1. Overcoming barriers in poststroke rehabilitation: eHealth technologies to bridge routing and financial gaps
V.G. Polushkin, R.A. Khalfin, K.V. Lyadov, M.V. Kizeev, E.S. Koneva, D.S. Arkhipova, V.V. Madyanova.
Burden of diseases: poststroke patient in need for rehabilitation
Prevalence of stroke per (around people living with it’s consequences); patients are of working age
Overall 3-year estimated budget losses for all the patients without rehabilitation programs: CHF
Problem: low access to poststroke rehabilitation services
Human resources
Finance
Transports and routing
Low governmental rehabilitation insurance tariffs – around 60 CHF/day for two weeks (87,5 minimum required)
High losses for families due to home care and workforce loss ( CHF for 3 years)
High social spending ( for 3 years)
Overall required budget for 3 years: CHF
Long-term education for rehabilitation tutors
High working hours for effective rehabilitation of a single patient
Pivotal “role of hand labour”
Lack of neurologists
Low car-per-capita level
Private cares unsuitable for disabled patients
High costs of transport brigades
15-20% patients live in 2+ traveling hours to nearest rehabilitation facility
Decision: e-health technologies (implemented in two regions)
Integrated regional medical records
Conveying rehabilitation
Distant rehabilitation system
High-speed wireless net + rehabilitation devices installed by hospital team
Real-time telemetry
Working with tutor via Internet
Increase in accessibility
Structured diagnosis
Neurological status
ICF class
Social aid status
Rehabilitation process dynamics
Multistakeholder collaboration
Insurance companies
Industry& private sector
Regional governments
Technology assessment
Insurance programs remodeling
Overall politic initiative
Legislation
Promotion
Technologies
Investment
Education
Results and conclusion
National rehabilitation program
Price with 100% coverage, CHF
No program
Classic rehabilitation
Conveying rehabilitation
Conveying rehabilitation + distant rehabilitation
Conclusions:
Growing eHealth component decreases the per capita and overall price of rehabilitation
It gives access to best healthcare services to larger number of patients (possibly – 100%)
It helps to overcome transport barriers
Life quality changes and de-facto spendings are to be assessed in future research