wow! trial in uk's largest pharma group boots, page-24

http://www.dhcarenetworks.org.uk/_library/Resources/Telecare/Telecare_advice/Newsletter/Telecare_LIN_eNewsletter_August_2010.pdf

link is worth a look


Cochrane backs remote monitoring
Tags: Ageing population Telehealth
13 Aug 2010

Remote monitoring of patients with heart failure can reduce deaths and hospital admissions, according to a research review.

A Cochrane Database Systematic Review found those patients whose condition was being monitored remotely were 34% less likely to die than those without access to technology.

Among people taking part in a programme to remotely monitor heart failure, there were 102 deaths per 1,000 patients compared with 154 deaths per 1,000 patients who did not receive remote monitoring.

The review, which looked at 245 studies covering 9,500 patients with chronic failure and 2,710 undergoing monitoring, found a difference between remote monitoring involving digital or wireless transmission of data to a clinician and telephone support in which patients reported their own data over the telephone.

The report found that deaths were lower among patients offered telephone support, although the difference was less marked.

A review of trials of telephone support covering more than 5,000 people showed that about 112 in 1,000 people receiving telephone support died compared to 127 in 1,000 people in the standard care group.

The researchers also found that telephone support and telemonitoring reduced the number of hospital admissions due to worsening heart failure

Lead researcher Sally Inglis from the Heart and Diabetes Institute in Melbourne, Australia, said limited health funding, and a rapidly expanding population of older patients, meant it was increasingly difficult for healthcare systems to provide high quality to patients with heart failure.

She added: These technologies can provide specialised care to a large number of patients who otherwise may have limited access to this type of specialised healthcare.

The review found the technology was acceptable to patients, with only between 3% and 4% unable to use the technology, and that some studies also showed improved in quality of life and reduced health care costs.

Inglis added: More work is required on the cost-effectiveness of telemonitoring to establish the best business models. These may vary depending on local organisation of health services. The optimal duration of monitoring has not yet been addressed.

In an accompanying editorial, Dr Juan-Pablo Casas and colleagues from the London School of Hygiene and Tropical Medicine argued that telemonitoring for chronic heart failure should now be the subject of an appraisal by the National Institute for Health and Clinical Excellence.

They added: On the current evidence it is likely that the verdict will be 'more trials needed'."

Fiona Barr


Telemedicine: Its a Boom!
August 13, 2010 Terry McLeod No comments
Telemedicine is being called a boom, and when a nurse shares that she can see 20 patients in a day, as opposed to 6 or 7 patients for the same treatment, the positive business results are obvious. Devices are being used to monitor conditions in the home, electronically reporting the results to the healthcare provider, resulting in longer-term, more accurate information as well as better care. Psychotherapists are providing telephone sessions. Webcams and other devices bring us together with care providers without either party having to go anywhere.

When travel is removed from an equation, the overhead drops and profits increase. Additionally, office space costs money. Companies with troops in the field commonly maintain less office space to account for them. If 10 employees are in the field, they may be able to share 5 desks at headquarters, resulting in less rented space, less heat, less water in the water coolerand more productive time because those troops arent clustered around that water cooler and can focus exclusively on the tasks theyre being paid for.

Meridian Health in New Jersey (http://www.meridianhealth.com/) was featured in a CNN story about telemedicine, and the positive results look to be good for business, good for the healthcare professional, and good for the patient. Now if we can only get somebody to pay for it.

Actually, insurance companies see promise in telemedicine, and the Center for Medicare and Medicaid Service (CMS) sees the value, determining that states can choose to include telemedicine as viable treatment alternatives that can be paid by Medicaid. Whether any states are actually paying for mental health or substance abuse treatment services will have to wait for another entry on this subject. The general outlook I see toward telemedicine is bright and positive, so if its not in your life today you may be on the phone, using devices or communicating via the internet through secure connections soon.

If the Electronic Health Records (EHR) would require modifications to account for telemedicine in mental health and substance abuse treatment, they would be minor, like changing the location code for a service, and perhaps adding a telemedicine provisional statement in documentation of those services. These sorts of things and the training and quality control measures of the EHR shouldnt pose any problems for facilities considering adding telemedicine to their treatment arsenal.

With all the positive information Ive run across, and the apparent willingness to pay for at least some telemedicine procedures, I felt compelled to dig up something negative to balance the scales.

The New York Times covered the negative side of the story. A recent article discusses how the technology might affect the doctor/patient relationship, decreasing the trust factor.

Im a big fan of face-to-face connections. When I was in the sales profession, seeing somebodys eyes was the most effective contact in gaining a person as a customer, so I tend to agree with Dr Pauline W Chens coverage in the Times story, trust is built stronger with personal contact. Today I find balance is necessary. In order to cultivate strong relationships and trust, I use all the communication avenues I can, and face-to-face contact is a key factor in those relationships.

A friend of mine uses the phone to connect with her therapist and gladly pays for the sessions out of her pocket, since they arent covered by her insurance. She lives in Manhattan, and her therapist is on Long Island. Needless to say, the relationship started years ago, and after many sessions, the travel got to bee too much. She wasnt about to shop for another therapist, after spending years to find a professional she could relate with, open up to, and reap positive results.

Telemedicine certainly has a place in our world, and Im sure Ill be discussing more on the subject as the boom continues