorded by the St George's Respiratory Questionnaire, hospitalisations, emergency department visits and deaths. DATA COLLECTION AND ANALYSIS: Two authors independently selected trials for inclusion and extracted data. We combined data into forest plots using fixed‐effects modelling as heterogeneity was low (I(2) < 40%). MAIN RESULTS: Ten trials met the inclusion criteria. Telehealthcare was assessed as part of a complex intervention, including nurse case management and other interventions. Telehealthcare was associated with a clinically significant increase in quality of life in two trials with 253 participants (mean difference ‐6.57 (95% confidence interval (CI) ‐13.62 to 0.48); minimum clinically significant difference is a change of ‐4.0), but the confidence interval was wide. Telehealthcare showed a significant reduction in the number of patients with one or more emergency department attendances over 12 months; odds ratio (OR) 0.27 (95% CI 0.11 to 0.66) in three trials with 449 participants, and the OR of having one or more admissions to hospital over 12 months was 0.46 (95% CI 0.33 to 0.65) in six trials with 604 participants. There was no significant difference in the OR for deaths over 12 months for the telehealthcare group as compared to the usual care group in three trials with 503 participants; OR 1.05 (95% CI 0.63 to 1.75). AUTHORS' CONCLUSIONS: Telehealthcare in COPD appears to have a possible impact on the quality of life of patients and the number of times patients attend the emergency department and the hospital. However, further research is needed to clarify precisely its role since the trials included telehealthcare as part of more complex packages

Comparing local policy practices to implement ICT-based home care services for aging-in-place in Finland, France, Italy, Spain & Sweden

International audienceBackground. The current aging of the population across Europe is creating multiple challenges to the European states as well as to the European authorities. They have to design and implement sustainable policies for aging-in-place (for home care services for the elderly) to improve their wellbeing and inclusion in the information society. So far, several European initiatives have been runned to bring answers and solutions. Research aim. The aim of this paper is to understand wether and how several local authorities in the European Union build regulations and strategies for the ICT-based home care services intended to the elderly and where they stand regarding the literature’s recommendations.Method. We focus on the results of the SILHOUETTE project, that was part of CREATOR, an INTERREG-IV C mini-programme. We particularly focus on the public policy practices for the development of the ICT-based solutions for aging-in-place (home care services for the elderly) that the project identified. This paper is an analytical and comparative synthesis of these data in relation to the scientific literature. Public policy practices have been compared across territories of seven European countries. Results. We found that the seven regions are at different levels of maturity of public policy practices and that the SILHOUETTE project succeeded to enlighten different ways to boost the implementation of ICT-based solutions.Discussion. From this comparison we built a table showing the integrated stages of local strategies’ development. Comparison with the literature showed a greater development of Nordic countries, with the Finnish region being the only one whose guidelines included a great number of recommendations. Moreover, in this sector, the East/West gap is less present than in the global long-term care services sector and studies from other regions of the world can be useful for European stakeholders

A framework for decision making on teleexpertise with traceability of the reasoning

This paper provides a methodological framework for decision making process to ensure its traceability generally in the context of telemedicine and particularly in the act of teleexpertise. This act permits to medical professionals and/or health professionals to collaborate in order to take suitable decisions for a patient diagnosis or treatment. The main problem dealing with teleexpertise is the following: How to ensure the traceability of the decisions making process? This problem is solved in this paper through a conceptualisation of a rigorous framework coupling semantic modelling and explicit reasoning which permits to fully support the analysis and rationale for decisions made. The logical semantic underlying this framework is the argumentative logicto provide adequate management of information with traceability of the reasoning including options and constraints. Thus our proposal will permit to formally ensure the traceability of reasoning in telemedicine and particularly in teleexpertise in order to favour the quality of telemedicine’s procedure checking. This traceability is to guarantee equitable access to the benefits of the collective knowledge and experience and to provide remote collaborative practices with a sufficient safety margin to guard against the legal requirements. An illustrative case study is provided by the modelling of a decision making process applied to teleexpertise for chronic diseases such as diabetes mellitus type2

Tile-Ippokratis: The Experience of an Ehealth Platform for the Provision of Health Care Services in the Island of Chios and Cyprus

Tile-Ippokratis proposed an integrated platform for the provision of low-cost ehealth services to citizens in southeast Mediterranean area (Island of Chios and Cyprus). The aim of the paper is to present the architecture, the design, and the evaluation results of this platform. The platform based on already evaluated state-of-the-art mobile ehealth systems and using wireless and terrestrial telecommunication networks is able to provide the following health care services: (i) telecollaboration and teleconsultation services between health care personnel and between health care personnel and patients and (ii) ehealth services for “at risk” citizens such as elderly and patients with chronic diseases (Island of Chios) and postsurgery patients (Cyprus). The ehealth systems supported capabilities for vital signal measurements (ECG 1 lead, SPO2, HR, BP, weight, and temperature), an Electronic Patient Record (EPR) infrastructure, and video conference, along with communication gateways for data transmission over ADSL, GPRS, and WLAN networks