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James P. Marcin1 , Ulfat Shaikh1 and Robin H. Steinhorn1
The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists’ geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.
Agathe Leo´ n1*, Ce´ sar Ca´ ceres2 , Emma Ferna ´ndez1 , Paloma Chausa2 , Maite Martin3 , Carles Codina3, Araceli Rousaud4 , Jordi Blanch4 , Josep Mallolas1 , Esteban Martinez1 , Jose L. Blanco1 , Montserrat Laguno1 , Maria Larrousse1 , Ana Milinkovic1 , Laura Zamora1 , Neus Canal5 , Josep M. Miro´ 1 , Josep M. Gatell1 , Enrique J. Go ´ mez2 , Felipe Garcı´a1
1 Infectious Diseases Unit, Hospital Clinic, Institut d’Investigacions Biome`diques August Pi I Sunyer, University of Barcelona, Barcelona, Spain,
2 Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain,
3 Pharmacy Service, Hospital Clinic, Institut d’Investigacions Biome `diques August Pi I Sunyer, University of Barcelona, Barcelona, Spain,
4 Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d’Investigacions Biome `diques August Pi i Sunyer, University of Barcelona, Barcelona, Spain, 5Health Economics and Outcomes Research, IMS Health, Inc., Barcelona, Spain
Abstract
Background: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.
Methodology: We developed a new internet-based home care model covering the entire management of chronic HIVinfected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.
Findings: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels .90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.
Conclusions: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. Trial Registration: Clinical-Trials.gov: NCT01117675.
Citation: Leo´n A, Ca´ceres C, Ferna´ndez E, Chausa P, Martin M, et al. (2011) A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study. PLoS ONE 6(1): e14515. doi:10.1371/journal.pone.0014515
Editor: Rupert Kaul, University of Toronto, Canada Received May 7, 2010; Accepted December 1, 2010; Published January 21, 2011
Copyright: © 2011 Leo ´n et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Dr. Leo ´n is supported by Contract CM06/00170 from the Institut de Investigacions Biome `diques August Pi I Sunyer and Fundacio ´ Clı´nic in collaboration with the Spanish Health Department. The role of Health Economics and Outcomes Research IMS Health in the study had been only to analyze the patients’ quality of life data. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: A Leo ´n, C Ca ´ceres, E Ferna ´ndez, P Chausa, M Martin, C Codina, A Rousaud, A Milinkovic, M Laguno, M Larrousse, L Zamora, and EJ Go ´mez have no potential conflicts of interests. Neus Canal is employed by a commercial company, Health Economics and Outcomes Research IMS Health. E Martinez, F Garcı´a, J Blanch and JL Blanco have received research grants from Abbott, Bristol-Myers Squibb, and Gilead Sciences. J Mallolas and JM Miro have received research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences and Roche. JM Gatell has received honoraria or research grants from Bristol-Myers Squibb, MSD, GlaxoSmithKline, Gilead Sciences, Tibotec, Roche, Boehringerngelheim, Abbott and Pfizer. This does not alter our adherence to all the PLoS ONE policies on sharing data and materials."
B. Atiyeh, S.A. Dibo, and H.H.. Janom
Summary
Access to specialized burn care is becoming more difficult and is being restricted by the decreasing number of specialized burn centers. It is also limited by distance and resources for many patients, particularly those living in poverty or in rural medically underserved communities. Telemedicine is a rapidly evolving technology related to the practice of medicine at a distance through rapid access to remote medical expertise by telecommunication and information technologies. Feasibility of telemedicine in burn care has been demonstrated by various centers. Its use facilitates the delivery of care to patients with burn injuries of all sizes. It allows delivery of acute care and can be appropriately used for a substantial portion of the long-term management of patients after a burn by guiding less-experienced surgeons to treat and follow-up patients more appropriately. Most importantly, it allows better effective triage which reduces unnecessary time and resource demanding referrals that might overwhelm system capacities. However, there are still numerous barriers to the implementation of telemedicine, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and an inadequate evidence base of its value and efficiency.
Sima Ajami and Arezo Arzani-Birgani Additional article information
Abstract
Background:
In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients.
Materials and Methods:
This study was a narrative review. The literature was searched on fast resuscitation and care of the patients’ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts.
Results:
In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy.
Conclusion:
Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.
