Gallar P, Gutiérrez M, Ortega O, Rodríguez I, Oliet A, Herrero J C, Mon C, Ortiz M, Molina A, Vigil A
Servicio de Nefrología, Hospital Severo Ochoa, Madrid.
Nefrologia. 2006;26(3):365-71.
Mean-term experience in the use of Telemedicine in Peritoneal Dialisis (PD) patients is limited as well as its cost-benefit. The main objective of this work is to evaluate Telemedicine utility in mean-long term control of stable PD patients, analyzing if the televisit (TV) could substitute 50% of the programed inhospital consults (HC) the time spent in both visit modalities, the quality of patient-personel contact as well as how image and sound have been perceived. Visit resolution was analyzed taking into account the need of HC after a TV; We also have studied if it would be possible to retrain patients in the dialisis technique with telemedicine, and we have checked the patient perceived quality and calculate the real and social costs.
during 18 months, the system has been implanted to 19 patients with 7 +/- 4 follow up (range 3-17). A Falcon videoconference kit at patient's place was used, connected to the home television set. In the hospital there was a computer with a videoconference card, webcam and software meeting point which permits the control of patient's camera from the hospital. Both are connected by a 3RDSI line system. A monthly programmed HC or TV has been made. If more controls had been required, they have been made by TV Time spent was recorded on each TV and patients and staff questionary were inquired.
(a)
mean age 44 +/- 8 years, 13 (68%) male. 12 (63%) had elemental educational level and 7 (37%) mean-superior. 17 (89%) were actively working. The PD technique was: CAPD 6 (32%) and APD13 (68%). (b) Televisits: 103 TV have been made. 22 +/- 9 minutes were spent on each TV less than in the HC, 33 +/- 8 minutes (p < 0.01). There were technical problems related with lines in 21 TV, but only in 4 the connection was not possible. 92 TV (89%) were made on time, 99 (96%) had a good image quality and 96 (93%) had a correct sound. 100% of patients perceived TV as close to HC. In 90 TV (87%) medical treatment was modified. Only in 4 cases (3.9%) patients needed an hospital visit. According to patient's valuation, TV replaced correctly to HC in 97 instances (94%) and in 97 (97%) in staff opinion. In all cases (100%) catheter exit site could be evaluated as well as edema presence. Retraining was possible in all cases. There was a save in nurse's time and patient's time and also, a save in physical hospital space. Initial investment apart, the daily cost increment was scarce (1.5 Euro) taking into account that there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.
Telemedicine is useful from the clinical point of view in the mean-term for stable patients in PD. Daily cost increment is scarce and there is a save in time for patients and personnel, save in physical space in hospital and in sanitary transport.
远程医疗在腹膜透析（PD）患者中的中期应用经验有限，其成本效益也不明确。这项工作的主要目的是评估远程医疗在稳定PD患者中长期管理中的效用，分析视频问诊（TV）是否可以替代50%的计划性住院会诊（HC），两种问诊方式所花费的时间、患者与医护人员接触的质量以及图像和声音的感知情况。考虑到视频问诊后是否需要住院会诊，对问诊结果进行了分析；我们还研究了是否可以通过远程医疗对患者进行透析技术再培训，并检查了患者感知的质量，计算了实际成本和社会成本。
在18个月期间，该系统被植入19例患者，平均随访7±4个月（范围3 - 17个月）。使用患者家中配备的Falcon视频会议套件，连接到家用电视机。医院有一台配备视频会议卡、网络摄像头和软件会议点的计算机，可从医院控制患者的摄像头。两者通过3RDSI线路系统连接。每月进行计划性的住院会诊或视频问诊。如果需要更多检查，则通过视频问诊进行。记录每次视频问诊所花费的时间，并询问患者和工作人员问卷。
（a）患者：平均年龄44±8岁，男性13例（68%）。12例（63%）为小学教育水平，7例（37%）为高中及以上水平。17例（89%）在职。PD技术为：持续性非卧床腹膜透析（CAPD）6例（32%），自动化腹膜透析（APD）13例（68%）。（b）视频问诊：共进行了103次视频问诊。每次视频问诊花费的时间比住院会诊少，分别为22±9分钟和33±8分钟（p<0.01）。21次视频问诊存在与线路相关的技术问题，但只有4次无法连接。92次视频问诊（89%）按时进行，99次（96%）图像质量良好，96次（93%）声音正常。100%的患者认为视频问诊与住院会诊相近。90次视频问诊（87%）调整了医疗方案。仅4例（3.9%）患者需要住院就诊。根据患者评估，97例（94%）视频问诊正确替代了住院会诊，医护人员认为97例（97%）也是如此。在所有病例中（100%），导管出口部位以及水肿情况均可评估。所有病例均可行再培训。节省了护士和患者的时间，也节省了医院的物理空间。除初始投资外，考虑到节省了患者和医护人员的时间、医院的物理空间以及卫生运输成本，每日成本增量很少（1.5欧元）。
从临床角度来看，远程医疗对稳定的PD患者中期治疗有用。每日成本增量很少，节省了患者和医护人员的时间、医院的物理空间以及卫生运输成本。
