231 / 290
Results:
The mean difference systolic pressure before and after
intervention-colonoscopy in the control and research groups was
17,7 mmHg (95%CI 14,6
–
20,8) and 7,9 mmHg (95%CI 5,5
–
10,4) (p <
0,001). The mean difference diastolic pressure before and after
intervention in the research and control groups was was 5,5 mmHg
(95%CI 1,9
–
9,0) and 3,1 mmHg (95%CI 1,2
–
5,0) (p = 0,22). The mean
difference heart rate before and after intervention in the research
and control groups was 8,0 bpm (95%CI 5,3
–
10,7) and 3,2 bpm (95%CI
2,2
–
4,6) (p = 0,001). The mean difference systolic pressure before and
after intervention-gastroscopy in the control and research groups
was 15,7 mmHg (95%CI 12,5
–
18,8) and 4,1 mmHg (95%CI (
−
)0,6
–
8,6)
(p < 0,001). The mean difference diastolic pressure before and after
intervention in the research and control groups was was 5,7 mmHg
(95%CI 2,4
–
8,9) and 4,1 mmHg (95%CI 2,1
–
6,1) (p = 0,5). The mean
difference heart rate before and after intervention in the research
and control groups was 7,0 bpm (95%CI 5,2
–
8,1) and 3,8 bpm (95%CI
1,5
–
6,1) (p = 0,03).
Conclusion:
Participants listening to music while endoscopy (gas-
troscopy and colonoscopy)had a significantly lower difference sys-
tolic pressure and heart rate before and after the intervention than
participants who were subjected to the standard procedure. The
difference in in diastolic pressure was similar in both groups. Listening
to music during endoscopic procedures can reduce stress in patients
during the study. Gastroskopy, colonoscopy, music therapy.
P-745
Resource based community development as an asset for integrated
long term care for chronicity at community level
S. Tsartsara.
Southeast Europe Healthcare, Athens, Greece
Introduction:
Chronicity is the first cause of healthcare cost burden
and will continue to increase due to the growing longevity worldwide.
National and local care budgets are already experiencing severe cuts
not only in EU countries under crisis (Greece, Karanikolos et al) but
also in advanced economies such as the UK (NHS recent social care
cuts, The Guardian Social Care 2016).
A solution must be found very quickly that it is not dependent neither
on state funding that is in constant decline in social care, the primary
driver of chronic care nor on Private Equity managing LTC, a high
risk option that has failed dramatically over the last years to assure
community based care (
“
Four Seasons
”
closing residential care in UK,
The Guardian Social Care, 2016).
The burden in finding a solution is transferred to the local com-
munities that are either offered slim resources such as the increase in
local tax for social care of 2% in the UK or close to not at all as in Greece.
The national and local authorities are defensive in moving forward
with care reforms as those demand serious investment from state
resources. None of the care reform proposals actually proposes how to
generate income to build a sustainable community based system for
long term care especially.
In this research we are proposing a RoI reinvested in a community
based integrated care, generating revenue and income model, that is
established on local resources, lateral to the care services provided
to the local population such as senior tourism, health tourism and
thermal rehabilitation in natural springs, or secondary housing
of people relocated after retirement, or prevention services for the
whole population. Although frailty is the Chronicity
’
s final stage of
disease development, people with mild frailty whose rate to the
Comprehensive Geriatric Assessment for Instrumental Living is quite
high, are pursuing an active and healthy living and they are also
traveling quite a lot, the above 60 y.o. segment being the first globally.
The choice of those senior travelers is conditioned by product offers
that are matching their individual diseases or conditions and their care
plans. The region that disposes with the capacity to provide, manage
and cover the elderly visitor
’
s needs, who have similar conditions and
needs for chronic care that is provided to the local population as well,
will raise its brand equity and attract more of those visitors over 60 for
any reason (housing, tourism, wellness, care etc.).
The more they are going to be integrated not as patients but as
Wellbeing visitors, in the existing care system same as for the
local population but with extended activities for integrated and
citizen centered enablement services, the larger the revenue margin
will be for the care structure. We think that this new business
model should be managed and provided by private public partner-
ships and provided by public, or not-for-profit private companies
which adhere to the principles of the New Care Model in a form
of social entrepreneurship. Companies for Community Interest
might be a solution for local authorities that have potential for Local
Resource Based Community Care Development to sustain self
–
financed structures providing long term care to the local population
in a sustainable manner. And this model can function as a strong
motivation for the authorities to move on and reform care to integrate
health services and professionals in their localities with double
purpose: assuring population health management and generating
income to reinvest in their Territorial Care Hubs. The 1st pilot was
in Greece at the region of Aegean islands. The pilot now will be
transferred to a new location.
Methods:
1.
Extraction of epidemiological data and Risk Factors Assessment
for population over 60,
2.
VES -13 self-administered CGA questionnaire to measure i-ADL of
the >60y.o. cohort. GIS mapping of population acc. to primary and
secondary prevention and care needs embedded in a E-Health
monitoring platform (existing and tested product),
3.
Desk research analysis on the local health and other lateral to care
resources of the region e.g. thermal springs, rehab centers, day
care centers etc.
4.
Regression analysis of care means to the needs per CGA risk factor,
5.
Alignment of the local Health and Care services and professionals
of the area,
6.
Focus Groups and structured interviews to establish a Memoran-
dum of Understanding between mayors of the area to create the
Care Hub managed by Private Public Partnership with the local
health ecosystem and with the Twinning and support of EU
Regions with advanced experience
7.
Setting the Investment Facility between theMunicipal Authorities,
a Bank in Greece and the public and private providers; elaborating
the Business Plan of the entire Care Hub operations incl. Silver
Economy service management and provision organization e.g.
Senior tourism, retirement real estate, home care for senior
dwellers, professionalized Living Labs, prevention services etc.
8.
Proposing the Investment blending and assuring private equity,
crowd funding, VC and impact investment at different stages of
the Care Hub deployment until stabilization of the RoI and the
cashable savings
Results:
The results were compromised due to bank capital controls
in July
“
15 and to the refugee crisis in the pilot area (the Aegean islands
as entry gate) between June 2015 and October 2015 and due to
expropriation of all public assets of Greece from the Lenders for the
Greek public debt in June 2016, resulting for the Greek LGA not to own
anymore their local resources and therefore without decision making
power over the RoI of their assets. Hence the relocation plans and
transfer of the pilot to other areas of Europe for health tourism, where
the health and care costs are covered by the EU Social Security
Regulation and the C.B.H.Dir 24/2011/EC.
Partial results were:
9.
Needs analysis for care service and HR for the local population
prepared with primary and social care services aligned.
10.
Telemedicine for acute care and 2nd opinion deemed possible.
11.
Care Hub structure and business plan prepared
12.
Senior Tourism and Health Tourism model designed and
delivered
13.
Investment blending, investment familiarization tour to health
resorts organized
Poster presentations / European Geriatric Medicine 7S1 (2016) S29
–
S259
S225