1. SARAH Greater Trust in Home based care Anna-Lena Andersson, Social welfare services, City of Luleå Susanne Andersson, Norrbotten county council

2. Patients recieve care in their homes  General Practisioner and district nurse (daytime)  GP and nurse at nursing home (daytime)  GP and nurse (evening/night/weekend)  District nurse and home help service (daytime)

3. Participating staff General Practisioners (day/evening/night)  16 GP´s  5 Medical centers in Luleå + Råneå + Boden + Vittangi District nurses (daytime) in county council  3 district nurses  Medical centers in Råneå + Vittangi Nurses (Nursing home day/evening/night)  37 nurses at 16 Nursing homes in Luleå and 2 in Boden Home help service  11 staff from Home help service in Råneå => In total 67 participants

4. General practisioner – District nurse/ nurse (day/evening/night)  SARAH mobile – bag; portable equipment for diagnostics  Mobile access to patient record  Audio– and video communication

5. Mobile equipment and mobile access to patientrecord ( GP – District nurse/Nurse,daytime/ evening/night ) Mobile access to patientrecord SARAH mobile bag - equipment for diagnostics

7. General practisioner - Nurse (Nursing home, daytime)  Trolley with WLAN connected lap top, web cam, microphone, elektronic stetoscope, equipment for diagnostics  Mobile access to patient info  Message from nurse  Audio - och video

8. Distance consultation with stetoscope Distance meeting

9. District nurse and Home help service Home help service TES Blå Pocket District nurse

10. SARAH – Social Welfare Services City of Luleå  76 000 citizens  The citizens which: To be able to stay at home as long as possible.  Ageing population

11. Organisation Day - 14 Night- 1 Day - 12 Night - 1 Day - 12 Night- 1 Day - 7 Night - 1

12. Evaluation  Field test October 2006 until May 2007  Intensive evaluation March- May  Result presentation and report June-August 2007

13. Personnel in care and health care How does the personnel experience the new technique? - usability, accessibility, security and safety? Patient focus How does the patient experience the new technique and the new way of working? - Accessibility, safety and security - The quality of the consultation? What is new? New technique are used in care and health care for distance work. - New way of communicating and integrate. - A implementation process - Changes in the way we work, roles and tasks - Quality on care and health care - Economical effects and aspect Personnel in care and health care How does the personnel experience the new way of working? - attitudes against changes process? - use of each other competence - Quality of distance work compared with traditional way of working SARAH from a research perspective

14. Possibilities and obstacle  Obstacle Heavy bag/ equipment Consent IT-communication Motivation Changes in the way we work requires other planning.  Possibilities Better medical information Convenient cooperation Increased quality of healthcare Increased security Increased efficiency Mobile access to journal Mobile test equipment

15. Sarah results Use of Sarah mobile bag - different time during the day and week (total 113 times) Evening 11% Weekend 27% Daytime 57% Night 5%

16. Sarah result 1 5 50 8 47 59 0102030405060 12-lead ECG Digital camera Other instrument Internal records Meddix Patientrecord VAS Areas of Use

17. Sarah result 0%10%20%30%40%50%60%70%80%90%100% 12-lead ECG Digital camera Other instrument Internal record Meddix Patientrecord VAS Functionalities GoodAcceptableNot at all

18. Sarah result Contact with GP Tried but did not succeed 1% No 77% Yes 22%

19. Sarah result 7 6 4 5 0 59 12 9 0102030405060 Write in patientrecord Send message from district nurse Send message and test result Send photo /ecg Book, controller visit with GP Test result/ordination Information from visit at GP Other patient information Use of patient record

20. Aspects for success  Support from the organisation management- approve - motivate  Give the project the right terms  Planning together - all participants in the project.

21. See beyond the Horizon To “dare” to do something new and work in a different way and with new methods are developing…

22. Thank you for your attention Anna-lena.andersson@soc.lulea.se Susanne.b.andersson@nll.se www.cdh.ltu.se