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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


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 (



(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


6,1) (p = 0,03).


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.


Resource based community development as an asset for integrated

long term care for chronicity at community level

S. Tsartsara.

Southeast Europe Healthcare, Athens, Greece


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.



Extraction of epidemiological data and Risk Factors Assessment

for population over 60,


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),


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.


Regression analysis of care means to the needs per CGA risk factor,


Alignment of the local Health and Care services and professionals

of the area,


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


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.


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


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:


Needs analysis for care service and HR for the local population

prepared with primary and social care services aligned.


Telemedicine for acute care and 2nd opinion deemed possible.


Care Hub structure and business plan prepared


Senior Tourism and Health Tourism model designed and



Investment blending, investment familiarization tour to health

resorts organized

Poster presentations / European Geriatric Medicine 7S1 (2016) S29