Diapositiva 1

1
Problematiche gestionali della Telemedicina
Literature Review rapporto costo/beneficio
Alfredo Potena
U.O. di Fisiopatologia Respiratoria
Azienda Ospedaliera Universitaria Arcispedale
S.Anna Ferrara

2
Telemedicina

• Limpiego di telemedicina al fine di migliorare
  le prestazioni sanitarie potrebbe rivelarsi
  particolarmente utile in zone ove sia carente la
  disponibilità di personale medico
• Nella sanità pubblica cè una forte richiesta di
  servizi di telemedicina anche se, in molte
  specialità, i costi ed i benefici rappresentano
  ancora oggi unarea grigia
• Tra i principali difetti della medicina occorre
  annoverare la tendenza ad impiegare metodiche
  prima che ne sia stata stabilita con certezza non
  soltanto la sua utilità, ma anche il rapporto
  costo/beneficio

3
Perceptions of the most important benefit of
Telemedicine
S. Martin CMAJ 2001
Representative Sample of 2592 Canadians
The greatest concern was about responsibility and
liability for malpractice and errors with 87.7
indicating that they were very or somewhat
concerned
4
Quali risorse sono necessarie?
Quanto Costa?
Qual è il rapporto costo/efficacia?
5
Measure of Effectiveness

• LEffectiveness si misura in termini di
  successo della visita o della prestazione e l
  utilità di queste per il paziente
• Una visita o una prestazione hanno successo
  quando permettono di conseguire una diagnosi
  senza bisogno di una seconda opinione

Costi annuali (diretti indiretti)
Effectiveness successo
della visita o della prestazione x
utilità di queste per il paziente
La telemedicina ha una sua effectiveness basata
su evidenze scientifiche?
6
(No Transcript)
7
Assessing telemedicine a systematicreview of
the literature
Risto Roine CMAJ 2001

• 1124 studies were identified, 133 full-text
  articles were obtained for closer inspection, 50
  were deemed to represent assessment studies
  fulfilling the inclusion criteria of the review
• Thirty-four of the articles assessed at least
  some clinical outcomes the remaining 16 were
  mainly economic analyses
• Relatively convincing evidence of effectiveness
  was found only for teleradiology,
  teleneurosurgery, telepsychiatry, transmission of
  echocardiographic images, and the use of
  electronic referrals enabling email consultations
  and video conferencing between primary and
  secondary health care providers
• Evidence regarding the effectiveness or
  cost-effectiveness of telemedicine is still
  limited

8
Systematic review of cost effectiveness studies
of telemedicine interventions
PS Whitten BMJ 2002

• A comprehensive literature search of cost related
  articles on telemedicine identified more than 600
  articles, but only 9 contained any cost benefit
  data
• Only 4 of these articles met quality criteria
  justifying inclusion in a formalised quality
  review, and most of these were small scale, short
  term, pragmatic evaluations with few
  generalisable conclusions
• There is little published evidence to confirm
  whether or not telemedicine is a cost effective
  alternative to standard healthcare delivery

9
Ricerca effettuata il 27.10.2004
10
Hospital at home for AECOPD
Ram The Cochrane Database of Systematic
Reviews 2003

• Objectives To evaluate the efficacy of "hospital
  at home" compared to hospital inpatient care in
  AECOPD
• Seven studies with 754 patients were included in
  the review
• Studies provided data on hospital readmission
  and mortality both of which were not
  significantly different when the two study groups
  were compared

11
Hospital at home for AECOPD
Ram The Cochrane Database of Systematic
Reviews 2003

• one in four carefully selected patients
  presenting to hospital emergency departments with
  AECOPD can be safely and successfully treated at
  home with support from respiratory nurses
• This review found no evidence of significant
  differences between "hospital at home" patients
  and hospital inpatients for readmission rates and
  mortality at two to three months after the
  initial exacerbation
• Both the patients and carers preferred "hospital
  at home" schemes to inpatient care.

12
Telemedicine versus face to face patient care
effects on professional practice and health care
outcomes
R Currell The Cochrane Database of Systematic
Reviews 2000

• Establishing systems for patient care using
  telecommuni-cations technologies is feasible, but
  there is little evidence of clinical benefits
• The studies provided variable and inconclusive
  results for other outcomes such as psychological
  measures, and no analysable data about the cost
  effectiveness of telemedicine systems
• The review demonstrates the need for further
  research and the fact that it is feasible to
  carry out randomised trials of telemedicine
  applications
• Policy makers should be cautious about
  recommending increased use and investment in
  unevaluated technologies

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(No Transcript)
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Cost Effectiveness of Telemedicine for the
Delivery of Outpatient Pulmonary Care to a Rural
Population
Z. Agha Telemedicine J and E-Health 2002
Case series 65 patients (99 visits)

• AIM to compare the cost/effectiveness of
  providing outpatient telemedicine pulmonary
  consultations with alternative treatment methods

Cost effectiveness of telemedicine is related to
three major factors 1) cost sharing, i.e.,
adequate patient volume and sharing of
telemedicine infrastructure amongst various
clinical users 2) effectiveness of telemedicine
in terms of patient utility and successful
clinical consultations 3) indirect cost savings
accrued by decreasing cost of patients' lost
productivity
15
Telecare of patients with COPD
M.
Pfeifer Med Klin 2004

• Regular transmissions of lung function values
  insure a close contact of COPD or asthma patients
  to specialized institutions without impairing or
  ignoring medical home care
• 
  
• Whether it will be possible to react more quickly
  to disease changes by telemetric means or whether
  other treatment advantages will result remains
  yet to be seen
• Results, so far, are encouraging in such a way
  that the use of telemedical means in chronically
  ill patients will be further evaluated

16
A feasibility study of remote monitoring of
asthmatic patients
Steel J. Telemed Telecare2002

• Multi Center Study Aim to assess a remote
  monitoring system for asthmatics to use in their
  own homes following discharges after acute
  exacerbation
• Patients 84 invited to participate
• 33 monitored for two weeks
• Patient compliance with monitoring was 80
• compliance with transmitting the
  results using a
• modem was 52

17
A feasibility study of remote monitoring of
asthmatic patients
Steel J. Telemed Telecare2002

• time spent teaching patients for measurements was
  16 min
• time spent providing asthma education was
  39 min
• 96 of pts found the equipment easy or very easy
  to use
• 92 of pts said they would use the equipment
  again
• medical intervention occurred in 48 of patients
• THE USE OF REMOTE MONITORING COULD BE IMPORTANT
  IN REDUCING ASTHMA MORBIDITY AND IMPROVING
• TREATMENT OUTCOMES

18
Telemedicine for multidisciplinary lung cancer
meetings A.G. Davison
J Telemed Telecare 2004

• Lung cancer cases should be reviewed
  prospectively by a lung cancer multidisciplinary
  team (MDT) and a thoracic surgeon should be
  readily available to liaise with the MDT
• Over a one-year period, 28 MDT meetings were held
  at a district general hospital in Southend, at
  which 62 patients were presented to a tertiary
  cardiothoracic centre in London, 80 km away, via
  ISDN videoconferencing at 384 kbit/s
• The annual resection rate increased by 30
  following the introduction of the telemedicine
  MDTmeetings, and the mean time from first being
  seen in the clinic to surgery was reduced from 69
  to 54 days
• We estimate that the telemedicine meetings saved
  over three working weeks of thoracic surgical
  time during the year.

19
R Roine CMAJ 2001
PS Whitten BMJ 2002
Currell Cochrane Rev 2000
Z. Agha Pulmonary Dis 2002
Pfeifer 2004 (COPD)
Davison 2004 (Cancer)
Steel 2002 (Asthma)
20
BPCO
I.R.
Asma
Neoplasie
21
Conclusioni
La telemedicina applicata alla Pneumologia può
essere C/E
E necessario programmare studi clinici (RCT)
che lo dimostrino
BPCO con IRC, Asma Bronchiale, Neoplasie
polmonari sono le patologie su cui concentrare
gli studi
E auspicabile lo sviluppo di joint venture tra
AIPO Industria della Telemedicina ed
associazioni dei pazienti per realizzare i
progetti di studio