17th Jan 2018

Northern Netherlands – Groningen


Programme:

  • Asthma / COPD telemedicine

Target Group:

  • Asthma and COPD patients


 

In the Netherlands, 60% to 80% of asthma and COPD patients are treated by their GP, and only referred to pulmonologists in cases of uncontrolled asthma or severe COPD. However, distinguishing asthma from COPD and other pulmonary problems is difficult. Early treatment can enhance asthma control, reduce morbidity, and improve the quality of life. This telehealth management support service assists GPs by examining patients and providing detailed advice from pulmonologists.

The aim is to provide an accurate and easily accessible service for GPs and patients, including also rural areas. Every patient suspected of having asthma, COPD, ACOS or who presents with pulmonary symptoms of unknown origin is eligible for inclusion.


 

Programme:

  • Embrace – Connecting health and community services

Target Group:

  • Citizens above the age of 75
embrace

More than 50% of people aged 60-plus suffer from multiple chronic conditions, and this percentage will increase in years to come. Despite the array of health services they use, older adults do not always receive appropriate care. This often leads to difficulties participating in treatment, and even treatment errors.

Embrace connects the health system with community services, and reflects the four key elements of the Chronic Care Model (CCM): self-management support, delivery system design, decision support, and clinical information systems. These are combined with a population health management model in terms of the Kaiser Permanente triangle to classify community-living older adults into risk profiles. Suitable levels of care and support are applied to each risk profile.


 

Programme:

  • Heart Failure Programme

Target Group:

  • Complex heart failure patients
effective-cardio

Congestive heart failure (CHF) is a complex and increasingly common clinical syndrome. The guidelines of the European Society of Cardiology recommend a multidisciplinary approach, often implemented as personal follow-up visits. Telehealth uses IT to assist in the management of a long-term medical condition of a patient at home. This lessens the burden on cardiologists. The telemonitoring system checks patient vital signs (blood pressure, pulse, weight) daily. Patients also receive videos on topics such as symptoms, daily care, compliance, and relapse prevention. The aim is to demonstrate how telemonitoring can be integrated in the care pathway, to measure the impact on workload, patient and staff satisfaction, and the economic consequences for hospitals.