Malone Francis, Callahan Charles W, Chan Debora S, Sheets Scott, Person Donald A
Department of Pediatrics, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Telemed J E Health. 2004 Summer;10(2):138-46. doi: 10.1089/tmj.2004.10.138.
A Web-based store-and-forward teleconsultation asthma management system was implemented to provide subspecialty asthma care to military children with asthma living in the Western Pacific. Seven children with moderate to severe asthma (mean age 11.9 +/- 3.7 years) were followed for 1 year by their primary care provider (PCM) using a Web-based asthma pathway, with regular pediatric pulmonary teleconsults to Tripler Army Medical Center. Therapeutic monitoring included MPEG video recording of patient using metered-dose inhaler (MDI) technique submitted to the pulmonologist at specified intervals. Utilization of services for unscheduled asthma-related visits was monitored. PCMs were surveyed regarding their asthma practice before and after the intervention. Data were analyzed using Student's t test for continuous variables and Wilcoxon signed-rank or chi-square for noncontinuous variables. Therapeutic adherence was evidenced by improved inhaler technique in all patients. There were fewer ED visits for asthma (3.85 +/- 5.14, range 0-15 vs. 0 visits, p < 0.05) and fewer unscheduled acute clinic visits (1.57 +/- 1.27, range 0-4 vs. 0.286 +/- 0.48, p < 0.05) in the study year versus the preceding year. There were two hospitalizations in the year prior to the study; however, no patients were hospitalized during the study PCM use of an asthma action plan increased from 24% to 73% (p < 0.01) and provision of asthma education increased from 18% to 73%, (p < 0.01). However, PCMs reported that they were not more likely to watch their patient's MDI technique themselves (29% vs. 45%) nor order or interpret spirometry on their patients (12 vs. 18%). In this project, children with asthma followed by teleconsultation had improved outcomes. Store-and-forward teleconsultation can be used to follow children with chronic disease such as asthma over time.
实施了一个基于网络的存储转发远程会诊哮喘管理系统，为居住在西太平洋地区的患有哮喘的军属儿童提供专科哮喘护理。七名患有中度至重度哮喘的儿童（平均年龄11.9±3.7岁）由其初级保健提供者（PCM）使用基于网络的哮喘治疗路径进行了1年的跟踪，并定期与特里普勒陆军医疗中心进行儿科肺部远程会诊。治疗监测包括按指定间隔向肺科医生提交的患者使用定量吸入器（MDI）技术的MPEG视频记录。监测了与哮喘相关的非计划就诊的服务利用情况。对PCM在干预前后的哮喘诊疗情况进行了调查。使用学生t检验分析连续变量数据，使用威尔科克森符号秩检验或卡方检验分析非连续变量数据。所有患者的吸入器技术均有所改善，证明了治疗依从性。与上一年相比，研究年度因哮喘而进行的急诊就诊次数减少（3.85±5.14，范围0 - 15次对0次，p < 0.05），非计划急性门诊就诊次数减少（1.57±1.27，范围0 - 4次对0.286±0.48，p < 0.05）。研究前一年有两次住院；然而，在研究期间没有患者住院。PCM对哮喘行动计划的使用从24%增加到73%（p < 0.01），哮喘教育的提供从18%增加到73%（p < 0.01）。然而，PCM报告称，他们自己观看患者MDI技术的可能性并没有增加（29%对45%），对患者进行肺活量测定的医嘱开具或解读也没有增加（12对18）。在这个项目中，通过远程会诊跟踪的哮喘儿童的治疗效果有所改善。存储转发远程会诊可用于长期跟踪患有哮喘等慢性病的儿童。
