Maria’s first-hand experience: how telemedicine brings health care closer to remote Swedish villages

Living in a small village nestled in southern Lapland’s wilderness is a dream come true for any outdoor enthusiast. Maria, 65, has been living this very dream in Slussfors – a serene little hamlet tucked away in the heart of Västerbotten Region, Sweden. However, her idyllic lifestyle was threatened 25 years ago when a herniated disc forced her to limit her walks and physical activity in general.

“Since then, I have been sensitive to strain, and had pain in my entire musculoskeletal system. I need help with rehabilitation, help with my chronic pain, which is occasionally severe, depending on what I’ve done and how active I’ve been,” Maria says. “I’ve also been a bit unlucky and suffered from accidents and injuries and had to rehabilitate myself.”

Her medical condition and age meant that frequent visits to physiotherapists and occupational therapists were previously a life-sustaining necessity. Residing in a sparsely populated remote village like Slussfors did her no favours. She would have to endure a 4-hour car ride to reach a doctor’s office at the closest hospital. These trips were especially challenging for Maria as the simplest activity of sitting is “the thing that has been stressing my back the most,” she shared.

Fortunately, in response to the challenges of residents living in rural areas, Sweden has been at the forefront of developing telemedicine in sjukstugor (commonly referred to as cottage hospitals in English) since the early 1990s. For over a century, these cottage hospitals were small primary care units staffed with general practitioners. However, the recent developments have introduced a new care model that combines face-to-face consultation, digital solutions and mobile teams to deliver a broad spectrum of health services by a multidisciplinary team. The new model utilizes multiple platforms and over 40 telemedicine tools – bridging the gap between health-care providers and patients, regardless of their physical location.

The digital tools and the development of those services have really helped me. I have been able to reduce my travels,” Maria said. “What is most exciting is that if I need to be examined, I can visit the community room in Slussfors, connect and receive an examination by video. If there is someone with health-care expertise, such as a physiotherapist, in the room with me, then the doctor can remotely supervise the examination and ensure that the right steps are taken.”

Health financing, innovation and workforce policies extended the sjukstugor service model to a “virtual community room” with 24/7 access. Today the Västerbotten Region has 8 virtual community rooms, where patients can self-check their blood pressure and blood glucose, among other self-tests, and have video consultations with health-care professionals. Additionally, a digital remote doctor service collaborates with local nurses and assistant nurses to provide better medical services to nursing homes, resulting in improved continuity of care for chronically ill patients.

Maria appreciates even the simplest digital solutions, such as mobile applications that make it easier to manage her doctor appointments, monitor her medical history and revisit prescriptions – “if you were too stressed when you met the doctor and don’t remember what he said”. After her hip replacement, she recalls benefitting greatly from a training app: “I got messages every morning saying: ‘do these two exercises today,’ and it takes 5 minutes. Then in the afternoon, I got two exercises – 5 minutes. I was in good shape before the prosthetic surgery, and it didn’t take long before I felt strong enough to stop thinking about how I moved with my new prosthesis,” she explained.

Sweden’s innovative approach has had a profound impact on the quality of life of Maria, her neighbours and many people living in remote communities. Rapid advancements in digital technology still offer immense potential for telemedicine in ensuring the provision of uninterrupted, cost-effective, high-quality services in primary health care (PHC), emergency care, rehabilitation and more. The long-term strategy of the Västerbotten Region is to systematically move the technology closer to the patients through continued research, development and innovation in rural PHC.

In October 2022, the WHO European Centre for Primary Health Care and Västerbotten regional and local health authorities launched the WHO Primary Health Care Demonstration Platform in Sweden. The Platform exemplifies a well-performing digital PHC model for remote and sparsely populated areas. It shows how PHC can be adapted to various contexts and needs by expanding the scope of practice of general practitioners and nurses, and applying innovative and remote delivery solutions, including drone technology and a wide range of telemedicine applications.

The WHO European Centre for Primary Health Care continues to provide support and coordination for health-care managers from other countries to visit WHO PHC demonstration platforms. Georgia was the first country to send a delegation to see the Platform in Sweden, as it faces many similar challenges that require advanced digital solutions. The visit to Sweden provided the Georgian study group with excellent opportunities to develop the design of a new model, which prioritizes enhanced communication and interaction between PHC professionals and specialists. The Centre also plans to organize a visit for policy-makers, PHC managers and health professionals from Kazakhstan to study the Platform in 2023, highlighting the continued efforts to improve primary health care in the WHO European Region.