Part-financed by the European Union (European Regional Development Fund and European Neighbourhood and Partnership Instrument)

Part-financed by the European Union (European Regional Development Fund and European Neighbourhood and Partnership Instrument)

Flagship Project Counteracting brain drain and professional isolation of health professionals in remote primary health care through tele consultation and telementoring to strengthen social conditions in remote Baltic Sea Regions. Event Venue Date 2

The project at a glance Partnership Health care professionals, medical doctors associations, hospitals, planning and financing authorities, regional development administrations and ehealth research organisations. Number of partners 16 Partner countries Lead Partner Belarus, Estonia, Finland, Germany, Latvia, Lithuania and Sweden South Ostrobothnia Health Care District, Finland Total budget 2,5 million Duration 33 months (September 2011 June 2014) Event Venue Date 3

Partners from seven countries Finland Estonia Latvia Lithuania Germany Belarus Sweden Event Venue Date 4

Partner organisations (1/2) Partner South Ostrobothnia Health Care District Seinäjoki University of Applied Sciences Regional Council of South Ostrobothnia Kauhava Primary Health Care District ehealth Institute, Linnaeus University Blekinge Institute of Technology County Council of Västerbotten Flensburg University of Applied Sciences Country Finland Finland Finland Finland Sweden Sweden Sweden Germany Event Venue Date 5

Partner organisations (2/2) Partner The Estonian Society of Family Doctors Institute of Clinical Medicine of the Technomedicum of the Tallinn Technical University Vilnius University Hospital Santariškių Klinikos Kaunas University of Technology Lithuanian University of Health Sciences State Educational Institution Belarusian Medical Academy of Post Graduate Ostrovec Central Regional Hospital National Health Service Country Estonia Estonia Lithuania Lithuania Lithuania Belarus Belarus Latvia Event Venue Date 6

Integration into the PrimCareIT project structure WP1 Project Management and Administration South Ostrobothnia Healthcare District, Finnland WP3 Needs and strategies to counteract brain drain and professional isolation in remote primary health care through teleconsultation and tele mentoring. Fachhochschule Flensburg, Germany WP5 Implementation of tele mentoring for career development of health professionals in remote primary health care. Estonian Society of Family Doctors, Estonia PrimCareIT WP2 Communication and Information Vilnius University Hospital Santariškių Klinikos, Lithuenia WP4 Implementation of tele consultation for improved professional cooperation and quality in remote primary health care. Blekinge Institute of Technology, Sweden WP6 Political awareness of strategies to ensure high quality and accessible services in remote primary health care by the means of ehealth. Blekinge Institute of Technology, Sweden Final Conference 7

Project Process Final Conference 8

Definition of brain drain and professional isolation Brain Drain skilled professionals who leave their native land to seek more promising opportunities elsewhere (Kwok, V.; Leland, H. (1982): 91) Fields of studies dealing with brain drain: Economical Studies (Beine, M.; at all (2000)) Scientometrics (Laudel, G. (2003)) Medical Studies (concerning health professional brain drain from 3rd to 1st world countries) (Pang, T.; Lansang MA.; Haines A (2002)) Professional Isolation an isolation from the professional peers that can result in estrangement from the professional identity or a feeling to have no one to turn to to discuss and share professional issues and ideas (http://www.sarrahtraining.com.au) Professionals move away Professionals feel isolated Final Conference 9 9

Reasons for BD and PI literature review Economical Technical Personal/Social/ Organisational Low salaries Limited resources Lack of ITtechnologies Lack /or poor quality of working tools Geographical remoteness More single practices in rural regions Lack of professional career opportunities Lack of knowledge dissemination in health care County government s support differs Large start up investments to open practice Insufficient infrastructure/ poor accessibility Insufficient labour process organisation Provision of certain services impossible High bureaucracy Bad image of rural regions Poor working atmosphere in health care Inadequate working conditions Much responsibility Risk of being overloaded by work Lack of free time activity options Lack of educational institutions Lower remuneration Missing job opportunities for partners Missing support by colleagues Final Conference 10

Reasons for BD and PI expert interviews Working conditions Social/Organisational Medical doctor s large job description Loss and lack of good coworkers Professional isolation Low medical profession s reputation in society Poor working schedules One sided working content Lack of social protection Illusions about conditions in other countries Poor working conditions Population decline Final Conference 11

Reasons for BD and PI literature review and expert interviews Economical Working conditions Social/Organisational Lack of professional career opportunities Lower remuneration Insufficient labour process organisation Insufficient infrastructure/ poor accessibility Lack of free time activity options Missing support by colleagues Missing job opportunities for partners Final Conference 12

Conclusion All participating countries strongly believe that tele consulting and tele mentoring enhance the working environment for healthcare professionals working in primary health care in rural districts It is important to meet the requirements to change the attitude of health professionals and patients towards ICT The literature reviews, expert interviews and also the pilots showed that piloting tele consulting and tele mentoring counteract brain drain and professional isolation. Final Conference 13

Implementation of Tele consultation in pilots Prof T. Larsson Part-financed by the European Union (European Regional Development Fund and European Neighbourhood and Partnership Instrument)

Work tasks Situation analysis: analysis of the country specific working models within remote primary health, e.g. communication and division of work between GP and nurse Literature study on best practices in tele consultation Needs assessment in the pilot regions, e.g. what kind of technology and methods, for example webcam, is still needed Process assessment on how to implement tele consultation in the daily work routine Assessment of legal aspects of tele consultation Pilot deployment Evaluation Recommendation and best practices handbook Final Conference 15

Tele consultation demonstration pilots Pilot 1 Tele consultation between Blekinge Wound Center and primary care actors (Municipality and County Councils, Sweden) Pilot 2 BelMAPO Professional support of GPs from remote (Belarus) Pilot 3 KPHCD Central hospital to home care units (Finland) Pilot 4 VCC Psychogeriatric in distant rural area (Sweden) Pilot 5 Vilnius University Hospital Santariškių Klinikos (Lithuania) Pilot 6 Estonian Vormsi Health Center GP support Consultation between nurse and GP; Nurse and specialist doctor; GP and specialist doctor (Estonia) Pilot 7 National Health Service Supporting GPs from remote areas via tele consultations Professional support of doctors from remote areas (Latvia) Final Conference, Tallinn 16

Conclusions 7 pilots implemented; All pilots measured attitude and experience changes turning the tele consultation sessions. Information was collected in each participating organisation with a questionnaire and an interview. Pilots worked together in close cooperation and learned from the experiences of each other. Pilots reported that tele consultation helped to improve professional capabilities in remote areas. Participants felt less isolated and the self confidence of making decisions and solving cases improved. Tele consultation as a tool for counteracting brain drain was not seen in the study but would be helpful tool for young medical personnel to work in the rural areas and still have access to peer network. Tele consultation is a modern approach and good tool to develop professional experience for younger medical specialists and it could also be one of the factors reducing potential professional isolation and brain drain while working in remote areas. Final Conference, Tallinn 17

Implementation of Tele mentoring in pilots Kristian Krass (Estonia) Part-financed by the European Union (European Regional Development Fund and European Neighbourhood and Partnership Instrument)

BACKROUND What? Why? and Where? Tele mentoring is a form of virtual mentoring that enhances different tools for education; Tele mentoring enhances medical education programs and provides better opportunities for continuing education and professional development for health workers in remote areas. Therefore, it is a very suitable tool to counteract professional isolation; Tele mentoring activities took place in Finland, Lithuania, Estonia, and Republic of Belarus and existing elearning solutions were shared; Final Conference, Tallinn 19

OBJECTIVE What? To develop the comprehensive e learning solution; Content Technology Services To run the pilot: develop pilot e courses and organising user training sessions; To analyse the results and to develop recommendations; Final Conference, Tallinn 20

TASKS How? The steps forward To define main principles of evaluation; To make country specific analysis on continuous medical education; To describe state of art solutions; To exchange of existing experience in technical and content solutions; To assess the needs in the pilots; To assess the processes: how to implement pilots in the daily work routine? To set up of the pilots; To complete pilots by evaluating the results; To publish guidelines; Final Conference, Tallinn 21

Partner organisations Who? (9) Partner Country Role South Ostrobothnia Health Care District Finland Pilot#3&4 Seinäjoki University of Applied Sciences Finland Pilot#3&4 Kauhava Primary Health Care District Finland Pilot#3&4 Flensburg University of Applied Sciences Germany Lit. Review The Estonian Society of Family Doctors Estonia Pilot#2/ lead Vilnius University Hospital Santariškių Klinikos Lithuania Pilot#5 Lithuanian University of Health Sciences Lithuania Evaluation State Educational Institution Belarusian Medical Academy of Post Graduate Belarus Pilot#1 Ostrovec Central Regional Hospital Belarus Pilot#1 Final Conference, Tallinn 22

SUMMARY of Pilots The five pilots that have been implemented in 2013 and worked together in close cooperation and learned from the experiences of each other; Tele mentoring is a good tool to develop professional experience for younger medical specialists and it could also be one of the factors reducing potential professional isolation and brain drain while working in remote areas; Financial perspective has to be studied in further: time and travel savings versus higher maintenance cost on technology; Final Conference, Tallinn 23

WP6 leader Johan Berglund (Sweden) AIM: Political awareness of strategies to ensure high quality and accessible services in remote primary health care by means of e Health Final Conference, Tallinn 24

Actors and stakeholder categories National level 1. Health care politicians, ministers, chairs, chancellors 2. Health care boards, Health departments, directors, managers Public Health officers, 3. Medical and ehealth associations and societies, Health insurance companies 4. IT ehealth telemedicine departments, divisions and centers 5. IT companies 6. Scientific institutes and universities 7. Citizens and patient organizations Regional/Locallevel 1. Health care politicians, authorities, boards, councils 2. Health Care boards, directors, managers 3. Medical and ehealth associations and societies, Health insurance companies 4. IT ehealth telemedicine departments, divisions and centers 5. IT companies 6. Scientific institutes and universities 7. Health and medical professionals in PHC and hospitals 8. Citizens, patients and patient organizations Final Conference, Tallinn 25

Stakeholder discussion Challenges 1. Missing IT infrastructure, lack of high speed broad band internet, lack of ICT knowledge/missing guidelines or lack of knowledge on IT possibilities, insecurity among users 2. Missing engagement in organisation, lack of time to provide or participate in tele consultation or tele mentoring health professionals' lacking personal will to use something new, patient concerns 3. Lack of financial incentives, impossibility to get financial reimbursement for providing or using tele consultation/tele mentoring Final Conference, Tallinn 26

Stakeholder discussion Objectives 1. To assess the regional needs and strategic opportunities as well as assess current barriers of tele consultation and tele mentoring to avoid professional isolation of health professionals in remote primary care. 2. To implement and validate transnationally developed tele consultation and tele mentoring solutions for career development of younger health professionals in remote primary care in pilot sites. 3. To prepare the durability and large scale implementation of the piloted solutions in the partner regions. Final Conference, Tallinn 27

Stakeholder discussion Main results and achievements (1/2) 1. Tele consultation and tele mentoring were positively influencing and supporting the daily work of health care professionals in remote regions, through offering opportunities for professional guidance, knowledge sharing and networking. Another benefit of tele consultation/telementoring was the cost and time saving. 2. Several solutions to counteract brain drain and professional isolation were revealed through PrimCareIT studies. These include financial, social and organisational solutions. 3. Problems of brain drain and professional isolation are relevant in all countries; therefore the aim of counter acting those challenges are similar in all countries. A joint research approach towards best practices and networking among professionals in different BSR countries should be further encouraged. Final Conference, Tallinn 28

1., 2., 3., Stakeholder discussion Main results and achievements (2/2) 4. The absence of legal acts on distance learning is a problem, which should be considered on a national level in order to set general acts on distant diagnosing and treatment. 5. Integrated transnational strategy paper to attract health professionals to remote primary care was created (including multi national context with a large sample of ideas on tele consultation and tele mentoring). Final Conference, Tallinn 29

Thank you!! PrimCareIT Lead Partner Sami Perälä, project director e mail: sami.perala@eptek.fi +358 44 332 2270 Minna Kamula, project coordinator e mail: minna.kamula@eptek.fi South Ostrobothnia Health Care District Koskenalantie 16 60220 Seinäjoki More Information: www.primcareit.net Final Conference, Tallinn 30