On 13th and 14th March, Bilbao has been the venue selected to host the new follow-up meeting for this European project.

The European project ACT@Scale aims to scale-up good practices in Integrated Care and Telemonitoring. With this in mind, the Consortium, made up of 13 European partners, is implementing a collaborative methodology to detect and analyse areas of improvement, and implement specific actions to facilitate scaling-up the programmes selected. Its ultimate aim is to reduce mortality and improve the quality of life of those affected by chronic diseases, frailty or mental illnesses.

The Basque Country is represented in this project by Kronikgune and Osakidetza. Work is currently in progress at local level to enhance two corporate programmes implemented by Osakidetza: the integrated care pathway for patients with multiple comorbidities and the telemonitoring service for patients with heart failure. These multidisciplinary teams include managers and health professionals from all the Integrated Healthcare Organisations (IHOs), Gorliz Hospital, Santa Marina Hospital, the Health Council and Osakidetza Central Services, which have been involved in this work for months. Thanks to a collaborative method based on continuous improvement cycles, also known as Plan, Do, Study, Act (PDSA), both programmes are gradually reaching all organisations within the Basque Health Service (Osakidetza).

The 5th Assembly held in Bilbao has enabled the pilot regions (Catalonia, Groningen, Scotland, the Region of Southern Denmark, the Region of Kinzigtal in Germany and the Basque Country) to share the milestones achieved to date. The regions exchanged their experiences implementing the programmes, the hurdles found and the solutions applied. Moreover, several meeting sessions were dedicated to the exploitation and centralised analysis of data being collected in relation to change management, professional staff’s involvement, service adaptation to patients’ needs, business models and sustainability, as well as citizens’ activation.

María Aguirre, the Director of Healthcare Research and Innovation of the Basque Government, opened the meeting welcoming all the participants and making a presentation on the Basque Country and the Basque health system.

Igor Zabala, the Director of Osakidetza’s Integrated Care and Chronicity Service (SIAC), presented the work carried out by the multidisciplinary team on the healthcare pathway for patients with multiple comorbidities. In particular, he described the improvements implemented in this healthcare pathway, including activities related to empowering patients and carers.

Kronikgune on the other hand, presented the work undertaken in the Basque Country and Catalonia regarding service selection. The aim of this work is to achieve the correct distribution of healthcare resources and address the changing needs of patients and the population at large. In order to assess how this target is achieved, Kronikgune has analysed the impact of actions implemented in terms of: patients’ stratification according to their characteristics; service adaptation based on needs; realisation of personalised care plans; and professional staff’s involvement, in both regions.

Furthermore, during the assembly, Kronikgune obtained feedback from the European partners regarding the project management and progress since its inception. In general terms the outcomes were positive.

For further information about the project, click here to visit the project website.