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Patient noncompliance with paper diariesArthur
A Stone, et al.

• This study shows that concerns about compliance
  with paper diaries are justified. Although
  patients reported high compliance, actual
  compliance was low and hoarding was common. The
  excellent compliance achieved with the electronic
  diary indicates that low compliance was not due
  to this particular sample or to an overly
  burdensome protocol. Overall, these results call
  into question the validity of paper diary
  records.
• BMJ VOLUME 324 18 MAY 2002 1193-1194

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• COPD

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An evaluation of the west Surrey telemedicine
monitoring projectJeremy Dale Sarah Connor
Kim Tolley

• ...there was evidence of a substantial
  (approximately 50) decrease in rates of hospital
  admission. The service was highly acceptable to
  the patients.
• Journal of Telemedicine and Telecare Volume 9
  Number 3 Supplement 1 Page 39 41

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Home telemonitoring for patients with severe
respiratory illness the Italian
experience.Maiolo C Mohamed EI Fiorani CM De
Lorenzo A

• The numbers of hospital admissions and of
• acute home exacerbations during the
• telemonitoring phase of the study
• decreased by 50 and 55, respectively,
• in comparison with the first phase .
• J Telemed Telecare 20039(2)67-71

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E-Health services for home monitoring and
rehabilitation in COPD patients Theodore A.
Vontetsianos, Periklis G. Giovas, Anna N.
Rigopoulou, Georgia M. Mpirmpa,Pantelis A.
Giaboudakis, Theodore M. Katsaras, Spiros K.
Contos

• the number of hospital days fell to 6 per
  patient from 14 in the correspondent time of the
  previous year.
• J Telemed Telecare 20039(2)67-71

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CHRONIC

• Department Pulmonology Catholic University of
  Louvain
• Target group patients with severe COPD (325
  patients)
• Hospitalisations/year 500 (325 patients)
• Mean hospitalisation 10,4 days
• Mean costs 5.386, - Euro
• Method telecall 50 target group
• nurse calls patients at home and performs
  questionnaire
• Duration 1 year
• Results telecall group 52 re-hospitalisation
• control group 90 re-hospitalisation

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CHRONIC

• 104.051 patients with severe COPD in Belgium
• 1,5 exacerbations/year/patient
• 10,4 days hospitalisation
• Cost 5.386/hospitalisation
• TOTAL COSTS
• 104.051 x 1,5 x 5.386 840.628.029/year
• 38 reduction of hospitalisation days possible
  benefit of
• 319.438.651/year

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CHRONIC

• COSTS
• 44.065.598,50 (104.051 Spirotel x 1.270,50/3)
  
• 16.648.160,- (104.051 x 160/year data
  transmission)
• 26.012.750,- (104.051 x
  250/year/pulmonologyst)
• 26.012.750,- (104.051 x 250/year/GP)
• 7.000.000,- (Salary  Data manager  (
  70000) x 100)
• Total cost 119.739.258,50/year

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CHRONIC

• POSSIBLE BENEFIT COSTS REAL BENEFIT
• 319.438.651/year - 119.739.258.50/year
• 199.699.392,50/year

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• ASTHMA

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Hospitalization reduction by an asthma
tele-medicine systemKokubu F, et al.

After a six-month study period, an 83
reduction in hospitalization was demonstrated in
the telemedicine group versus the control
group First Department of Internal Medicine,
School of Medicine, Showa University.
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• SENIORS

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Telehealth for older patients the Hong Kong
experienceElsie Hui Jean Woo

Substantial savings were achieved in the study
period through a 9 reduction in visits to the
hospital emergency department and 11 fewer
hospital bed-days. Telemedicine was a feasible
means of care delivery to a nursing home and
resulted in enhanced productivity and
cost-savings. Linking more such institutions to
care providers would further increase
cost-effectiveness. Journal of Telemedicine and
Telecare   Volume 8 Number 6 Supplement 3
Page 39 41
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An estimation of economic effects of
tele-home-care hospital cost-savings of the
elderly.Tsuji M Miyahara S Taoka F Teshima M

Our results indicated that in the year 2050,
US257.3 billion, or nearly 7.4 of total
hospitalization costs of the aged could be saved
by tele-home-care Medinfo 200110(Pt 1)858-62
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• DIABETES

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Children's medical services pediatric diabetes
telehealth project Cost avoidance dataDubault
et al.

• ... Thus, across the three years, the state of
  Florida could have realized a net potential
  savings of 89,590.22. Conclusion Telehealth is
  an efficient and cost effective way of providing
  clinical services to children with diabetes.
• Telemedicine Journal and e-Health 9 (Suppl 1)
  S135-6.

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Are there time and cost savings by using
telemanagement for patients on intensified
insulin therapy? A randomised, controlled
trial.Biermann E, Dietrich W, Rihl J, Standl E

• Setting up an optimal telemanagement scenario, a
  cost analysis was carried out yielding savings of
  approximately 650 euro per year per patient.
• Comput Methods Programs Biomed. 2002
  Aug69(2)137-46

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Telecare in a structured therapeutic education
programme addressed to patients with type 1
diabetes and poor metabolic control.Jansa M et
all,

• Intensive telematic follow-up achieves similar
  results to those of intensive face-to-face
  follow-up with lower patient costs. However,
  communication technology must be improved.
• Diabates Res Clin Pract 2006 Apr 16

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Establishment of blood glucose monitoring
system using the internet.Kwon HS et all,

• This new IBGMS resulted in a significant
  reduction of HbA(1c) during the study period. We
  propose that this IBGMS be used as a method for
  improving diabetes control.
• Diabetes Care 2004 Feb27(2)478-83.

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• HEART DISEASE

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Can a disease self-management program reduce
health care costs? The case of older women with
heart diseaseWheeler JR

Program participants experienced 46 fewer
in-patient days (P lt0.05) and 49 lower
in-patient costs (P lt0.10) Hospital cost savings
exceeded program costs by a ratio of nearly
5-to-1. Med Care 2003 Jun41(6)706-15
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Monitoring multiple cardiovascular paramaters
using telemedicine in patients with chronic heart
failureOeff M, Kotsch P, Gosswald A, Wolf U.

, the number of admission to the hospital could
be reduced by 62, those of days spent in
hospital by 69. Herzschrittmacherther
Elektrophysiol. 2005 Sep16(3)150-8.
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PATIENT AT GP

• Key Indicators for Considering a COPD Diagnosis
• Chronic cough
• Present intermittently or every day.
• Often present throughout the day seldom only
  nocturnal.
• Chronic sputum production
• Any pattern of chronic sputum production may
  indicate COPD.
• Acute bronchitis
• Repeated episodes.
• Dyspnea that is
• Progressive (worsens over time).
• Persistent (present every day).
• Worse on exercise.
• Worse during respiratory infections.
• History of exposure to risk factors
• Tobacco smoke (including popular local
  preparations).
• Occupational dusts and chemicals.
• Smoke from home cooking and heating fuel.

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PATIENT AT GP
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PATIENT AT GP
Source GOLD Pocket Guide (updated 2003)
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PATIENT AT GP
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REFERRAL
In addition to spirometry, the following other
tests should be undertaken for the assessment of
a patient with Moderate (Stage II), Severe (Stage
III), and Very Severe (Stage IV) COPD.
Bronchodilator reversibility testing Chest
X-ray Arterial blood gas measurement.
Alpha-1 antitrypsin deficiency
screening Source GOLD Pocket Guide (updated 2003)
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REFERRAL
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REFERRAL BACK
COPD is usually a progressive disease. Lung
function can be expected to worsen over time,
even with the best available care. Symptoms and
lung function should be monitored to follow the
development of complications, to guide treatment,
and to facilitate discussion of management
options with patients. Source GOLD Pocket Guide
(updated 2003)
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PATIENT THUIS
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Dear Doctor,Alert 150 linked to patient 10,
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WIPAM
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SPIROLOGISTICS