2. Neuronetworking Teresa Paiva et al. Lisbon, Portugal

3. 1 st QUESTION? What to do when you have too many patients and too few doctors? ????? Try Telemedicine... Why? To support patients and doctors with simple and low cost solutions. Is that the Key?

4. 2 nd QUESTION? How do you do it? Health care systems are difficult to change! ????? Understanding and acting upon human factors and providing proper technological solutions Is that the solution?

5. 3 rd QUESTION? Which will be your target? ????? High global burden disorders and key professionals. Neurological disorders and General Practitioners?

6. Neurological complaints are extremely common. They represent 7 to 15% of the General Practitioners daily practice The prevalence of headache reaches 80% in adult female. Work loss due to headache is enormous: 820 workdays /1000 employees/ year. Sleep disturbances affect 30% of the population 8.4% of adults fall asleep at their jobs Somnolence at wheel is the third cause of traffic accidents, and 87% of the fatalities Epilepsy represents an annual cost of $12.5 billion, with a lifetime cost of $11.1 billion. Indirect costs account for 85% of the total

7. High global burden disorders: Increased costs Unnecessary medications Unnecessary tests Increased accidents

8. Understanding human factors 1 - Identifying needs What do they know What do they want 2 - Predicting attitudes and behaviors Modeling Questioning

9. Identifying needs What do they know? 152 GPs; Lisbon =23, Oporto= 129 Mean age of GPs = 42.8 + 4.4 years old. More female doctors =67.5%. Errors to Basic Questions How many sleep stages: ONLY 2.6% correct. Percentage of SWS : ONLY 30.9% correct. Long term efficacy of hypnotics : ONLY 48.7% correct. Treatment of Sleep apnoea : ONLY 58.3% correct. Gender difference (females 56.8%; males 38.8%) p=.0500.

10. Identifying needs What do they want? Reduce Isolation Networking Support, mainly off-line Dedicated expert systems Multimedia teaching Dedicated tutorials Interaction with specialists Teleconsultation - doctor-to- doctor Gender difference:females higher variability of THEMES lower computer literacy

11. Measuring attitudes and intentions Predictive model: Theory of Reasoned Action Sample of GP’s: 10 interviews Thematic content analysis 53 questionnaires Statistical Analysis: Factor Analysis Multiple Regression

13. Measuring attitudes and intentions

14. Strong intention of utilization!

15. NETWORKING Reduce Isolation

16. DEDICATED EXPERT SYSTEMS SUPPORT

17. MUTIMEDIA LEARNING TEACHING

18. INTERACTION WITH SPECIALISTS teleconsultation

19. DISCUSSING DATA teleconsultation

20. ON LINE EVALUATION teleconsultation

21. The Portuguese Network BENFIC A LUMIAR ALVALADEODIVELAS LOURES

22. Teleconsultation: Structure and Methods : 1) Teleconsultation protocol: video-conferencing, digital archive; evaluation of benefits. 2) Physical communication network 3) The routine teleconsultations; 4) Dissemination of usage; 5) Evaluation of results and corresponding benefits.

23. Teleconsultation: Doctor-to-doctor Easy and friendly usage Free clinical information Problem solution paradigm Auto-evaluation forms Interactivity;document sharing Multimedia communication (written material, sounds;image) Digital archiving

24. Teleconsultation: Strengthening measures Weekly scheduled period Official entities involvement Medical and explanatory meetings Courses on teleconsultation

25. Teleconsultation: Benefits evaluated “online” Support in diagnosis Prevention of sending the patient to another speciality Prevention of unneeded tests Prevention of sending the patient to the Hospital Santa Maria Medication treatment counselling Other

26. Teleconsultation: Results Period: 1st June 98 - 14th April 00 75 working weeks 109 teleconsultations Average=1.5±1.3/week, min=0; max = 6 Duration from 10 to 45 min Difficulties : Use of computers Low computer literacy Maintenance services

27. Teleconsultation: Patient data 42 males and 46 females Mean age =38.8 +/- 20; min= 1; max= 84 years old Health Care Centers requests

28. Teleconsultation: Reasons for requests (%)

29. Evaluated benefits (%)

30. Teleconsultation: Comments: The needs are in accordance with the predicted values (real 722; predicted 687 to 699 patients per year) Only 7% of GPs, used the Teleconsultation. This small number used it regularly Low adherence shows the difficulties of new technologies in routine use. Efforts for dissemination through meetings were relatively unsuccessful.

31. Teleconsultation: Comments: Results were quite promising Multiple benefits, the total higher then 208% Allows the quick solution of doubts, GPs preserve control of patients information while receiving expert information A direct, on-demand, personalised teaching, Prevented a lot of strain to the patients Reduced costs and complexity of the National Health Care System

32. Teleconsultation NICE, EFFICIENT, PROMISING METHOD