1 Telemedicine - how does it work in Poland?Authors: Magdalena Wojtuszek, Justyna Kachnic, Joanna Wutke. Tutor: dr Krzysztof Krysta International Psychiatry Medforum Congress December 2016, Wisła

2 TELEMEDICINE Telemedicine is a very interesting area of modern treatment, using a comprehensive spectrum of communication technologies. Modern telemedicine has begun with experiments, conducted to provide medical services evenly to everybody, such as those by Willem Einthoven’s 1905 long distance transfer of electrocardiograms, through the era of teleradiology and telepsychiatry of the 1950s. The development of telemedicine matured in the 1990s and has reached its final in the adoption to the present technology [2]. As the prefix ‘tele’ suggests, it enables the contact between patients and doctors no matter what the distance is, via , SMS or videoconferencing.

3 Web pages with data about diseases and their therapyFORMS OF TELEMEDICINE Web pages with data about diseases and their therapy Video- and audiobooks Sms Videocofenrencing Others Additionally, it consists of web pages with data about diseases and their therapy, video- and audiobooks, which patients can use at home. Contemporarily, videoconferencing has become the mainstream in telemedicine treatment and other forms defined as e-health.

4 THE MAIN OBJECTIVE OF TELEMEDICINESave time Improve access to professional treatment Remind patients of health goals Appointment planning Homework therapy The main objective of telemedicine is to save time, improve access to professional treatment for all patients, remind patients of health goals, make appointment planning as well as therapy homework more efficient [1]. Efforts to make telemedicine part of common treatment in Poland are still in process. Reliable web pages are being developed day by day, however, there are still some problems with communication, concerning fear of abuse, lack of knowledge in practitioners, lack of actual law regulations and financial support from the health system [5]. Due to the lack of researches on acceptance and attitude of Polish professionals towards telemedicine, we decided to conduct two studies on utility of the telemedicine as a therapeutic tool in different medical specialties.

5 STUDY ABOUT TELEPSYCHIATRY IN POLANDMATERIALS AND METHODS POLISH TELEMEDICAL PROJECT STUDY ABOUT TELEPSYCHIATRY IN POLAND Study group 1) CARDIOLOGISTS 2) UROLOGISTS 3) PULMONOLOGISTS 4) MANAGERS 1) PSYCHIATRISTS 2) PSYCHIATRIC PATIENTS *** Number of respondents 4) 100 * 12** 1) 105 2) 102 Method EVALUATIVE RESEARCH WITH THE USE OF CATI *** ANONYMOUS SURVEY The aim of the study was to examine doctors’ attitude to telemedicine. The first study was part of the Polish telemedical project, granted from National Center for Research and Development (grant no.POIG /12) conducted to assess medical Platform Moneo as a therapeutic tool in the therapy of the areas other than psychiatry. It also serves to evaluate the potential ability of introducing this to standard therapy. Method of the study was based on a questionnaire filled with the use of a scale scored from 1 to 5, where 1 means “unsuitable” and 5 “very useful”. The survey was directed at the staff of health care management: individual medical practice (25 people), private health care center (25 people), state hospitals (25 people), private hospitals (25 people) - Giving us a total of one hundred people from Poland. The survey was also dedicated to 12 specialist doctors. The second study was based on authors’ anonymous questionnaires distributed amongst psychiatrists from Poland (105 doctors aged 26-74, including 74 women and 31 men). * The survey was directed at the personnel of health care management: Individual medical practice (25 people), Private health care center (25 people), State hospitals (25 people), Private hospitals (25 people) - Giving a total one hundred people from whole Poland. ** The survey was also dedicated to 12 specialist doctors. *** Computer Assisted Telephone Interview; realized with the use of information tools based on CATI study script from , without patients’ participation. **** Patients of the Department of Psychiatry and Psychotherapy of Medical University of Silesia.

6 INDIVIDUAL MEDICAL PRACTICE PRIVATE HEALTH CARE CENTERRESULTS INDIVIDUAL MEDICAL PRACTICE PRIVATE HEALTH CARE CENTER STATE HOSPITAL PRIVATE HOSPITAL >4 educational materials appointments’ planning therapy planning, educational materials, appointments’ planning, side effects reporting 3-4 therapy planning , compliance’s measurement, appointments’ planning, side effects reporting video conference examination with the use of clinical scales   <3 report about clinical factors, examination with the use clinical scales Managers All healthcare institutions noticed advantages of the possibility of using Medical Platform as a therapeutic tool. In the question which estimates currently available Platform functionalities, in an individual medical practice group ‘educational materials’ received the highest grade (average 4.12). For private health care centers ‘planning appointments’ was the best option (average 4.36) and in public and private hospitals it was ‘therapy planning’ - it received the best score (average 4.24). The worst rated was the concept of ‘videoconference’ (average 3.04) and ‘examination using clinical scales’, it was rated at the lowest level (2.92). As regards the question about proposals for improving the Platform, considered as “useful” or “very useful” (average more than 4) the following were approved: ‘improvement of e-prescribing system’ (4.12), ‘collection of information about hospitalizations of the patient’ (4.07), ‘collection of information about operations’ (4.05). Only options ‘entering the results of laboratory tests by the patient/guardian’, ‘monitoring patient’s physical activity’ and ‘monitoring the patient's diet’ received on average less than 3 points. Opinions of the management of health care institutions, concerning the possibility of employment of telemedicine were divided (average score 2.71). The level of interest in the offered solutions fluctuated around The situation was similar when assessing charging fees for using the telemedicine. Majority of respondents, i.e. 61%, rated this possibility in the range of 1-2 (average 2.25). Managers were unanimous in evaluating the amount of first-time visits that could be done through the Platform - 84% of respondents indicated range of 0-20%. In the case of follow-up visits, opinion of respondents were divided, but majority of respondents (89%) do not see the possibility that more than 60% of the visits could be done through the Platform. As regards the question: "Have you noticed the need of the introduction of telemedicine services in patients aged more than 65 years?", responses were split in proportion to each level of the 5-point scale. The average was However, the possibility of implementing the Platform in patients aged more than 65 years was rated more critically (average 2.36). In the presented analysis, this Platform received the highest rate from the management of private hospitals, while the lowest mark was given by the management of private practices. Evaluation obtained from Non-public Health Care Centre and public hospitals were very similar.

7 Evaluation of the Platform's possibilites by pulmonologists, cardiologists and urologists:The most frequently chosen functionality was ‘planning visits’ (4.67), ‘videoconference’ then ‘treatment planning’ (4.58), then ‘compliance measurement’ (4.33) and then ‘educational materials’ (4.08). The most uncommonly selected component was ‘clinical reports’ (3.58).It is worth emphasizing that the average assessment of individual medical specializations did not differ among themselves.

8 PSYCHIATRISTS: The use of virtual reality therapy:Niemalże jednoznacznie lekarze zgadzają się, że wirtualna rzeczywistość może być przydatna w terapii fobii, leczeniu lęku przed lataniem czy jazdą samochodem, leczeniu PTSD czy w wykonywaniu ćwiczeń poprawiających pamięć i uwagę, Almost uniquely doctors agree that virtual reality can be useful in the treatment of phobias, to treat fear of flying or driving a car, treatment of PTSD, or in carrying out exercises to improve memory and attention.

9 PSYCHIATRISTS: Diseases where is virtual reality therapy contraindicated:

10 DISCUSSION Telemedicine in the world…In psychiatry telemedicine was used with great success. But it is used also in dermatology radiology, cardiology and even stomatology. Telemedicine is used in treatment of both chronic diseases and sudden cases. It is also confirmed that this method can be used in adults as well as children and neonates. For some people telemedicine is the only chance to consult a doctor, and as proven by a group of scientist from India [16] it is an effective method of treatment for people living in high mountains.

11 DISADVANTAGES ADVANTAGES Side effects Operating costsdizziness, nausea, headache, eye strain, reduced limb control, reduced postural control, decreased sense of presence, the development of responses inappropriate to the real world Social isolation leads to depression Lack of standardisation Equipment costs Limitation with devices ADVANTAGES Operating costs Wide range of applications It is the technology of the future and is constantly growning The technology is safe and easy to use SIDE EFFECTS The major side effect of this technology is VR‑induced sickness which can present with dizziness, nausea, headache, eye strain, reduced limb control, reduced postural control, decreased sense of presence, and the development of responses inappropriate to the real world. Subjects who develop seizures when watching television or playing video games, should not be exposed to VR Wirtualna rzeczywistość może wywołać tak zwaną izolacje społeczną w której użytkownik wirtualnej rzeczywistości opiera się bardziej na interakcji w świecie wirtualnym niż w rzeczywistym. Ten brak prawdziwej, fizycznej interakcji, może doprowadzić do nieprawidłowych skojarzeń, które nie są częścią w realnym świecie. Izolacja może ostatecznie wywołać depresję, lub agresję ZALETY: -niski koszt terapii -wysoka skuteczność terapii

12 CONCLUSIONS Telemedicine is a useful method for specialists and for directors. Can be cheaper than traditional methods without losing its effectiveness. Can make prevention more effective. It can improve healthcare service and make an access to it possible for some people. …but… It requires legal and refunding system changes. This technique is not only a cure for patients but also a profitable medium to improve healthcare service and patients’ self-awareness. Considering all data, telemedicine is a useful method for specialists and for directors. It can improve healthcare service and make an access to it possible for some people. However, it might be implepented in Poland too only if some effort will be made to introduce legal and refunding system changes as well as improvements in telemedical services, especially in terms of expanding it by adding more fields of action.

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14 Thank you!