Alfredo Potena

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. L’impiego 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 c’è una forte richiesta di servizi di telemedicina anche se, in molte specialità, i costi ed i benefici rappresentano ancora oggi un’area 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 Telemedicina

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 • L’Effectiveness 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?

7. Assessing telemedicine: a systematicreview of the literatureRisto 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

14. Cost Effectiveness of Telemedicine for the Delivery of Outpatient Pulmonary Care to a Rural Population Z. Agha Telemedicine J and E-Health 2002 AIM: to compare the cost/effectiveness of providing outpatient telemedicine pulmonary consultations with alternative treatment methods Case series: 65 patients (99 visits) 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 COPDM. 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 meetingsA.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