The Gatekeeper project at the Basque Country Pilot Site (PS) is led by Osakidetza Basque Health Service and two research institutes: Kronikgune Health Services Research Institute and Biocruces Bizkaia Health Research Institute (BBHRI).
Due to population ageing and advances in medical science, people with chronic diseases are living longer, which has become a challenge and a problem for the society. Challenges are how healthcare systems can cope with the cost burden of chronic disease, sustain quality independent living for patients; and ensure sustainable healthcare and social care systems. Currently, Osakidetza has a target population of more than 2.2 million inhabitants which, in 2021, more than 22 % of the total population was 65 years old or older. Therefore, ageing, chronicity and dependence are one of its strategic priorities.
To this end, the Basque Country PS intends to make them participants in their own illness by improving self-management and control over their health through active ageing activities. Information and Communication Technologies (ICT) and their applications in Basque healthcare practice are emerging as an alternative to tackle the challenges of the Basque Health system. Moreover, reducing dependence on the health system by chronic patients and the use of smart devices will lead to a reduction in both the number of hospital admissions and the number of visits to emergency services, as well as the reduction in healthcare costs.
The Basque Country PS is focused in multi-chronic elderly patients such as diabetes, stroke, cardiovascular problems, Parkinson’s disease or multimorbid patients with polypharmacy. Additionally, the intervention of the Basque community will address the promotion of healthy habits in the elderly. Gatekeeper will give a great opportunity to the Basque health system to implement sustainable measures over time without interfering with the daily life of chronic patients. It will also allow patients to interact with the healthcare system, providing them a better control of their diseases and empower patients, caregivers and citizens by improving their health outcomes and, therefore, the efficient use of health resources.
The solutions that the Basque Country PS will use lead to prevent the appearance of complications related to chronic diseases of ageing people, slow down the progression of worseness and/or even to enhance the evolution of their pathologies to improve the patients’ quality of life.
A short description of the use cases that are being implemented in the Basque Country is presented below:
In diabetes, especially in insulin-dependent patients (who are being treated with insulin), continuous blood glucose monitoring is very important. Smart devices, in addition to blood glucose levels, will monitor blood pressure, heart rate and possible arrhythmias associated with diabetes. This knowledge will allow patients to avoid the need to visit their general practitioner so often.
- Parkinson’s Disease:
Patients diagnosed of Parkinson’s disease, have alterations called on-off periods, in which they suffer blockages due to the spasms and spasticity they present. Through the Gatekeeper platform and smart devices, the aim is to anticipate the poor evolution that the disease may have and incorporate early treatments. Thus, avoiding the possible evolution of the disease and favoring a good control and management of it.
- Stroke identification and prevention:
One of the most pressing problems of cerebral infarctions are recurrent strokes. Education in the recognition of the signs and symptoms of strokes and continuous monitoring of physiological parameters will ensure avoidance of recurrent strokes. To this end, the Gatekeeper project will act on the primary and secondary prevention.
“Management of people with chronic diseases and polypharmacy» main objective is to assess the effectiveness and experience of using a mobile application (My Treatment) to improve adherence, and using of a web platform (CheckTheMeds) to optimize pharmacological prescription. More than 250 professionals (doctors, nurses and pharmacy staff) from Primary Care centres are involved in this intervention from 11 Integrated Healthcare Organizations.
- Promotion of Healthy lifestyle: A self-managed mobile App for healthy habits promotion will encourage active and healthy ageing, promoting physical activity, cognitive training, and social participation. The purpose is to enhance independence, autonomy and improve the well-being of older people, and increase the empowerment of older people and their caregivers by making accessible health educational materials.
The Basque Country is centered in designing and demonstrating the real-life effects of implementing digital and innovative tools for boosting patient and people well-being and quality of life. The use cases will make patients aware of their disease, the factors that influence a poor evolution, how to control them and how important is their involvement and participation in decision-making process.
For this reason, citizen participation is essential in order to improve the research and innovation environment. All the research projects carried out in the Basque Health Ecosystem are rigorous and safe. Thus, the coordinated action of healthcare professionals, in close collaboration with the patient, is postulated as a common denominator in strategies for improving the health Basque citizens.