A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

Abstract

BackgroundAntiretroviral 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.MethodologyWe developed a new internet-based home care model covering the entire management of chronic HIV-infected 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.FindingsOf 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.ConclusionsVirtual 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 RegistrationClinical-Trials.gov: NCT01117675.

Integration of Telehealth Services in the Healthcare System: With Emphasis on the Experience of Patients Living with HIV

“…Patients were satisfied and expressed a wish to continue with the virtual hospital model. Although this study showed that telemedicine could be a safe, feasible, and cost-effective alternative to in-clinic visits to manage HIV, the study only included patients who were virally suppressed with a CD4 count of more than 250 and was limited by the small sample size 43. Another study that examined the veteran population in rural Iowa and Illinois evaluated a collaborative approach where the patient would have a visit with his primary care provider at community-based outpatient clinics followed by telehealth visit with an HIV specialty clinic.…”

The cloud paradigm applied to e-Health

“…Related experiments also proved that the same method is useful for application related with the treatment of hypertensive patients [2] and in patients with chronic diseases in general [3]. By using telematic applications, the time dedicated to personalized clinical attention to patients increase, and clinicians more effectively scheduled and managed that time.…”

Bringing antiretroviral therapy (ART) closer to the end‐user through mobile clinics and home‐based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed

“…The three randomised studies had adequate sequence generation (Jaffar et al ., ; Selke et al ., ; Leon et al ., ). However, only one had adequate allocation concealment (Jaffar et al ., ), whereas this was unclear for two (Selke et al ., ; Leon et al ., ).…”

“…The fourth study compared a home care telemedicine system (Virtual Hospital), where patients were monitored virtually via the Internet, to standard care, where patients were monitored via the day hospital (Leon et al ., ). The study was conducted at a university hospital in Barcelona, Spain, and enrolled 83 stable HIV‐infected patients in the chronic stage of their disease.…”

“…() and Leon et al . () on the other hand used empirical data from an RCT for costs. Babigumira et al .…”