Istituti Clinici Scientifici Maugeri, IRCCS Lumezzane, Respiratory Rehabilitation Division, Via G Mazzini 129, Lumezzane (BS) 25065, Italy.
Respiratory Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS Lumezzane (Brescia), Italy.
Ther Adv Respir Dis. 2018 Jan-Dec;12:1753465818754778. doi: 10.1177/1753465818754778.
Within telehealth there are a number of domains relevant to pulmonary care: telemonitoring, teleassistance, telerehabilitation, teleconsultation and second opinion calls. In the last decade, several studies focusing on the effects of various telemanagement programs for patients with chronic obstructive pulmonary disease (COPD) have been published but with contradictory findings. From the literature, the best telemonitoring outcomes come from programs dedicated to aged and very sick patients, frequent exacerbators with multimorbidity and limited community support; programs using third-generation telemonitoring systems providing constant analytical and decisionmaking support (24 h/day, 7 days/week); countries where strong community links are not available; and zones where telemonitoring and rehabilitation can be delivered directly to the patient's location. In the near future, it is expected that telemedicine will produce changes in work practices, cultural attitudes and organization, which will affect all professional figures involved in the provision of care. The key to optimizing the use of telemonitoring is to correctly identify who the ideal candidates are, at what time they need it, and for how long. The time course of disease progression varies from patient to patient; hence identifying for each patient a 'correct window' for initiating telemonitoring could be the correct solution. In conclusion, as clinicians, we need to identify the specific challenges we face in delivering care, and implement flexible systems that can be customized to individual patients' requirements and adapted to our diverse healthcare contexts.
在远程医疗中，有许多与肺部护理相关的领域：远程监测、远程协助、远程康复、远程咨询和第二意见电话。在过去的十年中，已经发表了许多关于各种远程管理计划对慢性阻塞性肺疾病（COPD）患者影响的研究，但结果却相互矛盾。从文献中可以看出，最好的远程监测结果来自于针对老年和非常病重的患者、经常恶化且多病共存、社区支持有限的患者、使用第三代远程监测系统提供持续分析和决策支持（每天 24 小时，每周 7 天）的计划；在那些社区联系不紧密的国家；以及可以直接将远程监测和康复服务提供给患者所在地的地区。在不久的将来，预计远程医疗将改变工作实践、文化态度和组织，这将影响所有参与护理的专业人士。优化远程监测使用的关键是正确识别理想的候选人是谁，他们在何时需要，以及需要多长时间。疾病进展的时间进程因患者而异；因此，为每个患者确定启动远程监测的“正确窗口”可能是正确的解决方案。总之，作为临床医生，我们需要确定在提供护理方面面临的具体挑战，并实施灵活的系统，可以根据患者的具体需求进行定制，并适应我们多样化的医疗保健环境。
