EUROPEAN PAPERS ON THE NEW WELFARE

Domotics in the Counter-Ageing Society

3. Process Management

The management of alarms represents the first layer of service for the elderly, but technologies now allow the first implementations of lifestyle management, both for disease prevention and disease management. Biomedical devices can be installed at home, measuring signals such as:
• Blood Pressure
• Pulse
• OxySaturation
• Weight
• Body fat percentage
• Muscle percentage
• Water percentage
• Glucose
• 1-12 lead ECG
• Peak expiratory flow
• Coagulation
• etc.

The most common chronic diseases can be monitored through this approach, thanks to the ICT network linking the patients to nurses and doctors, as depicted in Figure 3.

Figure 3: Health management Network
pangher-fig-3.gif

Moving from an alarm management system to full time lifestyle management is the step that poses the most dramatic questions. Healthcare today is organised in order to deliver the services in ad-hoc environments, like hospitals, policlinics and practices, and all related organizational, economic and billing procedures are organised accordingly. There is space for home care services, which at the moment consist either in specialised nursing or social worker support that is available for very precise ‘atomic’ services, or in the presence of a ‘continuous’ caregiver, who often has no specific professional background . The only solution available today, when the level of disability reaches a given level, is represented by the nursing home, where the patient often spends the remaining part of his/her life.
The first big question posed by the contrast between the features of present healthcare systems and the needs of lifestyle management is represented by the issue of prevention. Chronic diseases now account for on average about 2/3 of Healthcare costs in the most advanced countries, yet about 80% of diseases are preventable. It is obvious that preventing the onset of disease is a most effective way to keep the costs of healthcare under control and therefore prevention should be the keyword for all future developments in healthcare organization. It is easy to see how an E-Health network could be of paramount importance to a prevention policy: phone and videocalls, easy to use software interface and the results from monitoring with medical devices are the bricks for collecting information and helping patients plan their everyday lives in terms of diet, physical exercise, use of selected drugs, reminders of specialised medical examinations. The huge hurdle is that at present we finance the healthcare service in order to treat existing diseases. how much would it cost to finance such detailed lifestyle support strategies, where professional advice and monitoring services should be available in a continuos prevention mechanism? How could we finance a system designed to treat the healthy population? Now the financing is left to the single individual and is not leading to satisfactory results: in many cases the onset of a chronic disease is not seen as a real and immediate health threat, and the efficacy of individual strategies are often very closely connected to the economic and educational status of the single person. Is there any new possible insurance policy that could result in effectively financing prevention? There are some experiences that link health policies to lifestyle targets, offering services like gyms, dieticians and medical checkups at reduced prices and trying to link insurance premium discounts to the real achievements of these targets.
Managing a chronic disease does pose a similar question: avoiding complications requires a very strict adherence to a specific lifestyle and a very capillary and continuous support is a complex and expensive organizational task.
The patient, the informal caregivers, nonmedical caregivers, nurses, primary care organizations, medical specialists: all these professionals represent well separated islands, that are now being grouped in multidisciplinary teams under the responsibility of case managers responsible for following single individuals. While this organization is in many regions still a future goal and not a present reality, the real challenge is represented by the design and implementation of care processes that are effective and efficient. Modern communication technologies allow almost immediate good quality audio and video communication between the patient and any operator in the care chain, while the standards in health information exchange allow the set-up of ‘continuity of care’ systems. But what are the relevant information and effective care delivery processes?
The real challenge lies in identifying the pathways to manage disease, to set up a framework to introduce and evaluate all possible medical and technological innovations, to distribute the information to all players from the patient himself to his family to all social and medical caregivers: the choice and the use of technologies has to find a place within a well defined picture. The technology assessment project has to be based on scenarios which are partly based on evidence, but must also accommodate rules to introduce new steps and new technologies. small scale pilots are not significant in this respect, but statistically significant approaches have to be put to the test.

4. Conclusions

The implementation of domotics for chronically ill and disabled elderly patients requires a carefully designed integrated care delivery processes, in order to identify proper technologies that can help the patient to reach lifestyle goals. Both in completely public and in private insurance healthcare systems, the need to design continuous care processes, including social elements, is the challenge for tomorrow. The insurance sector represents a service industry and the challenge of innovation is represented by the need to design new and more complete products.

References

Agency for Healthcare Research and Quality (2006): “Costs and Benefits of Health Information Technology”, Evidence Report/Technology Assessment N. 132.

“Assistive Technology for Aging Population – Written Testimony of Eric Dishman to the U.S. Senate Special Committee on Aging”, 2004.

Barlow, J. et al. (2007): “A Systematic Review of the Benefits of Home Telecare for Frail Elderly People and those with Long-Term Conditions”, JTT, 13, 172, 2007.

Börsch-Supan, A. et al. (2005 ): Health, Ageing and Retirement in Europe — First results from the survey of Health, Ageing and retirement in Europe, Mannheims Research Institute for the Economics of Aging.

European Commission (2006): “User Needs in ICT Research for Independent Living, with a Focus on Health Aspects”, Institure for Prospective Technological Studies.

Miller, E. A. and Mor, V (2006): “Out of the shadows — Envisioning a brighter future for Long Term Care in America”, A Brown University Report for the National Commission for Quality in Long Term Care, Edited.

Pare, G. et al. (2007): “Systematic Review of home Telemonitoring for Chronic Diseases: The Evidence Base”, JAMIA, 14,3,269.

Stachura, M.E. et al. (2007): “Telehomecare and Remote Monitoring: An Outcomes Review”, Prepared by the Medical College of Georgia for The Advanced Medical Technology Association.

Whitten, P.S. et al. (2002): “Systematic Review of Cost Effectiveness Studies of Telemedicine Interventions”, BMJ, 2002;324;1434.


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