Telemedical Disease Management in Europe

1
Telemedical Disease Management in Europe What
are the Chances and Risks Dr. med. Andy Fischer
, Swiss Center for Telemedicine MEDGATE Med
_e_Tel, Luxembourg, 18.04.2008
2
Disease Management Definition(Disease Management
Association of America, DMAA)

• Disease management is a system of coordinated
  health care interventions and communications for
  populations with conditions in which patient
  self-care efforts are significant

3
Telemedical Disease ManagementToday up to 10
described Intervention Models
4
Telemedical Management Concepts
5
Fast and effective blood pressure adjustment
6
Chances
7
Today Medical Care for each patient by a Health
Care Provider in a 11-setting
8
Number of patients per practicing Medical Doctor
(Decline of 2.4 p.a. from 1970-2005)
In 200 years 1 MD per family!
Quelle Das Gesundheitswesen der Schweiz, Pharma
Information
9
In the Future Medical Care for each patient in a
1n-setting Equal Medical Requirements
10
The Big Five are the same in EuropeMedically
there are no differences

• Heart failure
• COPD
• Asthma bronchiale
• Diabetes mellitus
• Hypertension

Diabetes kit
11
We have promising results but no evidence yet (I)

• Heart failure
• Remote monitoring programmes reduced the rates of
  admission for chronic heart failure and all cause
  mortality Clarc RA et al. Telemonitoring or
  structured telephone support programmes for
  patients with chronic heart failure systematic
  review and meta-analysis. BMJ 2007 May 5
  334(7600)942
• 1-year home-based telemanagement (HBT) reduced
  hospital readmission and costs in chronic heart
  failure patients Giordano A. et al. Multicenter
  randomised trial on home-based telemanagement to
  prevent hospital readmission of patients with
  chronic heart failure. Int. J. Cardiol. 2008 Jan
  25 Epub ahead of print
• Hypertension
• Telecommunication service with home service of
  automatic transmission of blood pressure data
  showed efficacy in reducing the mean arterial
  pressure of patients with established
  hypertension Rogers MA et al. Home monitoring
  service improves mean arterial pressure in
  patients with essential hypertension. A
  randomized controlled trial. Ann. Intern Med.
  2001 Jun 5134(11)1024-32
• Telemonitoring of BP over a 12-month period
  resulted in clinically and statistically
  significant reductions in systolic BP Artinian NT
  et al. Effects of nurse-managed telemonitoring on
  blood pressure at 12-month follow-up among urban
  African Americans. Nurse Res. 2007
  Sept.-Oct56(5)312-22

12
We have promising results but no evidence yet (I)

• Diabetes mellitus
• Telemedicine Diabetes Disease Management Program
  Reduction of over all charges, decrease in
  hospital admissions and emergency room encounters
  as well as improvements in quality of life Cherry
  JC et al. Diabetes Disease management program for
  an indigent population empowered by telemedicine
  technology. Diabetes Technol Ther 2002 4 (6)
  783-91
• Diabetes education via telemedicine and in person
  was equally effective in improving glycemic
  control and both methods are well accepted by
  patients Izquierdo RE et al. A comparison of
  diabetes education administered through
  telemdicine versus in person. Diabtes Care. 2003
  Apr 26(4)1002-7
• COPD / Asthma bronchiale
• Effects of telemonitoring Decrease in hospital
  admission rates and in total number of
  exacerbations. Trappenburg JC et al. Effects of
  telemonitoring in patients with chronic
  obstructive pulmonary disease.Telemed J E Health.
  2008 Mar 14 (2) 138-46
• Spirometry self-testing by asthma patients during
  telemonitoring is comparable to those under
  supervision of medical professionals.
  Internet-based home asthma telemonitoring can be
  successfully implemented in a group of patients
  with no computer background Finkelstein J. et al.
  Internet-based home asthma telemonitoring can
  patients handle the technology? Chest. 2000
  Jan117(1)148-55

13
Challenges and open questions
14
The balance of risk determines the insurers
incentive to provide DMP
Costs per insured and month (CHF)
Redistribution
700
600
500
400
300
Mean
200
100
0















19-
26-
31-
36-
41-
46-
51-
56-
61-
66-
71-
76-
81-
86-
91
25
30
35
40
45
50
55
60
65
70
75
80
85
90
risk groups age and sex
15
Risk adjustment formula

• The risk adjustment formula computes risk-related
  compensations. The variables included in the
  formula differ by country.
• For example
• Belgium socio-economic, disability, diagnosis of
  invalidity, eligibility of social exemption,
  chronic illness
• Germany age, gender, disability, registration in
  a certified DMP, and high-costs pooling
• Netherlands age, gender, urbanization,
  disability, pharmacy-based cost groups, and
  diagnostic cost groups
• Switzerland age, gender, and region
• The more powerful this formula is, the more
  incentive insurers have to offer disease
  management programs

16
Do TDMP really save costs?
17
Which intervention models have which advantages?
18
How shall we recruit patients?
Method of recruiting Success of recruiting
Data mining by the insurer and selective addressing of the target customer 2.9
Information letter from the insurer 3.0
Information letter to the general practitioner 4.0
19
Challenges in the following years

• Guidelines, Best Practice and Quality Assurance
  for TDMP
• Evidence for the use of the individual
  intervention models (multicentre studies)
• Medical outcome
• Cost effects
• Strategy for solving the problem of recruitment
• The single national players are too small to
  answer these questions on their own

20
European and International Collaboration
21
Even Europe has remote valleys...
22