Tele-medicine: a new promised land, just to save resources?

Ambrosino, Nicolino; Makhabah, Dewi Nurul

doi:10.1183/13993003.00410-2017

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…Despite its demonstrated benefits, because of the severity and complexity of patients’ conditions and the required intensity and time requirements of NIV, health care systems remain challenged in meeting the high costs of these services. This often results in an increased burden for patients, caregivers, and families, resulting from the transition from higher-cost hospitals to lower-cost home care or institutions with less professional input [ 71 ]. The use of telemedicine may provide some assistance with this transition, although it has been reported that a sizeable percentage of patients requiring home mechanical ventilation may be resistant to remote monitoring [ 72 ], and a survey of home mechanical ventilation patients residing in 11 European countries revealed that approximately one-half reported they would be confident using a telemonitoring system as part of their home mechanical ventilation program [ 72 , 73 ].…”

Section: Telemedicinementioning

confidence: 99%

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

2021

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Medical management of a chronic obstructive pulmonary disease (COPD) patient must incorporate a broadened and holistic approach to achieve optimal outcomes. This is best achieved with integrated care, which is based on the chronic care model of disease management, proactively addressing the patient’s unique medical, social, psychological, and cognitive needs along the trajectory of the disease. While conceptually appealing, integrated care requires not only a different approach to disease management, but considerably more health care resources. One potential way to reduce this burden of care is telemedicine: technology that allows for the bidirectional transfer of important clinical information between the patient and health care providers across distances. This not only makes medical services more accessible; it may also enhance the efficiency of delivery and quality of care. Telemedicine includes distinct, often overlapping interventions, including telecommunication (enhancing lines of communication), telemonitoring (symptom reporting or the transfer of physiological data to health care providers), physical activity monitoring and feedback to the patient and provider, remote decision support systems (identifying “red flags,” such as the onset of an exacerbation), tele-consultation (directing assessment and care from a distance), tele-education (through web-based educational or self-management platforms), tele-coaching, and tele-rehabilitation (providing educational material, exercise training, or even total pulmonary rehabilitation at a distance when standard, center-based rehabilitation is not feasible). While the above components of telemedicine are conceptually appealing, many have had inconsistent results in scientific trials. Interventions with more consistently favorable results include those potentially modifying physical activity, non-invasive ventilator management, and tele-rehabilitation. More inconsistent results in other telemedicine interventions do not necessarily mean they are ineffective; rather, more data on refining the techniques may be necessary. Until more outcome data are available clinicians should resist being caught up in novel technologies simply because they are new.

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Section: Telemedicinementioning

confidence: 99%

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

2021

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“…The use and funding of digital health technologies should be carefully evaluated and monitored by governments which should play a more active role in surveying its real outcomes on the health system [100][101][102][103]. It must be recognised that telemedicine may also carry ethical and legal problems that are still not recognised internationally [104].…”

Section: Telemedicinementioning

confidence: 99%

Patient's treatment burden related to care coordination in the field of respiratory diseases

Pierucci

Santomasi

Ambrosino

et al. 2021

Breathe

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The management of respiratory diseases requires various levels of care: multidisciplinary teams, educational and behavioural interventions, self-management and home-based technical support are vital to ensure adequate care management. However, it is often difficult to access these networks due to fragmentation of patient care and treatment burden. Care coordination aims to ensure patients have a central role and that there is continuity of care among various levels and professionals involved. Moreover, the coronavirus disease pandemic has caused strain on the global healthcare system, with care coordination becoming increasingly important in increasing the resilience of health systems, supporting healthcare professionals and ensuring the right treatment and adequate level of care for these patients.

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“…Because of this relatively high utilization, patient complexity, and the intensity of services, health care systems are challenged to meet costs of these services; consequently, some of the burden falls on patients and families. This has resulted in transition from higher-cost hospitals to lower-cost locations, such as home or institution with less professional assistance [103]. Telemedicine may provide some assistance with this transition.…”

Section: Using Telemedicine To Help Manage the Patient With Chronic Respiratory Failurementioning

confidence: 99%

Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7–8 September 2017

Donner

Raskin²,

ZuWallack

et al. 2018

Respiratory Medicine

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This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.

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Tele-medicine: a new promised land, just to save resources?

Cited by 7 publications

References 18 publications

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

The Role of Telemedicine in Extending and Enhancing Medical Management of the Patient with Chronic Obstructive Pulmonary Disease

Patient's treatment burden related to care coordination in the field of respiratory diseases

Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7–8 September 2017

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