Trosini-Désert Valery, Lafoeste Hélène, Regard Lucile, Malrin Roxane, Galarza-Jimenez Maria-Alejandra, Amarilla Cristina Esteban, Delrieu Jacqueline, Fôret Didier, Melloni Boris, El-Khouari Fadwa, Similowski Thomas
Department of Respiratory and Intensive Care Medicine, Salpêtrière Hospital, Paris, France.
ANTADIR Federation, Maison du Poumon, Paris, France.
Telemed J E Health. 2020 Nov;26(11):1336-1344. doi: 10.1089/tmj.2019.0246. Epub 2020 Apr 17.
Chronic obstructive pulmonary disease and asthma patients' use of inhalers is error prone. This study evaluated telemedicine to improve the use of inhalers. Prospective, single-center pilot study in 50 patients with long-term prescription of inhaled medicine and ongoing home health care visits. In an initial telemedicine intervention, tablet devices were used by the patient to record inhaler use at home in the real-time remote presence of a physician. Errors were identified, explained to the patient, and corrected remotely. When necessary, further telemedicine interventions were scheduled at 24-48 h intervals. Follow-up interventions were performed during routine outpatient visits. Patient satisfaction was evaluated on a scale of 0 (completely unsatisfied) to 10 (completely satisfied). An initial telemedicine intervention was conducted for 42 of the 50 patients included. In these patients, 96 initial inhaler medicine administration telemedicine interventions were performed, of which 94 were usable. In the initial interventions, 71 errors were identified, of which 22 (31%) were considered critical. In 81 follow-up interventions in 39 patients (median delay 256 days), 32 errors were identified ( < 0.001 vs. initial 71 errors), of which 7 were critical ( = 0.0017 vs. initial 22 errors). This paves the way for future studies testing putative benefits of telemedicine regarding inhaled drug delivery, treatment adherence, disease control, quality of life, and health care burden and costs. A telemedicine intervention aimed at improving the administration of inhaled medication by adult patients at home is feasible, highly appreciated by patients, and effective at correcting medicine administration errors.
慢性阻塞性肺疾病和哮喘患者使用吸入器时容易出错。本研究评估了远程医疗对改善吸入器使用情况的作用。对50名长期使用吸入药物且正在接受家庭医疗访视的患者进行了前瞻性单中心试点研究。在最初的远程医疗干预中，患者使用平板电脑设备在医生实时远程在场的情况下记录在家中使用吸入器的情况。识别出错误后，向患者解释并进行远程纠正。必要时，每隔24 - 48小时安排进一步的远程医疗干预。在常规门诊就诊期间进行随访干预。患者满意度采用0（完全不满意）至10（完全满意）的评分标准进行评估。纳入研究的50名患者中有42名接受了最初的远程医疗干预。在这些患者中，共进行了96次初始吸入药物给药远程医疗干预，其中94次可用。在初始干预中，识别出71个错误，其中22个（31%）被认为是严重错误。在39名患者的81次随访干预中（中位延迟256天），识别出32个错误（与初始的71个错误相比，<0.001），其中7个是严重错误（与初始的22个错误相比，=0.0017）。这为未来测试远程医疗在吸入药物递送、治疗依从性、疾病控制、生活质量以及医疗负担和成本方面的假定益处的研究铺平了道路。旨在改善成年患者在家中吸入药物给药情况的远程医疗干预是可行的，深受患者赞赏，并且在纠正给药错误方面有效。
