Telemedicine

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Telemedicine, also known as telehealth, telecare or e-health, is a new approach to healthcare, which uses technology to help you, as a patient, to manage your own condition from home.

  • What is telemedicine?
  • Telemedicine and lung diseases
  • What are the potential benefits of telemedicine?
  • Risks of telemedicine
  • Case study: Telescot trial
  • Case study: NEXES: Supporting Healthier and Independent Living for Chronic Patients and Elderly
  • Case study: Renewing Health

What is telemedicine?

Telemedicine is an innovative approach that combines medical expertise and equipment with information and communications technology to allow examinations, monitoring and treatment to be carried out in your home.

Across Europe, people are living longer, so that more people suffer from one or more chronic (long-term) conditions. The need for long-term treatment has led to the development of new models of care that enable people to be treated and also monitored at home.Using electronic forms of communication, telemedicine is revolutionising the way healthcare is provided.

Below are some examples of telemedicine services:

  • Video conference with your healthcare professional. This enables you to speak with your doctor online via a video link, reducing the need for you to visit the doctor’s surgery or hospital.
  • Recording your symptoms on an electronic device at home. Symptoms and measurements (such as peak flows and spirometry readings which test your lung function) can be recorded electronically using a touchscreen computer or a device similar to a mobile phone. This will enable you to collect important information on how your condition affects you whilst you are carrying out day-to-day activities either at home or when you are out of the house.   Measurements can then be sent to your healthcare provider who can monitor whether you need further treatment. This also enables you to ask your doctor questions about the measurements you have recorded.
  • Education and self-management support. Technology can be used to help you learn more about your condition, so that you are able to share your knowledge and experience with other people in similar situations. This concept is known as peer-to-peer education. It recognises the value of the lived experience of a condition and provides the opportunity to learn about a condition from first-hand accounts. Technology can also help to support successful self-management by using systems which can interpret your recordings and help with early recognition and management of any problems which may occur.
  • Online health information. Increasingly, many people are using the internet to obtain health information. This can be a valuable resource but it is important to check whether the health website you are using is providing you with accurate information. (Read the ELF’s Guide to Finding the Right Health Website). You can also join social networking sites which often have specific groups for people with similar conditions.
  • Call centres. There has been a growth in call centres providing health information over the telephone. These services enable healthcare professionals to decide who needs urgent medical attention and who can benefit from appropriate over-the-phone advice.

These examples are just some of the ways that telemedicine can help you become more independent by enabling you to have more control and manage your condition.

Telemedicine and lung diseases

Various telemedicine devices and services can enable individuals to monitor lung function and manage lung conditions at home.

Asthma
In recent years, a number of studies have highlighted the potential benefits of telemonitoring for asthma patients. Findings have demonstrated that people conducting their own lung function test, known as spirometry, at home, were able to record accurate results comparable to those collected by a healthcare professional.(1) Another study demonstrated that video monitoring enabled a doctor to assess and treat children with asthma, and the lack of face-to-face contact did not affect the quality of care and experience of the children.(2)

 

Chronic obstructive pulmonary disease (COPD)
It is well recognised that improving a person’s self-monitoring of their COPD symptoms can reduce the frequency of hospitalisations caused by a flare-up (exacerbation) of their symptoms. Using self-monitoring techniques can also reduce the time and cost implications of attending a hospital for treatment or monitoring. In a study which aimed to assess the impact of these services, people with COPD were provided with a videophone, an electronic stethoscope and a digital blood pressure monitor, allowing them to access specialist nursing support quickly. The results showed that remote video technology was effective and well-received by the study participants.(3) A further study showed that accessing web-based call centres after being discharged from hospital reduced the number of repeat hospitalisations.(4)

What are the potential benefits of telemedicine?

  • Enables individuals to have greater control over their condition and their lives by maintaining independence at home
  • Enables services that were previously only available at hospitals to be available at home
  • Reduces the need for hospital and doctor visits, saving time and travel costsSupports the longer-term management of a condition at home
  • The technologies can be tailored to each individual
  • Improving access to services in remote areas
  • Reduces costs of healthcare
  • Some forms of telemedicine provide direct access to a healthcare professional, removing appointment waiting times
  • Some forms of telemedicine provide continuous monitoring, 24 hours a day, 7 days a week
  • Solves the problem of shortages of healthcare providers
Thierry Troosters, an ERS expert in rehabilitation, said “Although telemedicine has not yet obtained the status of ‘usual care’ in most European countries, results of clinical trials are convincingly showing that this technology has a future for respiratory patients”

Risks of telemedicine

There are some concerns over the ethical issues of security, privacy and confidentiality of patients using telemedicine services. To reduce these risks, healthcare providers should follow the same ethical standards and duty of care as in a face to face meeting. As with all new interventions, telemedicine services should be subject to rigorous on-going assessment.

Case study: Telescot trial

The Telescot trial is currently investigating how telemedicine can support people with long-term conditions such as COPD in Scotland. One trial includes over 250 people with severe COPD, half of whom have been given touch-screen technology to record their symptoms every morning.

Patients also use a pulse oximeter to measure blood oxygen and heart rate, a peak flow meter to measure breathing and scales to check weight. These measurements are automatically transferred to a team of healthcare providers via a secure internet connection on a specifically-designed computer programme. This program is able to colour-code each person into a red, yellow or green category, so that the healthcare providers can instantly see who is in need of a visit or telephone call, and whose symptoms are currently stable.

Clair Sparrius, a respiratory physiotherapist who is working on the trial, said: “We’ve had a very positive response from the people involved in the trial and most individuals have enjoyed feeling in control of their own condition. The system enables people to have more say in the management of their condition and they are reassured by the knowledge that a healthcare provider is checking their readings every day. It was a bit of a culture change to get used to operating in a different way for both healthcare providers and individuals with COPD, but we have certainly seen the benefits of being able to monitor individuals in this way.”

Read more about the telescot trial

Case study: NEXES: Supporting Healthier and Independent Living for Chronic Patients and Elderly

NEXES is a European Union project focusing on people with chronic illnesses (chronic obstructive pulmonary disease (COPD); congestive heart failure (CHF); and Diabetes Type II). The aim of this project is to develop four types of care programs (a) Wellness and training; b) Enhanced care for frail patients/ Home hospitalization and early discharge; and, c) support to diagnostic procedures carried out in Primary Care), using information and communication technologies that support healthy and independent living.

Read more on the NEXES website

Case study: Renewing Health

RENEWING HEALTH is an European project working to scale-up tele-monitoring services that already exist at a local level.

The project will aim to give chronic patients suffering from diabetes, chronic obstructive pulmonary or cardiovascular diseases, central management of their condition. The care program will use home-based video conferences and remote monitoring with the aim of decreasing the rate of hospitalisations and emergency room consultations.

Visit the Renewing Health website for more information

Carme Hernández, a respiratory nurse, who is working on the NEXES and Renewing Health projects, said: “Our team is very excited and we have had a high level of response by professionals and the level of patients’ satisfaction is very high. The ICT platform enables professionals and patients to work together, improve patient’s self-management and avoid duplicities.”

Read about a COPD patient’s experience of a telemedicine trial:

“I am a 72 years old COPD patient and I also have alpha-1 antitrypsin deficiency. Some years ago, I was asked by my doctor if I wanted to be followed for one year at home with the aid of telemedicine. I decided to join the trial and I received regular calls from my nurse to check I was feeling well. I also sent him records of my symptoms and how they varied day-to-day. On some occasions, the nurse felt I should speak with the doctor and this was then arranged. I felt very secure with this service and with this process of treatment and I hope it will one day be available to all patients as part of our healthcare systems in Europe.”

This material was compiled with the help of Clair Sparrius, Dr Bruno Balbi (Fondazione Salvatore Maugeri and Associazione Nazionale Alfa-1 AT, Italy) and Carme Hernández RN, MSc (Hospital Clinic. Barcelona)

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