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Bernocchi P, Giudici V, Borghi G, Bertolaia P, D'Isa S, Trevisan R, Scalvini S. Telemedicine home-based management in patients with chronic heart failure and diabetes type II: study protocol for a randomized controlled trial. Trials 2024; 25:333. [PMID: 38773662 PMCID: PMC11106884 DOI: 10.1186/s13063-024-08171-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Heart failure and type 2 diabetes are prevalent public health issues in Europe. These complex chronic conditions require extensive pharmacological management, ongoing self-care, and behavioral changes. Despite the known benefits of lifestyle changes, such as regular exercise and better control of blood sugar levels, patients may need help implementing the recommended changes. This study aims to assess the effectiveness of a telemedicine program for managing heart failure and type 2 diabetes at home. The program focuses on promoting lifestyle changes. METHODS AND ANALYSIS During scheduled outpatient cardiology evaluations, eligible patients are recruited and randomly assigned to either an intervention or control group in a 1:1 ratio. The intervention group receives support from a nursing case manager through a structured home-based teleassistance program and a trainer for daily physical activity stimulation. They also have access to teleconsultations with cardiologists and diabetes specialists as needed, telemonitoring of vital signs, and daily step tracking. An app records and monitors daily drug treatment, glycemia, blood pressure, heart rate, and other clinical parameters. Patients can also self-report symptoms and communicate via a chat and videoconference system with a Nurse Case Manager. The control group receives routine care. Data collection occurs before intervention and 6 months after baseline during a new outpatient cardiology evaluation. The primary outcome is to measure the difference in the distance walked during a 6-min walk test between baseline and after 6 months. The key secondary outcomes include improving the disease status and physical activity profile. Data will be analyzed according to the intention-to-treat principles. DISCUSSION This study will provide evidence on the efficacy of a telemedicine home-based management model to maintain correct lifestyles in patients with both heart failure and type 2 diabetes, improving self-management, their empowerment on the diseases, and increasing their knowledge and ability to recognize symptoms early. TRIAL REGISTRATION ClinicalTrials.gov NCT05633784. Registered on November 30, 2022.
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Affiliation(s)
- Palmira Bernocchi
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy.
| | - Vittorio Giudici
- Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio-Sanitaria Territoriale Bergamo Est, Seriate, Bergamo, Italy
| | - Gabriella Borghi
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy
| | - Patrizia Bertolaia
- Socio-Health Management Direction, Azienda Socio-Sanitaria Territoriale Bergamo Est, Seriate, Bergamo, Italy
| | - Salvatore D'Isa
- Cardiovascular Department, Cardiology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Roberto Trevisan
- Endocrinology and Diabetes Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Simonetta Scalvini
- Continuity of Care Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Via G. Mazzini 129, 25065, Lumezzane, Brescia, Italy
- Cardiac Rehabilitation Unit, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
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Seigel CR, Martin H, Bastin G, Myers LJ, Taylor S, Pike F, Wilkinson J, Williams LS. Patient acceptance of teleneurology across neurologic conditions. J Neurol 2024; 271:2850-2858. [PMID: 38388928 PMCID: PMC11055742 DOI: 10.1007/s00415-024-12200-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/08/2024] [Accepted: 01/16/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Patient acceptability with outpatient teleneurology has been reported within specific conditions, but less is known about acceptability across neurologic conditions. The study objective was to compare the acceptability of teleneurology between patients with various neurological conditions and determine what other factors influence acceptability. METHODS This was a prospective study of Veterans who completed new outpatient teleneurology visits with the Department of Veterans Affairs National Teleneurology Program. Visits were conducted via video to home or video to the outpatient clinic. Patient acceptability was assessed via telephone interview two weeks post-visit. Acceptability was a summed score (3-21) of three 7-point Likert questions (higher = more acceptable). Clinical diagnosis categories were based on the neurologists' ICD10 diagnosis code. Acceptability score was modeled using a censored Tobit model controlling for demographics, type of tele-visit, medical comorbidity, and ICD10 category. RESULTS In FY 2021, 277 of 637 (43.5%) patients completed an interview with analyzable acceptability data. Of these 277, 70 (25.3%) had codes indicating headache, 46 (16.6%) movement disorder, 45 (16.2%) general symptoms, and 116 (41.9%) for all other categories. Mean patient acceptability was 18.3 (SD 3.2). There was no significant difference in scores between these groups. The only factor independently related to acceptability was medical comorbidity, with higher comorbidity associated with higher acceptability scores. DISCUSSION Patients find their outpatient teleneurology experience highly acceptable independent of neurologic condition. Those with more comorbidity report higher acceptability. Use of teleneurology may be useful and acceptable across many outpatient neurologic conditions including for more medically complex patients.
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Affiliation(s)
| | - Holly Martin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Grace Bastin
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
| | - Laura J Myers
- Indiana University School of Medicine, Indianapolis, IN, USA
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Stan Taylor
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Francis Pike
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jayne Wilkinson
- Corporal Michael J Crescenz VAMC, Philadelphia, PA, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda S Williams
- Richard L. Roudebush VAMC HSR&D EXTEND QUERI, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Iqbal MP, Newman B, Ellis LA, Mears S, Harrison R. Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis. PATIENT EDUCATION AND COUNSELING 2023; 115:107922. [PMID: 37542823 DOI: 10.1016/j.pec.2023.107922] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.
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Affiliation(s)
- Maha Pervaz Iqbal
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Stephen Mears
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Bernocchi P, Crotti G, Beato E, Bonometti F, Giudici V, Bertolaia P, Perger E, Remuzzi A, Bachetti T, La Rovere MT, Dalla Vecchia LA, Angeli F, Parati G, Borghi G, Vitacca M, Scalvini S. COVID-19 teleassistance and teleconsultation: a matched case-control study (MIRATO project, Lombardy, Italy). Front Cardiovasc Med 2023; 10:1062232. [PMID: 37645519 PMCID: PMC10461473 DOI: 10.3389/fcvm.2023.1062232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023] Open
Abstract
Background During the COVID-19 pandemic, telemedicine has been recognised as a powerful modality to shorten the length of hospital stay and to free up beds for the sicker patients. Lombardy, and in particular the areas of Bergamo, Brescia, and Milan, was one of the regions in Europe most hit by the COVID-19 pandemic. The primary aim of the MIRATO project was to compare the incidence of severe events (hospital readmissions and mortality) in the first three months after discharge between COVID-19 patients followed by a Home-Based Teleassistance and Teleconsultation (HBTT group) program and those discharged home without Telemedicine support (non-HBTT group). Methods The study was designed as a matched case-control study. The non-HBTT patients were matched with the HBTT patients for sex, age, presence of COVID-19 pneumonia and number of comorbidities. After discharge, the HBTT group underwent a telecare nursing and specialist teleconsultation program at home for three months, including monitoring of vital signs and symptoms. Further, in this group we analysed clinical data, patients' satisfaction with the program, and quality of life. Results Four hundred twenty-two patients per group were identified for comparison. The median age in both groups was 70 ± 11 years (62% males). One or more comorbidities were present in 86% of the HBTT patients and 89% in the non-HBTT group (p = ns). The total number of severe events was 17 (14 hospitalizations and 3 deaths) in the HBTT group and 40 (26 hospitalizations and 16 deaths) in the non-HBTT group (p = 0.0007). The risk of hospital readmission or death after hospital discharge was significantly lower in HBTT patients (Log-rank Test p = 0.0002). In the HBTT group, during the 3-month follow-up, 5,355 teleassistance contacts (13 ± 4 per patient) were performed. The number of patients with one or more symptoms declined significantly: from 338 (78%) to 183 (45%) (p < 0.00001). Both the physical (ΔPCS12: 5.9 ± 11.4) component and the mental (ΔMCS12: 4.4 ± 12.7) component of SF-12 improved significantly (p < 0.0001). Patient satisfaction with the program was very high in all participants. Conclusions Compared to usual care, an HBTT program can reduce severe events (hospital admissions/mortality) at 3-months from discharge and improve symptoms and quality of life. Clinical trial registration www.ClinicalTrials.gov, NCT04898179.
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Affiliation(s)
- Palmira Bernocchi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Giacomo Crotti
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Elvira Beato
- Epidemiology Unit, Bergamo Health Protection Agency, Bergamo, Italy
| | - Francesco Bonometti
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Vittorio Giudici
- Department of Cardiac Rehabilitation, Bolognini Hospital, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Patrizia Bertolaia
- Socio-Health Management Direction, Azienda Socio Sanitaria Territoriale Bergamo Est, Bergamo, Italy
| | - Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
| | - Andrea Remuzzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Tiziana Bachetti
- Scientific Direction, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Maria Teresa La Rovere
- Cardiac Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Montescano, Pavia, Italy
| | | | - Fabio Angeli
- Department of Medicine and Technological Innovativon (DiMIT), University of Insubria, Varese, Italy
- Department of Medicine and Cardiopulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Tradate, Varese, Italy
| | - Gianfranco Parati
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Gabriella Borghi
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Michele Vitacca
- Department of Respiratory Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Continuity Care and Telemedicine Service, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
- Department of Cardiac Rehabilitation, Istituti Clinici Scientifici Maugeri IRCCS, Institute of Lumezzane, Brescia, Italy
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Cristina Rezende1 L, Geraldo Ribeiro1 E, Carvalho Parreiras1 L, Assunção Guimarães1 R, Maciel dos Reis1 G, Fernandes Carajá1 A, Batista Franco2 T, Patrícia de Souza Mendes1 L, Maria Augusto1 V, Lara Silva1 K. Telehealth and telemedicine in the management of adult patients after hospitalization for COPD exacerbation: a scoping review. J Bras Pneumol 2023; 49:e20220067. [PMID: 37132694 PMCID: PMC10171265 DOI: 10.36416/1806-3756/e20220067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023] Open
Abstract
Objective: A substantial number of people with COPD suffer from exacerbations, which are defined as an acute worsening of respiratory symptoms. To minimize exacerbations, telehealth has emerged as an alternative to improve clinical management, access to health care, and support for self-management. Our objective was to map the evidence of telehealth/telemedicine for the monitoring of adult COPD patients after hospitalization due to an exacerbation. Methods: Bibliographic search was carried in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, Biblioteca Virtual de Saúde/LILACS and Cochrane Library databases to identify articles describing telehealth and telemonitoring strategies in Portuguese, English, or Spanish published by December of 2021. Results: Thirty-nine articles, using the following concepts (number of articles), were included in this review: telehealth (21); telemonitoring (20); telemedicine (17); teleconsultation (5); teleassistance (4); telehomecare and telerehabilitation (3 each); telecommunication and mobile health (2 each); and e-health management, e-coach, telehome, telehealth care and televideo consultation (1 each). All these concepts describe strategies which use telephone and/or video calls for coaching, data monitoring, and health education leading to self-management or self-care, focusing on providing remote integrated home care with or without telemetry devices. Conclusions: This review demonstrated that telehealth/telemedicine in combination with telemonitoring can be an interesting strategy to benefit COPD patients after discharge from hospitalization for an exacerbation, by improving their quality of life and reducing re-hospitalizations, admissions to emergency services, hospital length of stay, and health care costs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Kênia Lara Silva1
- 1. Universidade Federal de Minas Gerais – UFMG – Belo Horizonte (MG) Brasil
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Bonometti F, Bernocchi P, Vitali A, Savoldelli A, Rizzi C, Scalvini S. Usability of a continuous oxygen saturation device for home telemonitoring. Digit Health 2023; 9:20552076231194547. [PMID: 37588158 PMCID: PMC10426309 DOI: 10.1177/20552076231194547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
Background The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients. Method The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service. Results A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support. Conclusions Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients' feedback, are needed to scale up the service.
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Affiliation(s)
- Francesco Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
| | - Andrea Vitali
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Savoldelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Caterina Rizzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care Service of the Institute of Lumezzane, Brescia, Italy
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Vitali A, Ghidotti A, Savoldelli A, Bonometti F, Rizzi C, Bernocchi P, Borghi G, Scalvini S. Definition of a Method for the Evaluation of Telemedicine Platforms in the Italian Context. Telemed J E Health 2022; 29:769-777. [PMID: 36206021 DOI: 10.1089/tmj.2022.0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool.
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Affiliation(s)
- Andrea Vitali
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Ghidotti
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Anna Savoldelli
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Francesco Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Caterina Rizzi
- Department of Management, Information and Production Engineering, University of Bergamo, Bergamo, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Gabriella Borghi
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS Continuity of Care (Telemedicine Service) of the Institute of Lumezzane, Brescia, Italy
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Werren M, Valent F, Di Chiara A. Effectiveness of home-rehabilitation in patients after an acute coronary syndrome and myocardial revascularization. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200131. [PMID: 35663539 PMCID: PMC9160771 DOI: 10.1016/j.ijcrp.2022.200131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
Physical activity is a mainstay (class IA) of rehabilitation programme after an acute coronary syndrome, but less than 40% of patients is physically active at one year. Home-rehabilitation, initially designed to manage the increasing number of patients in rehabilitation programmes, could result in a better strategy to increase adherence and persistence to physical activity. Objectives To test such hypothesis, At Cardiac Rehabilitation Centre (Institute of Physical Medicine and Rehabilitation, Udine, Italy), physical activity adherence was compared between patients treated with a standard in-office rehabilitation programme and a cohort where home rehabilitation programme was added. Methods From February 2017 to February 2019, 372 patients after an acute coronary syndrome (72 were excluded according to study criteria) were included, 193 patients in standard rehabilitation and 179 in home rehabilitation. At the end of follow-up, patients of both groups were called on the telephone to collect physical activity items according to a standardized questionnaire. Results At a medium follow-up of 30.1 months, there are more physically active patients in home rehabilitation than in standard, respectively 139 vs 108 patients (77,1% vs. 56%, p < 0,0001).At multivariate analysis, including age, gender, and rehabilitation model, the probability to be fully physically active at the end of the rehabilitation programme, is 3 times higher (OR 3.0 CI 1,9-6,0 p < 0,0001) for home rehabilitation programme compared to standard one. Conclusions Home rehabilitation, when applied to selected populations, resulted in a feasible and effective strategy to promote long term physical activity in secondary prevention after an acute coronary syndrome.
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Affiliation(s)
- Marika Werren
- Cardiologia Riabilitativa, Istituto di Medicina Fisica e Riabilitazione, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
| | - Francesca Valent
- Servizio di Epidemiologia Clinica e Valutativa, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy
| | - Antonio Di Chiara
- Cardiologia Ospedale Tolmezzo-San Daniele, Azienda Sanitario-Universitaria Friuli Centrale, Udine, Italy
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Guo L, Guo Y, Booth J, Wei M, Wang L, Zhu Y, He Y, Liu Y. Experiences of health management among people at high risk of stroke in China: A qualitative study. Nurs Open 2022; 10:613-622. [PMID: 36054680 PMCID: PMC9834500 DOI: 10.1002/nop2.1327] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 12/28/2021] [Accepted: 07/29/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Effective health management of people at high risk of stroke in China is challenging. AIM To explore and identify the experiences of health management among people at high risk of stroke in order to provide a foundation for a targeted health management strategy for this special group. DESIGN A qualitative, descriptive study based on interviews. METHODS Semistructured interviews were conducted with 31 people at high risk of stroke. The interviews were collated and analysed using Colaizzi's seven-step method. RESULTS A total of 31 people at high risk of stroke were included, and the ages ranged from 40 to 86, with an average age of 60.71 (SD = 11.55). The experiences of health management were categorized into three themes. Theme 1: Facing many ongoing problems in health management, limited knowledge, lack of confidence and poor compliance. Theme 2: Accumulated some value experiences of coping with problems of health management, becoming active learners, promoting social interaction and enhancing self-health management. Theme 3: Sensitivity to multiple influencing factors, the severity of disease and complexity of disease management, family income and economic burden and the value of social support. CONCLUSIONS This study explored the experiences of health management among people at high risk of stroke, and these findings are of great significance in the primary prevention of stroke.
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Affiliation(s)
- Lina Guo
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yuanli Guo
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Jo Booth
- Centre for Living, School of Health & Life SciencesGlasgow Caledonian UniversityGlasgowUK
| | - Miao Wei
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Lin Wang
- College of Medicine & AgricultureHenan Radio & Television UniversityZhengzhouChina
| | - Yiru Zhu
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yu He
- Department of Neurology, National Advanced Stroke CenterThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Yanjin Liu
- Department of NursingThe first Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
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Gazzi L, Comini L, Scalvini S, Taccolini I, Vitacca M. Feasibility of telepsychology support for patients with advanced cardiorespiratory diseases and their caregivers. Front Psychol 2022; 13:909417. [PMID: 36033038 PMCID: PMC9405428 DOI: 10.3389/fpsyg.2022.909417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to test the feasibility of telepsychology support for patients with severe cardiorespiratory disease and their caregivers. A secondary objective was to explore pre-post relationships between patients' and caregivers' clinical measures. Methods A telehealth program incorporating telepsychology support, i.e., an “on-demand” phone service with a psychologist, was provided to consecutive cardiorespiratory patients at discharge from inpatient rehabilitation and to their caregivers. At the start and end of the 1-year program, participants were interviewed “face-to-face,” and their anxiety/depression level, patients' quality of life (MRF-28, SF-36, and MQOL), and caregivers' (n = 18) family strain (FSQ) and needs (CNA) were assessed: we analyzed the correlations and evaluated customer satisfaction. Results Of 80 eligible individuals, 40 took part in this study: 22 patients (FVC = 39 ± 14%; EF = 39 ± 13%) and 18 caregivers. Eleven (28%, 6 patients and 5 caregivers) requested tele-psychological support, resulting in 51 consultations focused on anxiety, difficulty in patient management, worry about the patient's emotional state, and need for emotional support; 3 participants underwent a tailored psychotherapy program. All participants expressed high satisfaction with the service. At enrolment, anxiety was less evident in patients (73% men) than in caregivers, while depressive symptoms were more evident (6.5 ± 3.1), and correlated with MRF-28 and MQOL. Caregivers' (94% women) FSQ showed a “strongly recommended” need for support; at enrolment, high levels of anxiety/depression were correlated with high FSQ (for both, p < 0.05); depressive symptoms correlated negatively with age (p = 0.025) and positively with emotional needs (p = 0.025); anxiety was positively correlated with education level (p = 0.048). At follow-up, patients' perception of support (n = 13/22) tended to increase (p = 0.089), while caregivers' strain (n = 10/18) tended to decline (to within the “range of attention”). At enrolment, caregivers' anxiety/depression and strain correlated with patients' quality of life (for both; p < 0.05). At follow-up, caregivers' strain correlated with patients' quality of life (p = 0.028) and cognitive performance (p = 0.048). Conclusion Telepsychology support associated with a telehealth service is feasible and satisfying for both participants and psychological management. A suitable support program can benefit both patients and caregivers, particularly those at higher risk of depressive symptoms (younger caregivers) and anxiety (all caregivers).
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Affiliation(s)
- Lidia Gazzi
- Psychology Service, Neurorehabilitation Unit of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
- *Correspondence: Lidia Gazzi
| | - Laura Comini
- Scientific Direction of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Simonetta Scalvini
- Cardiac Rehabilitation and Continuity Care Unit and Telemedicine Service of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Irene Taccolini
- Cardiac Rehabilitation and Continuity Care Unit and Telemedicine Service of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
| | - Michele Vitacca
- Respiratory Rehabilitation of the Institute of Lumezzane, Istituti Clinici Scientifici Maugeri IRCCS, Brescia, Italy
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The Perceptions of Telehealth Physiotherapy for People with Bronchiectasis during a Global Pandemic—A Qualitative Study. J Clin Med 2022; 11:jcm11051315. [PMID: 35268406 PMCID: PMC8911072 DOI: 10.3390/jcm11051315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/10/2022] Open
Abstract
Physiotherapy is a core component of management for people with bronchiectasis and has predominantly been delivered in an in-person consultative format. With the global pandemic, a telehealth physiotherapy model of service evolved, but the perceptions and experiences from the consumer perspective of this service have not been evaluated. Participants who had a diagnosis of bronchiectasis and received a minimum of two telehealth physiotherapy sessions during the months of March 2020 to December 2020 at a private hospital were invited to take part in a semistructured interview. Interview transcripts were coded independently, with themes established by consensus from two researchers. In total, nine participants completed interviews (age range 44 to 83 years, 67% male), with four themes identified. Themes were initial mixed opinions and acceptance of telehealth physiotherapy as an alternate model, ease of use and limitations to the telehealth platform, enablers and barriers to physiotherapy service provision, and preferences for future models of telehealth physiotherapy beyond a pandemic. In the event of the continuation of telehealth physiotherapy services for people with bronchiectasis, the perceptions and experiences outlined by consumers could be applied to inform future modification of this model of service.
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12
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Telemedicine as a Means to an End, Not an End in Itself. Life (Basel) 2022; 12:life12010122. [PMID: 35054515 PMCID: PMC8777880 DOI: 10.3390/life12010122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Telemedicine (TM)—the management of disease at a distance—has potential usefulness for patients with advanced respiratory disease. Underscoring this potential is the dramatic expansion of its applications in clinical medicine. However, since clinical studies testing this intervention often provide heterogeneous results, its role in the medical management of respiratory disorders remains inconclusive. A major problem in establishing TM’s effectiveness is that it is not a single intervention; rather, it includes a number of divergent diagnostic and therapeutic modalities—and each must be tested separately. Reflecting the discord between the need for further documentation of its approaches and effectiveness and its rapid utilization without this needed information, a major challenge is the lack of international guidelines for its integration, regulation, operational plans, and guidance for professionals. Tailored TM, with increased flexibility to address differing healthcare contexts, has the potential to improve access to and quality of services while reducing costs and direct input by health professionals. We should view TM as a tool to aid healthcare professionals in managing their patients with respiratory diseases rather than as a stand-alone substitute to traditional medical care. As such, TM is a means rather than an end.
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13
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Using Telemedicine to Monitor the Patient with Chronic Respiratory Failure. Life (Basel) 2021; 11:life11111113. [PMID: 34832989 PMCID: PMC8620445 DOI: 10.3390/life11111113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/10/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Advances in management have improved mortality of individuals with chronic respiratory failure (CRF), leading to an increase in need for long-term oxygen therapy and/or ventilatory support. These individuals require frequent visits and monitoring of their physiological parameters as well as of the functioning of their devices, such as ventilators or oxygen concentrators. Telemedicine is a clinical application of Information Communication Technology connecting patients to specialised care consultants. This narrative review aims to explore the current available telemonitoring options for individuals with CRF and reported or potential results. Methods: The research focused on EMBASE, CINALH, PubMed, and Scopus databases. Papers published between 2003 and 2021 in English were considered. Results: Different sensors, transmission devices and systems, and interventions are used with promising but not conclusive clinical results. However, legal problems are still unsolved, and economic advantages for health care systems, although potentially high, are still under debate. Conclusions: Telemonitoring systems for individuals with CRF are increasingly used; with promising results still to be clarified, legal, economical and organisational issues must be defined.
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14
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Bernocchi P, Bonometti F, Serlini M, Assoni G, Zanardini M, Pasotti E, Guerrini S, Scalvini S. Telehealth and Telecare: A Real-Life Integrated Experience in the COVID-19 Pandemic. Telemed J E Health 2021; 28:720-727. [PMID: 34402684 DOI: 10.1089/tmj.2021.0181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: In the first few months of 2020, Lombardy was the hardest-hit region in Italy for COVID-19 cases. Our Rehabilitation Institute offered a telemedicine service to COVID-19 patients discharged after hospitalization. Methods: Patients transferred from Emergency, Intensive Care, and Pulmonology departments of the principal regional hospital hubs had an average stay in our hospital of 2-3 weeks. On discharge, at home, they underwent a telecare nursing and specialist teleconsultation program for 3 months, including monitoring of vital signs and symptoms. Patients completed the SF-12 questionnaire at the start and end of the program and rated their satisfaction with it. Results: The program involved 130 patients (51%). During the period, there were 14 ± 2 (1,800 in total) telenursing support phone calls per patient made, and 12.5 ± 3.4 oxygen saturation readings per patient (1,631 in total). Persisting symptoms, frequently in combination, were present at the start of the program in 124 (94%) patients. There was a significant reduction of symptoms (p < 0.0000) after the telecare program. The physical component of SF-12 significantly improved at the end [Δ(t1-t0) = 6.7 ± 9.3, p < 0.0001]. On the contrary, the mental component of SF-12 remained unchanged or decreased slightly in patients ≤70 years of age [Δ(t1-t0) = -2.7 ± 12.3, ns], while it decreased significantly [Δ(t1-t0) = -5.4 ± 12.4, p = 0.0367] in older patients (although remaining mild). Patient satisfaction with the program was very high in all 130 patients. Conclusions: Our Telehealth and Telecare Service offers an example of rapid scaling and adaptation of an existing program to meet the needs of COVID-19 patients. Our findings indicate that telemedicine can be an integral part of clinical practice if supported by the institution with training and IT support provided to patients, nurses, and clinicians.
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Affiliation(s)
- Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Francesco Bonometti
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Marilisa Serlini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Giuliano Assoni
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Margherita Zanardini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Elisa Pasotti
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Sofia Guerrini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
| | - Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity Care Unit of Lumezzane Institute, Italy
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15
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Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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16
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Paneroni M, Vitacca M, Bernocchi P, Bertacchini L, Scalvini S. Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia. Pulmonology 2021; 28:152-154. [PMID: 33893061 PMCID: PMC8045455 DOI: 10.1016/j.pulmoe.2021.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- M Paneroni
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - M Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - P Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy.
| | - L Bertacchini
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
| | - S Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy.
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17
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Smithson R, Roche E, Wicker C. Virtual models of chronic disease management: lessons from the experiences of virtual care during the COVID-19 response. AUST HEALTH REV 2021; 45:311-316. [PMID: 33583487 DOI: 10.1071/ah20190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022]
Abstract
Objective This study examined Gold Coast staff and patient experiences with the rapid expansion of a virtual model of chronic disease management during the COVID-19 pandemic. Methods The study undertook a survey of enrolled patients (n=24) and focus groups with clinical and administrative staff (n=44) delivering chronic disease programs at Gold Coast Health in Queensland. The study also examined routinely collected activity data for the chronic disease programs before COVID (January-February 2020) and for the first 3 months of the COVID-19 response (March-May 2020). Results Chronic disease programs continued to provide similar numbers of appointments over the COVID-19 response period, but there was a marked increase in the proportion of appointments that were delivered virtually, either by telephone or video conference. Most patients were satisfied with their virtual care experiences and felt that their health care needs were met. Conclusions The COVID-19 response provided an opportunity to learn and further develop models of virtual care. Staff and patients were generally supportive of continuing to include virtual appointments in the future. Ongoing concerns were predominantly around the support available to patients and staff to ensure they are trained and equipped to manage the technology and new mode of communicating. What is known about the topic? Emerging evidence suggests that virtual models of health care delivery, such as telephone and video consultations and remote patient monitoring, can be safe and cost-effective alternatives to traditional face-to-face chronic disease management programs. Virtual care is associated with equal or improved clinical outcomes, as well as efficiency improvements, such as reduced failure to attend rates. What does this paper add? The increasing burden of chronic disease across Australia, as well as the need to minimise the risk of vulnerable patient groups attending in-hospital appointments where it is safe and appropriate to do so, means that expanding the delivery of virtual chronic disease management will become increasingly necessary. The results of this study provide an opportunity to learn from a rapid rollout of virtual care for these staff and patient groups and will help inform advances in this area. What are the implications for practitioners? Existing evidence, demographic pressures and the COVID-19 pandemic response all point to virtual care as a viable and safe alternative to traditional models of chronic disease management. The lessons presented here provide more detailed guidance on the support that staff and patients require to ensure virtual care is a seamless and safe alternative or adjunct to traditional chronic disease management programs.
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Affiliation(s)
- Rachael Smithson
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ; ; and Corresponding author.
| | - Elisha Roche
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ;
| | - Christina Wicker
- Transformation and Digital, Gold Coast Health, Gold Coast University Hospital, Block D, Level 6, 1 Hospital Boulevard, Southport, Qld 4215, Australia. ;
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Behar JA, Liu C, Kotzen K, Tsutsui K, Corino VDA, Singh J, Pimentel MAF, Warrick P, Zaunseder S, Andreotti F, Sebag D, Kopanitsa G, McSharry PE, Karlen W, Karmakar C, Clifford GD. Remote health diagnosis and monitoring in the time of COVID-19. Physiol Meas 2020; 41:10TR01. [PMID: 32947271 DOI: 10.1088/1361-6579/abba0a] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly spreading across the globe. The clinical spectrum of SARS-CoV-2 pneumonia requires early detection and monitoring, within a clinical environment for critical cases and remotely for mild cases, with a large spectrum of symptoms. The fear of contamination in clinical environments has led to a dramatic reduction in on-site referrals for routine care. There has also been a perceived need to continuously monitor non-severe COVID-19 patients, either from their quarantine site at home, or dedicated quarantine locations (e.g. hotels). In particular, facilitating contact tracing with proximity and location tracing apps was adopted in many countries very rapidly. Thus, the pandemic has driven incentives to innovate and enhance or create new routes for providing healthcare services at distance. In particular, this has created a dramatic impetus to find innovative ways to remotely and effectively monitor patient health status. In this paper, we present a review of remote health monitoring initiatives taken in 20 states during the time of the pandemic. We emphasize in the discussion particular aspects that are common ground for the reviewed states, in particular the future impact of the pandemic on remote health monitoring and consideration on data privacy.
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Affiliation(s)
- Joachim A Behar
- Faculty of Biomedical Engineering, Technion-IIT, Haifa, Israel
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19
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Ferrua M, Minvielle E, Fourcade A, Lalloué B, Sicotte C, Di Palma M, Mir O. How to Design a Remote Patient Monitoring System? A French Case Study. BMC Health Serv Res 2020; 20:434. [PMID: 32429987 PMCID: PMC7236289 DOI: 10.1186/s12913-020-05293-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS design case to provide insights into the methodology required in order to manage this phase. METHODS This study was carried out at Gustave Roussy, a comprehensive cancer centre, in France. A multidisciplinary team coordinated the CAPRI RPMS design process (2013-2015) that later produced positive outcomes. Data were collected during eight studies conducted according to the Medical Research Council (MRC) framework. This project was approved by the French National Data Protection Authorities. RESULTS Based on the study results, the multidisciplinary team defined strategies for resolving obstacles prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty clinical decision support tools enable NNs to prioritise and decide on the course of action to be taken. CONCLUSION In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study is also consistent with the notion that an RPMS is more than a technological innovation. This is indeed an organizational innovation, and principles identified during the design phase can help in the effective use of a RPMS (e.g. locating NNs if possible within the care organization; recruiting NNs with clinical and managerial skills; defining algorithms for clinical decision support tools for assessment, but also for patient decision and orientation).
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Affiliation(s)
- Marie Ferrua
- Capri program, Research Division, Gustave Roussy, Villejuif, France.
| | - Etienne Minvielle
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- I3, CRG, Ecole Polytechnique, CNRS, Palaiseau, France
| | - Aude Fourcade
- Capri program, Research Division, Gustave Roussy, Villejuif, France
| | | | - Claude Sicotte
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- EHESP, Department of Health Care Management, Rennes, France
| | - Mario Di Palma
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- American Hospital, Neuilly-sur-Seine, France
| | - Olivier Mir
- Capri program, Research Division, Gustave Roussy, Villejuif, France
- Outpatient Department, Gustave Roussy, Villejuif, France
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20
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Scalvini S, Comini L, Bernocchi P. How can multidisciplinary management with remote monitoring improve the outcome of patients with chronic cardiac diseases? Expert Rev Med Devices 2020; 17:153-157. [DOI: 10.1080/17434440.2020.1720510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Simonetta Scalvini
- Istituti Clinici Scientifici Maugeri IRCCS, Care Continuity Unit and Telemedicine Service, Lumezzane, Italy
| | - Laura Comini
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Direction of the Institute of Lumezzane, Lumezzane, Italy
| | - Palmira Bernocchi
- Istituti Clinici Scientifici Maugeri IRCCS, Care Continuity Unit and Telemedicine Service, Lumezzane, Italy
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21
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Macis S, Loi D, Ulgheri A, Pani D, Solinas G, Manna SL, Cestone V, Guerri D, Raffo L. Design and Usability Assessment of a Multi-Device SOA-Based Telecare Framework for the Elderly. IEEE J Biomed Health Inform 2020; 24:268-279. [DOI: 10.1109/jbhi.2019.2894552] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Vitacca M, Comini L, Tabaglio E, Platto B, Gazzi L. Tele-Assisted Palliative Homecare for Advanced Chronic Obstructive Pulmonary Disease: A Feasibility Study. J Palliat Med 2018; 22:173-178. [PMID: 30256709 DOI: 10.1089/jpm.2018.0321] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Despite real needs, very few chronic obstructive pulmonary disease (COPD) patients with life-limiting disease receive a well-organized support for palliative care (PC). OBJECTIVE To test the feasibility of, and patient satisfaction with, an advanced care plan for severe COPD patients followed by tele-assistance at home for six months that focused on monitoring patient's palliative topics through a dedicated checklist. METHODS Ten hospitalized patients with severe COPD (<1-year life expectancy) received a 60 minutes PC talk by a specialist to define an advanced care plan in the case of very severe respiratory insufficiency, based on three options: (1) endotracheal intubation (EI); (2) noninvasive ventilation; or (3) no mechanical aid; O2 and drugs, for example, opiates. After the talk, patients expressed their personal choice. Following discharge home, patients received structured monthly telephone monitoring from specialized tutor nurses for six months on palliative topics. Patient's anxiety before and after talk, depression, quality of life, specialist's quality of communication, and customer satisfaction were evaluated. RESULTS The palliative talk was feasible and anxiety low during the talk. Nine out 10 patients were followed up by nurse till the end of the program. Overall bad days of life, negative emotions, and perception of disease deterioration were the palliative topics more frequently declared by patient during the phone calls. Two patients changed their preference from EI to O2 therapy/sedation as a consequence of the intervention. Five out of 10 patients died. All patients expressed a high level of satisfaction of the service. DISCUSSION Tele-assisted PC is feasible and well accepted. According to these observations, a suitable supportive program can be the goal of a future study.
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Affiliation(s)
- Michele Vitacca
- 1 Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
| | - Laura Comini
- 1 Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
| | | | - Bruno Platto
- 2 ATS (Agenzia di tutela della salute) Brescia, Italy
| | - Lidia Gazzi
- 1 Istituti Clinici Scientifici Maugeri, IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane (BS), Italy
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23
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Yan Y, Liu L, Zeng J, Zhang L. Evaluation and Exploration on the Effect of the Management of Chronic Obstructive Pulmonary Disease in Rural Areas through an Internet-Based Network Consulting Room. Med Princ Pract 2018; 27:222-226. [PMID: 29558756 PMCID: PMC6062731 DOI: 10.1159/000488591] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/20/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aims to improve the management quality of chronic obstructive pulmonary disease (COPD) in rural areas. METHODS Two hundred forty discharged COPD patients were divided into an intervention group and a control group. In the intervention group, 120 patients established contact with doctors through the network consulting room, i.e., the doctor's mobile platform, and were managed through video, voice, and text by the doctors, kept close contact with the doctors after discharge (education, consultation), and received electronic prescriptions, and drugs were sent to the patients' door by online retailers. The patients in the control group were managed in the traditional manner. One year later, the predicted forced expiratory volume in 1 s (FEV1)%, FEV1/forced vital capacity (FVC), and CAT scores and the number of rehospitalized patients were compared between these 2 groups. RESULTS After 1 year of follow-up, the predicted FEV1% and the FEV1/FVC ratio were significantly higher in the intervention group than in the control group (p < 0.05). CAT scores were lower for patients in the intervention group than for those in the control group after 1 year of follow-up (p < 0.05). After 1 year of follow-up, 22 (18.33%) patients were rehospitalized in the intervention group and 58 (48.33%) patients were rehospitalized in the control group (p < 0.05). CONCLUSION Doctors can improve the quality of life of patients with COPD and reduce the number of rehospitalizations through use of the network consulting room.
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Affiliation(s)
- Yan Yan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Liu
- Tian You Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Jing Zeng
- School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ambrosino N, Fracchia C. The role of tele-medicine in patients with respiratory diseases. Expert Rev Respir Med 2017; 11:893-900. [PMID: 28942692 DOI: 10.1080/17476348.2017.1383898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Tele-medicine is a clinical application connecting a patient with specialized care consultants by means of electronic platforms, potentially able to improve patients' self-management and allow for the care of patients with limited access to health services. This article summarizes the use of tele-medicine as a tool in managing patients suffering from some pathological respiratory conditions. Areas covered: We searched papers published between 1990 and 2017 dealing with tele-medicine and respiratory diseases, chronic obstructive pulmonary disease, asthma, interstitial lung disease, chronic respiratory failure, neuromuscular diseases, critical illness, home mechanical ventilation, and also legal and economic issues. Controlled trials report different results on feasibility, cost-effectiveness, and safety of tele-medicine. Expert commentary: Progress in tele-medicine widens the horizons in respiratory medicine: this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, also allowing for the delivery of care in countries with limited access to it. Legal, safety, and privacy problems, as well as reimbursement issues, must still be defined and solved. At present time, we still need much more evidence to consider this modality as a real option in the management of these patients.
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Affiliation(s)
- Nicolino Ambrosino
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
| | - Claudio Fracchia
- a Istituti Clinici Scientifici Maugeri, Istituto di Montescano IRCCS , Pneumologia Riabilitativa , Montescano (PV) , Italy
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