Health Service Delivery Models and Tele-Health for the Elderly Living in Rural Areas

In Turkey, 12,4 % of population live in rural area. In rural area, the high rate of elderly population, low educational level, lack of social security, poverty and failure to access healthcare services difficulty are significant. When Health Statistics of Turkey are examined, it is observed that health problems such as obesity, diabetes, and hypertension observed at higher rates in elderly population are more common in rural areas. This can be explained by both demographic structure of rural population and insufficient access to health services in the rural area. Obstacles of healthcare in the rural area are lack of healthcare personnel and healthcare services, barrier to access healthcare services, lack of access to means of transportation, telephone services, and social welfare services, unpredictable travel and weather conditions, procedures about healthcare services, failure to understand needs of individuals coming from the rural area by healthcare professionals and their attitudes towards these individuals, and language and cultural barriers. Healthcare services for rural areas in Turkey are carried out by midwives or nurses working in the health houses as subject to family physicians in the very nearest region. Density of elderly population and complex health care needs of this group require nurses working in the rural area to be more competent. The aim of this review is to recognize the health needs of the elderly living in the rural areas, to evaluate the applications made to increase access to health services and to make suggestions for the elderly living in the rural areas in Turkey. For this purpose, the use of healthcare delivery models, mobile healthcare services, tele-health, and information and communication technologies in the rural area was examined. Projects prepared for elderly people living in rural area in Turkey and in the world; improving community based inclusive nursing services and health condition of people living in rural area, the project for supporting rural life in UK, ESAW (European Study of Adult Well-Being), National Tele-health Project for Scotland,OURSES (Offer of Rural Use of Services by Satellite), tele-medicine project in France, FW-MHIP (Western Australia’s The Far West Mental Health Integration project), America'sCCTH(The Care Coordination Home health), Germany's TEMPiS (Tele-medical Project for Integrative Stroke Care), America' IDEATel (The Informatics for Diabetes Education and Tele-medicine project) and Royal Flying Doctor Service of Australia.Consequently, tele-health and ICT Technologies as well as different health service models are commonly used for especially disadvantaged elderly people in the rural area to access healthcare services. Turkiye nufusunun % 12,4’u kirsal alanda yasamaktadir. Kirsal alanda; yasli nufusun fazlaligi, egitim duzeyi dusuklugu, sosyal guvencesizlik, yoksulluk ve saglik hizmetlerine erisim guclugu belirgindir. Turkiye Saglik Istatistikleri incelendiginde, yasli nufusta daha yuksek oranda gorulen obezite, diyabet, hipertansiyon gibi saglik problemlerinin kirsalda daha fazla oldugu gorulmektedir. Bu durum hem kirsal nufusun demografik yapisi hem de kirsalda saglik hizmetlerine yeterince ulasamama ile aciklanabilir. K irsal alanda saglik bakim engelleri; saglik personelinin ve saglik hizmetlerinin eksikligi, saglik hizmetlerine erisim engeli, ulasim araclari, telefon hizmetleri ve sosyal yardim hizmetlerine erisememe, tahmin edilemeyen seyahat ve hava kosullari, saglik hizmetleri ile ilgili prosedurler, saglik personelinin kirsaldan gelen bireylerin gereksinimlerini anlamamasi ve onlara karsi tavirlari, dil ve kulturel engellerdir. Ulkemizde kirsal alan saglik hizmetleri, saglik evlerinde gorevli ebe veya hemsireler tarafindan en yakin bolgedeki aile hekimlerine bagli olarak yurutulmektedir. Yasli nufusun yogunlugu ve bu grubun kompleks saglik bakim gereksinimleri kirsal alanda gorev yapan saglik evi hemsirelerinin daha yetkin olmalarini gerektirmektedir. Bu derlemenin amaci; kirsal alanda yasayan yaslilarin saglik gereksinimlerinin farkina varmak, saglik hizmetlerine ulasimi artirmak icin yapilan uygulamalari degerlendirmek ve ulkemizde kirsalda yasayan yaslilar icin onerilerde bulunmaktir. Bu amacla, kirsal alan saglik hizmeti sunum modelleri, mobil saglik hizmetleri, tele-saglik ve bilgi iletisim teknolojilerinin kullanimi incelenmistir. Turkiye ve dunyada kirsal alanda yasayan yaslilar icin yapilan projeler; toplum temelli kapsayici hemsirelik hizmetleri ile kirsal bolge halkinin saglik durumunun gelistirilmesi projesi, Ingiltere’de kirsal yasamin desteklenmesi projesi ESAW (European Study of Adult Well-Being) Avrupa yetiskin iyilik hali projesi, Iskocya tele-saglik projesi, Fransa OURSES (Offer of Rural Use of Services by Satellite) teletip projesi, Bati Avustralya FW-MHIP (The Far West Mental Health Integration), Amerika CCTH (The Care Coordination Home Tele-health), Almanya TEMPiS (Tele-medical Project for Integrative Stroke Care), Amerika IDEATel ( The Informatics for Diabetes Education and Tele-medicine) projeleri ve Avustralya Saglik Bakanligi tarafindan saglanan Kraliyet Ucan Doktor Hizmetidir. Sonu c olarak; kirsal alanda ozellikle dezavantajli konumda olan yasli bireylerin, saglik hizmetlerine erisimlerinde farkli saglik hizmet modelleri ile birlikte tele-saglik ve Bilgi Iletisim Teknolojileri yaygin olarak kullanilmaktadir.