Supporting Palliative Care Services

An IS System to Monitor the Patients and Manage the Mobile Support Team

Arsénio Reis

1,2

, Eliza Bento da Guia

, Vitor Rodrigues

and João Barroso

1,2

INESC TEC, Porto, Portugal

University of Trás-os-Montes e Alto Douro, Vila Real, Portugal

ACES Douro Sul, Moimenta da Beira, Portugal

Keywords: eHealth Services, Health Monitoring, Palliative Care.

Abstract: The health centers group (ACES) “Douro Sul II” is creating a Community Support Team for Palliative Care

(ECSCP) in order to provide palliative care services for the ACES’s population of 73,713 registered users.

The team comes as a follow-up from a strategic plan, recently issued by the health ministry, in order to serve

the patients in their own homes, providing the necessary support to them, to their families, and their caregivers.

This approach has several benefits for the patients and their families, as well as for the healthcare system

itself. To further promote the effectiveness of the ECSCP team, it was planned to develop an information

system (IS), comprising several application modules, with the main objective to monitor the patients in their

homes and deliver information to support the planning and execution of the ECSCP team activities. The

system is based on an electronic services platform and several mobile and web applications, to be used by the

patients, team’s staff and coordination. This way, we expect to overcome the geographic issues of the ACES

territory, as well as the team’s human resources constraints, while remotely monitoring the patients and

providing the necessary support, if and when needed, contributing to maintaining the conditions for the

patients to live with dignity and quality in the comfort of their own homes.

1 INTRODUCTION

The Portuguese Health Ministry published, in 2017, a

strategic plan for the development of palliative care

for the 2017/2018 biennium (MS, 2016). This plan

includes a framework for the implementation of

Community Support Teams for Palliative Care

(ECSCP). These teams are composed of specialized

staff, including: medicine doctors, nurses,

psychologists, and social assistants. The main

objective is to monitor and support the population in

need of palliative care, creating the conditions for

them to live in their own homes, autonomously or

with support from the family or a caregiver.

The strategic plan document recognizes that when

applied early in the diseases progression, the

palliative caring has benefits for the patients and for

their families. It reduces the problems associated with

the symptoms as well as diminishes the physical,

psychological and emotional burden imposed to the

patients and their families. The benefits for the health

care system are also significant, including the

reduction of: the hospitalization durations; the

number of hospital readmissions; the unnecessary

treatments; the usage of emergency services; thus,

prompting a general reduction of the global

healthcare costs (ANCP, 2006).

The ECSCP teams can be described as:

 A multidisciplinary team with their own resources

and managed at a regional level;

 A provider of specific support and counselling

regarding palliative care for all the regional health

units;

 A provider of home palliative care for patients

with complex palliative necessities, their families

and caregivers;

 A provider of training in palliative care for the

families, health professionals, and for the home

caregivers;

The creation of the ECSCP teams meets the basic

principle of palliative care by respecting the patient

right to choose the place where he wants to live at the

final stage of his life and, in case the patient choses

his own home, creating the conditions for the patient

to have all the necessary support to continue to live

Reis A., Bento da Guia E., Rodrigues V. and Barroso J.

Supporting Palliative Care Services - An IS System to Monitor the Patients and Manage the Mobile Support Team.

DOI: 10.5220/0006752607020706

In Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (HEALTHINF 2018), pages 702-706

ISBN: 978-989-758-281-3

with dignity and quality in the comfort of his own

home. These teams are particularly important in

territories where the population is geographically

scattered and the patients need to travel great

distances to access the health services.

2 THE SOUTH DOURO CASE

This paper addresses the case being developed by the

health centers group (ACES), named “Douro Sul II”

after their geographic location.

2.1 The Douro Sul II ACES Area

The Douro Sul II area of influence is the combined

areas of the following counties: Armamar, Lamego,

Moimenta da Beira, Penedono, São João da

Pesqueira, Sernancelhe, Tabuaço, and Tarouca. The

Figure 1 represents a map of this area, south of the

Douro River, which corresponds to a large area of

1,366.7 square kilometres with a scattered population

of 70,803 inhabitants, accounting for a population

density ratio of 51.8 inhabitants per square kilometre

(ARSN, 2012). In this area, the weather is mainly

continental with very cold winters and very hot

summers.

Figure 1: The geographic area of ACES Douro Sul II

(source: http://portal.arsnorte.min-saude.pt/ARSNorte/dsp/

ACES/PLS2012_1923_DouroSul.htm).

Consider the aging index defined as the ratio

between the elder (65 or plus years old) and the youth

(14 or less years old) populations.

According to recent data, from April 2017, the

Douro Sul II ACES has 73,713 registered users

(SIARS, 2017), representing an aging population,

which, according to Figure 2, has an increasing aging

index, from 76,7% in 1991 to 164,0% in 2011

(Pordata, 2011). This increase over the years is

mainly due to the decrease of the birth rate, the

increase of the life expectancy, and the reduction of

mortality.

Figure 2: Evolution of the aging index (1991 to 2009).

(source: ACES Douro Sul II).

In short, it is a large area, with a wide weather

temperature range, and geographically scattered and

aging population.

2.2 The ECSCP Team

The ECSCP team will serve all the 73,713 users,

registered in the health units of the area of the ACES

Douro Sul II, and has the following operational

objectives:

 Provide home support to patients and caregivers

with the help of a remote monitoring system.

 Control the patient’s symptoms.

 Increase the ratio of patients living in their homes

with the team’s support.

 Reduce the need for hospital admissions and the

usage of emergency services.

 Support the patients’ families and caregivers.

As defined by a regulatory document from the Health

Services Central Administration (ACSS), there

should be a dedicated ECSCP team for each group of

150,000 inhabitants (ACSS, 2017). In the ACES

Douro Sul II case, and considering its characteristics,

the ACES proposes a ECSCP team formed by:

 Medical doctor (35 hours/week);

 Nurse (35 hours/week);

 Psychologist (8 hours/week);

 Social services (6 hours/week).

This team will provide services every day, from 8am

to 8pm in the working days, and from 9am to 5pm on

the weekends and holydays. A 24h permanent

telephone support service will be available, providing

coordination for urgent visits and proper cooperation

with the hospitals units in order to support and follow-

up the users to the most suitable hospital unit.

3 THE INFORMATION SYSTEM

PROPOSAL

The University of Trás-os-Montes and Alto Douro

(UTAD) has been deeply involved in researching and

development projects related to the usage of

information technologies (ICT) to support healthcare

services, disable users and elderly people (Reis et al.,

2016 a), 2016 b), 2017; Paulino et al., 2017). This

proposal came as a natural follow-up to use ICT in

order to maximize the efficiency and effectiveness of

the Douro Sul II ACES’s ECSCP team.

The information system has three main

objectives:

1. To monitor the users served by the ECSCP team,

proving information to the team about the

evolution of the health status of each patient, and

providing an access channel to communicate with

the ECSCP team and have their best support.

2. To support the operation of the ECSCP team, e.g.,

interaction with the patients, data requests and

collection from the patients, data visualization,

planning and home visits registration, tracking

and registering the patients’ access to the

healthcare services.

3. To support the management of the ECSCP team

by compiling information and indicators related to

the development of the team’s activities.

3.1 Architecture

The system is composed by five modules:

1. An electronic services platform, hosted on the

cloud, including: a database system to store

information; the application logic software

modules to manage information and provide

electronic services for the user’s applications; an

application programming interface (API) for

further user’s application development.

2. A monitoring mobile application (for mobile

devices), to be used by the patients and their

caregivers.

3. An operations mobile application to be used by

the ECSCP team operative staff.

4. A management web application, to be used by the

(and for the) management of the ECSCP team’s

activities.

The Figure 3 represents the system’s architecture,

including some of its functionalities and

technological characteristics.

Figure 3: System architecture.

3.2 Functional Description

3.2.1 Electronic Services Platform

The electronic services platform is an online system,

with the proper characteristic for the implementation

of specific applications, by providing electronic

services, accessible over the internet, using standard

protocols for software integrations. It includes:

database for persistency; software components for

basic application logics; electronic interface, e.g.,

webservices, REST, for integration and

interoperability.

3.2.2 Monitoring Mobile Application

This application will be used by the patients and will

acquire and collect information regarding the

evolution of their health status, as well as other data,

including their health related needs and routes on the

healthcare system units. The application’s user

interface will be carefully designed and developed,

according to the NO INTERFACE and adaptive

interface paradigms (Carrol et al., 1991; Santos et al.,

2011; Stephanidis, 2001; Kamberov et al., 2017), so

it can be easily used by patients with physical or

cognitive disabilities. Some data collection will be

based on questionnaires surveying configured by the

ECSCP team. Other forms of interaction (Marcelino

et al., 2009; Felisberto et al., 2015; Abreu, 2017) are

also accounted for although in this case we opted to

keep it as simple as possible.

3.2.3 Operations Mobile Application

This application will be used by the operative staff of

the ECSCP team to: view the status of each patient;

view the monitoring results as collected by the

monitoring application; plan and register the home

visits to the patients; configure the individual

monitoring parameters for each patient; provide an

overall perspective of the patients’ population while

the team operates in a mobility context; support the

coordination of forwarding the patients throughout

the healthcare system units.

3.2.4 Management Web Application

The management application will be used by the

ACES to plan and coordinate the program of

palliative caring. It should provide information

regarding: the evolution of the patients’ support

service; a view of the geographic localization of the

patients and the team visits; a perspective of the

routes of the patients thought the units of healthcare

system; the management of the ECSCP visits routes.

4 CONCLUSION

This paper reports the inception of a project to use

ICT as tool to further improve the results of a

multidisciplinary palliatives care team, about to be

introduced by the national healthcare system. The

case of Douro Sul II presents a context which is

particularly appealing due to the geographic

dispersion, isolation and aging of the population. This

scenario might benefit from the introduction of

remote monitoring and other telematics related tools.

A first beta deployment is schedule to early 2018 and

the further developments will be incremental and

based on the results of each successive iteration. That

way, we expect to better understand the problem and

to better design an ICT solution.

ACKNOWLEDGEMENTS

This work was supported by Project "NIE – Natural

Interfaces for the Elderly/ NORTE-01-0145-FEDER-

024048" financed by the Foundation for the Science

and Technology (FCT) and through the European

Regional Development Fund (ERDF).

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