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Telemedical Disease Management in Europe: What are the Chances and Risks Dr. med. Andy Fischer , Swiss Center for Telemedicine MEDGATE Med _e_Tel, Luxembourg, 18.04.2008. Disease Management Definition (Disease Management Association of America, DMAA).

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Telemedical disease management in europe what are the chances and risks

Telemedical Disease Management in Europe:

What are the Chances and Risks

Dr. med. Andy Fischer , Swiss Center for Telemedicine MEDGATE

Med _e_Tel, Luxembourg, 18.04.2008


Disease management definition disease management association of america dmaa

Disease Management Definition(Disease Management Association of America, DMAA)

  • Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant


Telemedical disease management today up to 10 described intervention models

24h Service

Home visits by nurses

Telebiomonitoring/

Feedback

Anamnesis

Clinical signs, Symptoms

Follow-upBiomarker

Recruiting

Doctor

Studies

New clinical symptoms

Stable Situation

Cont. therapy adjustment

Monitoring phase

Adjustment phase

Diagnosis

Self management

Follow-upBiomarker

Follow-up goals

Risk-Stratification

Therapy-Plan

Doctor

Basic training

Cooperation GP

Basic investigation and Treatment planning

OBC Management

Peer Groups

Telemedical Disease Management:Today up to 10 described Intervention Models


Telemedical management concepts

Telemedical Management Concepts


Telemedical disease management in europe what are the chances and risks

Chances


Today medical care for each patient by a health care provider in a 1 1 setting

Today: Medical Care for each patient by a Health Care Provider in a 1:1-setting


Number of patients per practicing medical doctor decline of 2 4 p a from 1970 2005

4

Number of patients per practicing Medical Doctor (Decline of 2.4% p.a. from 1970-2005)

In 200 years 1 MD per family!

Quelle: Das Gesundheitswesen der Schweiz, Pharma Information


In the future medical care for each patient in a 1 n setting equal medical requirements

In the Future: Medical Care for each patient in a 1:n-setting: Equal Medical Requirements


The big five are the same in europe medically there are no differences

The „Big Five“ are the same in Europe:Medically there are no differences

  • Heart failure

  • COPD

  • Asthma bronchiale

  • Diabetes mellitus

  • Hypertension

„Diabetes kit“


We have promising results but no evidence yet i

We have promising results but no evidence yet (I)

  • Heart failure

    • Remote monitoring programmes reduced the rates of admission for chronic heart failure and all cause mortalityClarc RA et al. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ 2007; May 5; 334(7600):942

    • 1-year home-based telemanagement (HBT) reduced hospital readmission and costs in chronic heart failure patients Giordano A. et al. Multicenter randomised trial on home-based telemanagement to prevent hospital readmission of patients with chronic heart failure. Int. J. Cardiol. 2008 Jan 25 Epub ahead of print

  • Hypertension

    • Telecommunication service with home service of automatic transmission of blood pressure data showed efficacy in reducing the mean arterial pressure of patients with established hypertension Rogers MA et al. Home monitoring service improves mean arterial pressure in patients with essential hypertension. A randomized controlled trial. Ann. Intern Med. 2001 Jun 5;134(11):1024-32

    • Telemonitoring of BP over a 12-month period resulted in clinically and statistically significant reductions in systolic BPArtinian NT et al. Effects of nurse-managed telemonitoring on blood pressure at 12-month follow-up among urban African Americans. Nurse Res. 2007 Sept.-Oct;56(5):312-22


We have promising results but no evidence yet i1

We have promising results but no evidence yet (I)

  • Diabetes mellitus

    • Telemedicine Diabetes Disease Management Program: Reduction of over all charges, decrease in hospital admissions and emergency room encounters as well as improvements in quality of lifeCherry JC et al. Diabetes Disease management program for an indigent population empowered by telemedicine technology. Diabetes Technol Ther 2002; 4 (6): 783-91

    • Diabetes education via telemedicine and in person was equally effective in improving glycemic control and both methods are well accepted by patients Izquierdo RE et al. A comparison of diabetes education administered through telemdicine versus in person. Diabtes Care. 2003 Apr; 26(4):1002-7

  • COPD / Asthma bronchiale

    • Effects of telemonitoring: Decrease in hospital admission rates and in total number of exacerbations. Trappenburg JC et al.Effects of telemonitoring in patients with chronic obstructive pulmonary disease.Telemed J E Health. 2008 Mar; 14 (2): 138-46

    • Spirometry self-testing by asthma patients during telemonitoring is comparable to those under supervision of medical professionals. Internet-based home asthma telemonitoring can be successfully implemented in a group of patients with no computer background Finkelstein J. et al. Internet-based home asthma telemonitoring: can patients handle the technology? Chest. 2000 Jan;117(1):148-55


Telemedical disease management in europe what are the chances and risks

Challenges and open questions


The balance of risk determines the insurers incentive to provide dmp

The balance of risk determines the insurers’ incentive to provide DMP

Costs per insured and month (CHF)

Redistribution

700

600

500

400

300

Mean

200

100

0

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19-

26-

31-

36-

41-

46-

51-

56-

61-

66-

71-

76-

81-

86-

91+

25

30

35

40

45

50

55

60

65

70

75

80

85

90

risk groups: age and sex


Risk adjustment formula

Risk adjustment formula

  • The risk adjustment formula computes risk-related compensations. The variables included in the formula differ by country.

  • For example:

    • Belgium: socio-economic, disability, diagnosis of invalidity, eligibility of social exemption, chronic illness

    • Germany: age, gender, disability, registration in a certified DMP, and high-costs pooling

    • Netherlands: age, gender, urbanization, disability, pharmacy-based cost groups, and diagnostic cost groups

    • Switzerland: age, gender, and region

  • The more powerful this formula is, the more incentive insurers have to offer disease management programs


Do tdmp really save costs

Decrease of costs

Increase of

costs

Increase of costs

Decrease of mortality

Delay of disease progression and reduction of complications

Without Disease

Management

Program

With Disease

Management

Program

Improved medical therapy

Therapy costs

Reduction of risk group

Improved Compliance

Disease progression

Do TDMP really save costs?


Which intervention models have which advantages

24h Service

Home visits by nurses

Telebiomonitoring/

Feedback

Anamnesis

Clinical signs, Symptoms

Follow-upBiomarker

Recruiting

Doctor

Studies

New clinical symptoms

Stable Situation

Cont. therapy adjustment

Monitoring phase

Adjustment phase

Diagnosis

Self management

Follow-upBiomarker

Follow-up goals

Risk-Stratification

Therapy-Plan

Doctor

Basic training

Cooperation GP

Basic investigation and Treatment planning

OBC Management

Peer Groups

Which intervention models have which advantages?


How shall we recruit patients

How shall we recruit patients?


Challenges in the following years

Challenges in the following years

  • Guidelines, Best Practice and Quality Assurance for TDMP

  • Evidence for the use of the individual intervention models (multicentre studies)

    • Medical outcome

    • Cost effects

  • Strategy for solving the problem of recruitment

  • The single national players are too small to answer these questions on their own


European and international collaboration

European and International Collaboration


Even europe has remote valleys

Even Europe has remote valleys...


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