Prof Nuno Sousa is a neuroradiologist and the Director of the P5 Digital Medical Centre in Portugal. This centre has been developing digital health solutions to support the provision of healthcare in rural areas in Portugal. Their projects have been developed in close collaboration with the local communities they work with.

Episode summary:

01.00  Prof Sousa tells us about his professional background

06.00  What is P5 and what work has been done there?

09.20  What types of services are being provided?

20.10  What have the benefits been for rural communities?

26.30  Who have been the local mediators in rural areas?

28.50  How many consultations are provided?

31.15  What has the response been from the health providers?

34.45  Have there been challenges within the health system?

39.45  How do we scale and spread innovation?

43.45  What are some key insights from Prof Sousa’s research about aging?

54.15  What does Prof Sousa see for the future of digital health?

Key messages:

Created a clinical digital center (P5) to work in partnership with other healthcare providers and the local communities.

P5 is a way to give back to the community within which the center is working.  Embedding digital tools and technologies within the way we practice medicine.

Three main goals of P5: 1) to ensure that medical students are trained in a digital health setting, 2) reaching further and improving the quality of care, 3) promoting research.

Empowering patients is at the core of what P5 is doing.

Promotion of health - engaging with local institutions, such as schools, to tackle issues that these institutions ask for help with.

Large demographic shift is happening in Portugal, emphasis on promoting healthy aging programs to improve quality of life.

Health promotion activities are run in parallel with activities for health literacy and digital literacy.

Integrators of solutions rather than creators of new solutions.  They have searched for solutions that already exist that can be adapted to the local context.

Digital palliative care program - multi modal program adjusted both to the patient and the caregiver, currently in the pilot stage. Allows for continuous monitoring and support.

Initial meetings/consultations should still be face to face to help develop trust and this allows for better integration with the digital services.

Establishing partnerships with local municipalities has been important to the success of the program.  Digital removes the barrier of distance.

People prefer to express themselves in their mother tongue when they are unwell, for this reason P5 provides services to patients around the world.

People who use the services in urban areas are much younger than the people who use the services in rural areas.  In rural areas the interaction is not as easy due to technical obstacles such as digital literacy.

P5 has been meeting local people in local parishes, libraries and pharmacies to develop local mediators for communication to help people use the digital services.  The acceptance of the services can be slow.

P5 does not provide acute care, they focus on health promotion and monitoring of chronic decisions.

Local champions help to spread the word and support the adoption of the service.  Adoption is always growing but is very slow.

Mental health support has had good adoption particularly among younger people.

With older people the use is tied to the recommendation of the local health provider as there is an element of mistrust.

They found it was very important to engage with health professionals from the start and include them in the development of the program.  If this was not done the engagement with the services were not very good.

Digital literacy also needs to be developed among healthcare professionals.

New services need to reduce workload of healthcare workers not add to existing workload, this causes barriers to implementing new services.

Digital health is still seen as a side element and there are major barriers to integration.

A need for more tolerance and flexibility when looking at innovation. The health system can be very rigid which slows down the process of innovation.

Implementation science around healthcare services and processes is important if we want to move ahead.  The problem is if we are rigid in only giving one option of implementation, this can lead to dead ends.

Developing an ecosystem that allows them to explore healthy aging of the brain.

Could we develop interventions that improve mood which would improve cognitive function?

Social isolation negatively impacts cognitive function, it can decline dramatically in a short period of time.

Digital tools are not the enemy but the way for us to more effectively reach more people.

P5 had built on the process of P4 medicine and added proximity.

P5 website: https://www.p5.pt/

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