The findings suggest that, besides a reduction of costs, by participating in "Telemedicine for the Heart" patients with chronic heart failure experienced a reduced number of hospital stays, optimized medical therapy, better quality of life, and reduced mortality.
Chronic heart failure (CHF) is one of the most common diagnoses in internal medicine. It frequently results in a considerable loss of patient quality of life and is affected by improvable deficits regarding managed care, diagnosis, and treatment. Integrated care conceptions with telemetric support for persons concerned have proven to ameliorate the mentioned deficits. Apart from the resulting medical benefits, another significant advantage of such approaches is a reduction of costs of treatment and care for CHF patients due to a decrease in hospitalizations, which account for the better part of total costs. In this context the non-profit-making German foundation for chronic heart cases ("Deutsche Stiftung für chronisch Herzkranke") has, in cooperation with the statutory health insurance "Techniker Krankenkasse", developed an integrated, telemetric care and education program for patients suffering from CHF. Since January 2006, the conception stands open to all insurants of the participating health insurance. A growing number of patients, momentarily 431, has been inscribed and takes advantage of this program. The 27-month program seeks for integration of all participating health-care providers. Patients are, by frequent nurse-mediated telephone contact under supervision of physicians, intensely and individually cared for. Throughout the program all patients take advantage of repetitive teaching regarding individually relevant aspects of CHF. Subject to the severity of their condition, the patients are, with telemetric support, motivated to implement daily self-measurements of weight, blood pressure and pulse into their everyday life. In the course of every telephone contact greatest care is given to convey knowledge about limit values of measured parameters and symptoms of decompensation on the basis of the acquired data. Participating practicing physicians are regularly informed about the progress of their patients and, if necessary, encouraged to enhance adequate, guideline- and evidence-based pharmacological therapy. By means of interaction of all these program features and subject matters, patients are, beyond the end of the program, empowered to enduringly and self-dependently deal with their chronic disease. Intermediate data suggest that participation of CHF patients in the depicted program is, among other effects, able to decrease hospitalizations, optimize treatment, increase quality of life, and decrease mortality.
The changes in the demographic structure, the increasing multimorbidity in connection with a rise in the number of chronic illnesses and the absence of an effective coordination of the different levels of healthcare services with its discontinuous processes and redundancies will lead to intolerable economic burdens in the German health-care system, affecting medical, health-political and economic dimensions alike. This is the significance in terms of content and strategy of "health telematics" as an application of modern telecommunication and information technologies in the health-care system, and of "E-Health" as a specification of all services, quality improvements and rationalization effects, which are achievable by digitizing data collection as well as communication processes. Not only do digitizing and electronic transmission offer a better, faster and safer way of communication, but by possibilities of combining data they also allow the rationalization and quality-improving introduction of new methods of diagnosis, therapy and aftercare. The latest developments and appropriate logistic premises nowadays offer a realistic basis for implementing telemonitoring as a central service and information tool as well as an instrument controlling the information and data flow between patient, hospital and medical practitioner. Considering the enormous significance of cardiovascular diseases, focusing on corresponding cardiologic disease patterns seems almost self-evident. Notwithstanding remarkable medical progress during the past few years, cardiovascular diseases are still the number one cause of death in industrialized countries. In the cardiologic sector, telemedical systems are most commonly used with patients suffering from coronary heart diseases, e.g., for the detection of unclear dysrhythmia, as well as with patients suffering from chronic heart failure. Seen from a medical point of view, it is paramount to judge the clinical situation without delay as well as to take necessary therapeutic measures timely and to control their efficiency over a long period of time.Consequently, telemedical projects include the establishment of a nonstop monitoring of patients with increased or high risk of cardiovascular incidents, starting with the hospitalization, postoperative/post in-house health care and up to home care. This kind of monitoring needs to be adjustable to the respective situation modularly in order to guarantee a smooth possibility of surveillance both in the stationary and the ambulant sector, which, in addition, has to be individually adjustable to the demand of required monitoring functions (heart rate, blood pressure, S-T segments, oxygen satiation, weight, breathing rate, and temperature) and the intensity of the monitoring (event recording, "on-demand" vs. continuous monitoring). Certainly rich in meaning for the future is the integrated telemedicine care of a "primary" cardiac patient with his relevant comorbidities: diabetes and coagulation monitoring, respectively.
PurposeMedical impact of telemetric management on patients with asthma.ContextSectoral boundaries still cause problems in supervising chronically Ill patients in Germany. Integrated care models by means of modern telemedicine can help.Since the beginning of 2008, an agreement between the Techniker Krankenkasse (TK) and the German Foundation for the Chronically Ill has enabled a telemedical programme for asthma (see below).Case descriptionAdult TK insured asthmatics are enrolled by participating doctors. Supervision by a telemedical support centre differs according to the severity of their condition and in coordination with participating doctors.All patients receive electronic peak flow meters and training documents, and are phoned regularly by medically trained coaches. Major elements include information and training courses on asthma, self-management, target agreements, collection of medical data and regularly written reports to participants and doctors. High-risk patients also undergo telemonitoring of medical data via mobile phone. If values become critical, early intervention prevents escalation and medical emergencies.Results and conclusionsOver 1500 patients enrolled since programme launch.Pre-post comparison (n=1455) shows significant medical results.Increased percentage of participants receiving PRN medication (+10.6%) and long-term medication (by up to 40%) according to guidelines.Influenza vaccination rate increased by 18%; pneumococcal vaccination rate by 43%. Percentage of patients with self-management plan doubled. Sixty-four percent could prevent episodes of shortness of breath; 66% no longer suffered from asthma-related coughing.DiscussionIntegrated care models by means of modern telemedicine suitable for other chronic diseases and for multimorbid patients (whole patient management)?
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