mobile systems for chronic diseases telemonitoring: current status introdução à medicina 08/09...
Post on 21-Dec-2015
216 Views
Preview:
TRANSCRIPT
Mobile Systems for Chronic Diseases Telemonitoring:Current Status
Introdução à Medicina 08/09
Class no.5
1
DEFINITION
Telemonitoring: collection, record and transmission of clinical data between a patient at a distant location and a healthcare provider via remote telecommunications. It is provided on an outpatient basis.
(http://www.homehealthquality.org/shared/content/hhqi_campain/bpip_tm/Therapy.pdf)
2
Chronic diseases: Permanent disease, which leave residual disability, caused by nonreversible pathological alteration. They require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation or care.
3
Dictionary of Health Services Management, 2nd edition
DEFINITION
Physiological data: observable or measurable characteristics of the ocular system, the respiratory system, the musculoskeletal system, the nervous system or of the blood.
(http://www.ncbi.nlm.nih.gov.sites/entrez)
4
DEFINITION
In this new century medicine is facing a new challenge called TELEMONITORING
Revolution in the healthcare delivery processes
Telemonitoring allows the use of electronic equipment to observe or record physiologic processes while the patient
undergoes normal daily activities
[Mehmet R. Yuce, Peng Choong Ng, Jamil Y. Khan, Monitoring of Physiological Parameters from Multiple Patients Using Wireless Sensor Network, April 2008, Springer Science + Business Media, LLC 2008 ]
5
Telemonitoring is a way of responding to new needs in home care in an ageing population
6
A wide range of telemonitoring devices available, nowadays, for several diseases monitoring
Chronic diseases: the most promising applications (cardiopulmonary disease, asthma, heart failure, diabetes)
Most patients are elderly people – need to be regularly monitored (length of their disease, nature of their health condition, therapy)
Isolated areas do not have easy access to healthcare or specialized medical staff
TELEMONITORING ALLOWS
Earlier detection of abnormal health parameters
Corrective measures to be taken before more complications appear
Less frequent visits to healthcare facilities, shorter hospital stays and decrease of hospital admissions
Increased patient’s quality of life
7
Cost-effectiveness
Chronic diseases telemonitoring systems allow:
• To collect part of the diagnostic's relevant information
• To gather more information with less effort
• To follow the patients closely spending less time.
[N. Oliver and F. F. Mangas, “HealthGear: a real-time wearable system for monitoring and analyzing physiological signals,” Tech. Rep. MSR-TR-2005-182, Microsoft Corporation, Red-mond, Wass, USA, 2005 ]
[Otto, C. A., Jovanov, E., and Milenkovic, E., A WBAN-based system for health monitoring at home. In 3rd IEEE/EMBS Int. Summer School, Medical Devices and Biosensors. Sept, 20–23, 2006.]
8
- 500 articles about telemonitoring
- more than 93% of the publication's dates are from 2000 to the present year.
Publications indexed by Pubmed from 1990
9
A simple and not very restricted search at Pubmed ...
QUERY:(telemonitoring[All Fields] OR "telemedicine"[MeSH Terms] OR
"telemedicine"[All Fields]) AND ambulatory[All Fields]
10
This revels not only how recent this matter is, but also its emerging relevance
MobiHealth is an healthcare project created for the development of mobile health services and funded by the European Commission.
A patient who requires monitoring for short or long periods of time doesn't have to stay in hospital for monitoring. With the MobiHealth BAN the patient can be free to pursue daily life activities
www.mobihealth.org
11
Telemonitoring Status:
Despite their potential, most telemonitoring services are still limited to the status of temporary projects without clear prospects for wider use and proper integration into healthcare system.
12
There is limited evidence of the effectiveness of telemedicine services on a large scale. Awareness, confidence and acceptance still need to be strengthened.
On which chronic diseases have mobile telemonitoring systems been
used?
13
OBJECTIVES Expose the scientific evidence, produced by experimental studies, supporting the use of mobile telemonitoring systems. Determine which chronic diseases have been targeted by telemonitoring of physiological data.
Analyze which types of physiological data have been monitored and transmitted in chronic diseases telemonitoring.
Identify on which healthcare effects scientific evidence exists on the advantages or disadvantages of chronic diseases telemonitoring (health improvement, system usability, patient acceptance, etc.).
14
Keywords:
physiological, physiologic, process, phenomena, monitor, ambulatory, outpatients, non- hospital, telemedicine, telemonitoring, self monitoring, supervise, telesurveillance.
METHODS: Systematic Review
15
D) A comprehensive literature search was conducted on Pubmed and ISI to identify relevant published articles.
METHODS: Systematic Review
16
("physiological"[All Fields] OR "physiologic"[All Fields] OR physiologically[All Fields] OR process[All Fields] OR phenoma[All Fields] OR phenomal[All Fields]) AND (monitor [All Fields] OR ambulatory OR "outpatients"[MeSH Terms] OR "outpatients"[All Fields] OR "outpatient"[All Fields] OR non-hospital[All Fields] OR "monitoring, ambulatory"[MeSH Terms]) AND ("telemedicine"[MeSH Terms] OR "telemedicine"[All Fields] OR telemonitoring[All Fields] OR telemonitor[All Fields] OR "self monitor"[All Fields] OR "self monitoring"[All Fields] OR "supervise"[All Fields] OR "telesurveillance"[AllFields]).
17
Research results
502502TOTAL
18
Pubmed ISI Web of Knowledge
Methods
The articles obtained were subjected to a process of critical appraising according to its quality.
1st. REVISION: Revision by title and abstract 2 reviewers
- Articles excluded didn’t fit the inclusion/exclusion criteria. Any articles about mobile systems for chronic diseases telemonitoring were included.
19
Inclusion/Exclusion criteria
Inclusion criteria (1)experimental studies which include direct data collection from patients(2) in humans(3) using outdoor-usable devices and (4) document scientific evidence of telemonitoring effects
20
Exclusion criteria (1) do not include detailed description of the study, (2) are focused on athletes telemonitoring or (3) monitoring which does not make use of mobile systems, (4) general reviews and (5) conference and poster abstracts without study details.
Methods2nd. REVISION:
- Extensive analysis of the full article
- 2 reviewers
21
- The inclusion/exclusion criteria were changed
- None of the articles excluded in the first revision would have been included in the second revision since the new criteria is a restriction of the previous one.
Inclusion criteria (1)articles written in English, (2)with full text available, (3)regarding chronic diseases telemonitoring, (4)experimental studies which include direct data collection from patients, (5)using mobile telemonitoring systems(6)those which document scientific evidence of telemonitoring effects (health improvement, system usability, etc.).
Inclusion/Exclusion criteria
22
Exclusion criteria (1)do not present a detailed description of the study, (2)describes a project of a new instrument, (3) general reviews
STUDY VARIABLES:
Benefits and drawbacks (health improvement, system usability, cost-effectiveness, etc.) mobile systems for chronic diseases telemonitoribg can bring for the:
clinician patient healthcare institution
23
Types of chronic disease targeted by telemonitoring
Types of physiological data monitored
Country and publication date of the article
MethodsAfter the data extraction:
Check for and identify sources of heterogeneity in results across studies
Findings/Results of individual studies are synthesised and subsequently statistically analysed in SPSS
24
25
Percentage of included, excluded articles and those who needed a 3rd reviewer
10,92%
85,06%
4,02%
Graphic 1: Percentage of included, excluded articles and those who needed a 3 rd reviewer
Methods – Final decision
26
After completing the articles revision we had:
• 7,5% of the articles included
• 92,5% of the articles excluded
Methods – 3rd Reviewer
Regarding the articles subjected to a 3rd revision:
• 68,4% of the articles were included
• 31,6% were excluded
Methods– Number of included and excluded articles by each reviewer
27 Graphic 2: Number of included and excluded articles by each reviewer
Methods
A Chi-Square test was performed in order to check if there was
any statistically significant difference between the expected and
the actual number of excluded articles per reviewer. (p=0,668)
28
Methods – Frequency of use of each inclusion criteria
29 Graphic 3: Frequency of use of each inclusion criteria
Methods – Frequency of use of each exclusion criteria
30 Graphic 4: Frequency of use of each exclusion criteria
ResultsProfile of Chronic Diseases Telemonitoring Studies
31 Table 1: Profile of chronic diseases telemonitoring studies
RESULTS
DIABETES CARDIAC DISEASES
HYPERTENSION TOTAL
How many? Total numbers of studies
5 5 3 13
Where? USA 3 1 2 6Australia 1 2 - 3Canada - 1 1 2UK - 1 - 1Norway 1 - - 1When? 1996 - 1 - 12004 2 - - 22005 2 1 - 32006 1 - - 12007 - 2 3 52008 1 1
32
ResultsProfile of Chronic Diseases Telemonitoring Studies
With whom?
Patients with cardiovascular disease - 5 -
- Adults hospitalized with heart failure. - 1 -
- Enrolled in health centers. - 1 -
- Recently implanted with CRT-D. - 1 -
- With symptomatic chronic heart failure and left ventricular ejection.
- 1 -
- Undergoing cardiac rehabilitation. - 1 -
Patients with Diabetes 3
- Young patients and their parents. 1 - -
- Young patients using insulin for at least one year.
1 - -
- Wide-ranging patients with type I Diabetes 1 - -
- Adult patients with type II Diabetes and uncontrolled blood pressure.
- - 1
Patients with uncontrolled hypertension - - 2
DIABETES CARDIAC DISEASES
HYPERTENSION
ResultsOverview of Research Designs
33 Table 2: Overview of research designs
DIABETES CARDIAC DISEASE
HYPERTENSION TOTAL
Number of studies 5 5 3 13 Type of design, n (% within disease) Randomized trial with control group 1 (20) 1 (20) 2 (66) 4 Randomized trial without control group 1 (20) 1 (20) 2 Nonrandomized trial without control group 3 (60) 3 (60) 1 (33) 7 Size of experimental group Maximum 200 750 450 750 Minimum 10 30 20 10 Mean 55 236 168 Median 18 81,5 33 Size of control group, n (% within experimental group) Maximum 18 (50) 54 (44) 150 (25) 150 Minimum 18 (50) 54 (44) 10 (33) 10 Mean 18 (50) 54 (44) 80 (29) Median 18 54 80 Study duration Maximum 6
months18
months18 months 18
months Minimum 3 days 6 weeks 4 months 3 days Mean 3,82
months7,9
months11,3 months
Median 4 months
6 months 12 months
ResultsOverview of Research Designs
34
DIABETES CARDIAC DISEASE
HYPERTENSION TOTAL
Number of studies 5 5 3 13Main types of data transferred
Heart Rate - 3 1 4 Blood pressure - 1 3 4 Heart electrical activity - 2 - 2 Blood glucose 5 - - 5Frequency of data transmission to health care provider
More than once a day 3 - 1 4 Once a day - 2 - 2 A few times a week - 2 1 3 Once a week 1 - - 1 Once a month 1 - - 1 Once every three months - - 1 1 Once every six months - - 1 1
DIABETES CARDIAC DISEASE
HYPERTENSION TOTAL
Number of studies 5 5 3 13
Data quality 3 1 - 4
Patient condition 1 - 3 4
Patient attitudes and behaviors 2 1 3 6
Physician attitudes and behaviors - 1 2 3
Physician facilities - 2 3 5
Clinical efectiveness/ structural effects 4 3 3 10
Economic viability 2 4 1 7
Results - Frequencies of types of effects
35
36
Results - Frequencies of advantages and disadvantages
DIABETES CARDIAC DISEASE
HYPERTENSION TOTAL
Number of studies 5 5 3 13
Advantages to:
Patient 4 3 3 10
Physician 1 3 2 6
Health care institutions 3 2 1 6
Disadvantages to:
Patient 1 1 2 4
Physician 1 1 2 4
Health care institutions - - - -
37
Results – Advantages and disadvantages for the patient DIABETES CARDIAC
DISEASEHYPERTENSIO
NTOTAL
Number of studiesPatient
5 5 3 13
Advantages- Ability to overcome the problems. - 1 - 1- Increased level of patients’ responsibility. - 1 1 2- Helps in disease self-management. 1 - 2 3- Patients received an alert everytime the values of blood pressure are lower or higher than the normal-
2 - 2 4
- Patient enthusiam and acceptance. 2 - 1 3- System easily integrated into everyday life. 3 - - 3- Child independence while being monitored by their parents.
1 - - 1
- Allows patients with memory problems to remember to take medication.
1 - 1 2
- Allows the introduction of healthy habits of practice of physical exercise and alimentation in patients.
- - 1 1
Disadvantages 1 - 1 - Costs. 1 - 1 2 - Difficulty in using Internet. - - 2 2 - Difficulty in accepting new technologies. - - 1 1 - No physical contact with the doctor. - - 1 1 - Problems of integration of other diseases. - - 1 1 - Problems of adaptation in the routine. - - 1 1 - Warns unnecessarily in situations of low levels of glucose, especially during the night.
1 - - 1
DIABETES CARDIAC DISEASE
HYPERTENSION TOTAL
Number of studies 5 5 3 13
PhysicianAdvantages
- Facilitates realtime discussions between physicians in primary and secondary care.
2 2 - 4
- Less acute care needs when admitted. 1 - - 1 - More accurate decision regarding the treatment of BP. - - 1 1 - Larger amount of information about the patient’s condition enabling the patients’ follow-up the patient on a daily basis rather than just on the day of the medical exam.
1 1 1 3
- Shows when the medication has adverse effects. - - 1 1 - Integration of physician in the patient routine. 1 - - 1 Disadvantages - No longer able to contact the patient directly. - - 2 2 - Has to adapt its guidelines to the new technology. - - 1 1 - Availability of the physician to analyze patient data. - 1 1 2 - Failure in detection of low blood glucose values. 1 - - 1
Results - Advantages and disadvantages for the physician
38
DIABETES CARDIAC DISEASE
HYPERTENSION
TOTAL
Number of studies 5 5 3 13
HospitalAdvantages
- Reduction of hospitalization 2 - 2 4
- Automatically generated historical graphics transferred to the healthcare provider, feasibility of the system.
1 - - 1
- Reduction of hospital overcrowding. - 1 - 1
Results - Advantages for the hospital
39
Discussion
The date of publication of the articles ranges between from 1996 to 2008.
The majority of the articles were regarding Diabetes type I, revealing the importance to closely monitor and control the levels of blood glucose on a daily basis.
Cardiac diseases were also frequently targeted due to its high level of incidence and prevalence
40
Comparing to Paré et all, the number of included articles was considerably smaller since our research was restricted to experimental studies making use of mobile systems
Only articles about Diabetes, Cardiac Diseases and Hypertension were found.
USA is the country which has most explored the use of mobile technology to follow up chronic patients, as well as UK, Australia, Norway and Canada.
Discussion
Benefits of mobile telemonitoring systems for the patients
Telemonitoring systems enable patient’s quality of life
This kind of systems allows active participation in the process of healthcare, more patient’s independence and responsibility,
General satisfaction and a high level of acceptance
Increasing of patients’ compliance with the treatment, medication and telemonitoring which is a result of a tighter control achieved by an alarm system warning the patient .
41
Minimal patient intervention in the collection and transference of data, reducing bias and subjectivity
Promotion of a healthy lifestyle with an improvement in physical exercise practice and balanced diet as it increases patient awareness of their health condition
Discussion
Disadvantages of mobile telemonitoring systems for the patients
Problems related to the usage and access to the internet namely among elderly people since they are not used to deal with computer technology
The cost-effectiveness is quite controversial
Undesirable changes in the daily routine may happen as a result of the permanent monitoring which leads to dependency towards the equipment
42
Although it requires an initial investment in the equipment purchase, it may compensate in the long run, since it decreases future expenditures in healthcare services
Discussion
Benefits of mobile telemonitoring systems for healthcare professionals
Telemonitoring promotes the knowledge integration from the different healthcare areas, encouraging discussion
The physician has easier access to the patient information, and can be warned through an alarm system every time the patients’ health parameters are not normal
Emergency situations can be detected earlier preventing the occurrence of more serious complications
It is possible to follow closely the evolution of a patient health condition and consequently diagnose and apply treatment at distance
43
Discussion
Disadvantages of mobile telemonitoring systems for healthcare professionals
Less physical contact between physicians and patients
Adaptation of clinical guidelines to this new way of healthcare delivery service
It requires availability of the physician in order to analyze the patient data as well as ensure the maintenance of the equipment
44
Discussion
Effects of mobile telemonitoring systems on the hospitals
45
Little evidence was found on the telemonitoring effects on the hospital and additional research is required to further investigate and analyze the impact of chronic disease telemonitoring in healthcare facilities
Less frequent visits to the healthcare facilities, shorter hospital stays and decrease of hospital admissions
Decrease in waiting lists associated with cost-effectiveness
The hospital can be notified in case of medical emergency
Previous professional training is needed in order to make an adequate use of this equipment, benefiting from all its potentialities
References:[1] Louis AA, Turner T, Gretton M, Baksh A, Cleland JG., A systematic review of telemonitoring for the management of heart
failure, Eur J Heart Fail. 2003 Oct;5(5):583-90, Review.
[2] Mehmet R. Yuce, Peng Choong Ng, Jamil Y. Khan, Monitoring of Physiological Parameters from Multiple Patients Using Wireless Sensor Network, April 2008, Springer Science + Business Media, LLC 2008
[3] Otto, C. A., Jovanov, E., and Milenkovic, E., A WBAN-based system for health monitoring at home. In 3rd IEEE/EMBS Int. Summer School, Medical Devices and Biosensors. Sept, 20–23, 2006.
[4] GUY PARÉ, et al, Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base, Journal of the American Medical Informatics Association Volume 14 Number 3 May / June 2007.
[5] N. Oliver and F. F. Mangas, “HealthGear: a real-time wearable system for monitoring and analyzing physiological signals,” Tech. Rep. MSR-TR-2005-182, Microsoft Corporation, Red-mond, Wass, USA, 2005
[6] P.T. Cheng, L.M. Tsai, L.W. Lu, and D.L. Yang. The design of pda-based biomedical data processing and analysis for intelligent wearable health monitoring systems. In Proc. Intl. Conf. Computer and Information Technology (CIT’04).
[7] D. Konstantas, A.V. Halteren, R. Bults, K. Wac, I. Widya, N. Dokovsky, G. Koprinkov, V. Jones, and R. Herzog. Mobile patient monitoring: the mobihealth system. In Proc. Int. Conf. on Medical and Care Compunetics, NCC’04, 2004.
[8] D. Malan, T. Fulford-Jones, M. Welsh, and S. Moulton. Codeblue: An ad-hoc sensor network infrastructure for emergency
medical care. In Proc. Int. Workshop on Wearable and Implantable Body Sensor Networks, 2004.
46
[9] K.M. Scannell, D.A. Perednia, and H.M. Kissman. Telemedicine: Past, present, future. Technical report, U.S Department of
Health and Human Services. National Library of Medicine. Reference Section., 1995.
[10] R. Fensli, et al, Sensor Acceptance Model– Measuring Patient Acceptance of Wearable Sensors, Schattauer GmbH, 2008.
[11]Y. Hao and R. Foster, Wireless Body Sensor Network for Health-Monitoring Applications, Department of Electronic
Engeneering, Queen Mary, University of London, 2008.
[12] Paré Guy, Jaana Mirou, Sicotte Claude, Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base, Journal of The American Medical Information Association, Volume 14, Number 3, May / June 2007 .
[13] - Meystre S. The current state of telemonitoring: a comment on the literature. Department of Medical Informatics, University of Utah, Salt Lake City, Utah 84132-2913, USA. s.meystre@utah.edu
[14] - Speedie, S. M.; Ferguson, A. S.; Sanders, J. & Doarn, C. R. Telehealth: the promise of new care delivery models.
[15] – D. Konstantas, A.V. Halteren, R. Bults, K. Wac, I. Widya, N. Dokovsky, G. Koprinkov, V. Jones, and R. Herzog. Mobile patient monitoring: the mobihealth system. In Proc.Int. Conf. on Medical and Care Compunetics, NCC’04, 2004
[16] - Robyn A Clark, Sally C Inglis, Finlay A McAlister, John G F Cleland, Simon Stewart. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis, BMJ 2007;334:942
[17] - Telemedicine for the Medicare population: pediatric, obstetric, and clinician-indirect home interventions.
[18]- Otto, C. A., Jovanov, E., and Milenkovic, E., A WBAN-based system for health monitoring at home. In 3rd IEEE/EMBS Int. Summer School, Medical Devices and Biosensors. Sept, 20–23, 2006.
[19] – GUY PARÉ, et al, Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base, Journal of the American Medical Informatics Association Volume 14 Number 3 May / June 2007.
47
[20] - N. Oliver and F. F. Mangas, “HealthGear: a real-time wearable system for monitoring and analyzing physiological signals,” Tech. Rep. MSR-TR-2005-182, Microsoft Corporation, Red-mond, Wass, USA, 2005
[21] - . Cheng, L.M. Tsai, L.W. Lu, and D.L. Yang. The design of pda-based biomedical data processing and analysis for intelligent wearable health monitoring systems. In Proc. Intl. Conf. Computer and Information Technology (CIT’04).
[22] - D. Konstantas, A.V. Halteren, R. Bults, K. Wac, I. Widya, N. Dokovsky, G. Koprinkov, V. Jones, and R. Herzog. Mobile patient monitoring: the mobihealth system. In Proc. Int. Conf. on Medical and Care Compunetics, NCC’04, 2004.
[23] - R. Fensli, et al, Sensor Acceptance Model – Measuring Patient Acceptance of Wearable Sensors, Schattauer GmbH, 2008
[24] - Shou-jun Sun and Kai Wu and Xiao-Ming Wu; A wireless mobile monitoring system based on bluetooth technology; Zhongguo Yi Liao Qi Xie Za Zhi;2006
[25] -Bao-ming Wu and Xiang-fei Nie and Xin-jian Zhu and Qing-hua He and Yu Zhuo; Development of HPC-based monitoring devices for community medicine; Zhongguo Yi Liao Qi Xie Za Zhi; 2002.
[26] - Wan-Young Chung and Chiew-Lian Yau and Kwang-Sig Shin and Risto Myllyla; A cell phone based health monitoring system with self analysis processor using wireless sensor network technology; Conf Proc IEEE Eng Med Biol Soc; 2007.
[27] - The MobiHealth Project (IST-2001-36006), Innovative gprs/umts mobile services for applications in healthcare, http://www.mobihealth.org/.
[28] - Telemedic; Opportunities For Medical and Electronical Providers. BCC Research 2007
48
Authors:
ALVES, José Pedro Figueiral Oliva Soares; CAMPOS, Marta Sofia Gomes; DATA, Tânia Rodrigues; ESTEVES, Alexandra Sofia Moreira; FARIA, Carlos Augusto da Silva; FERNANDES, Diana da Silva; GUEDES, Paulo Renato Moreira; MACHADO, Marino João Pinto; MAGALHÃES, Ana Isabel Pereira; MARQUES, Pedro Seabra; MATOS, José Pedro Rodrigues; MELO, Inês Marisa Tribuzi de Magalhães; MOREIRA, Pedro Manuel Costa; NASCIMENTO, João António Santos; PEREIRA, Maria Francisca Azevedo Marques; SILVA, Ana Rita Carneiro.
Authors’ e-mail: intromed05@gmail.com
Adviser: RODRIGUES, Pedro Pereira.
Class Number: 05
49
top related