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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,

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Presentation on theme: "Telemedical Disease Management in Europe: What are the Chances and Risks Dr. med. Andy Fischer, Swiss Center for Telemedicine MEDGATE Med _e_Tel, Luxembourg,"— Presentation transcript:

1 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

2 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

3 Telemedical Disease Management: Today up to 10 described Intervention Models Anamnesis Clinical signs, Symptoms Studies Diagnosis Risk-Stratification Therapy-Plan Follow-up goals Adjustment phase Monitoring phase New clinical symptomsStable Situation Follow-up Biomarker Doctor Follow-up Biomarker Self management Doctor Telebiomonitoring/ Feedback Recruiting Basic investigation and Treatment planning Basic training Cont. therapy adjustment OBC Management 24h Service Home visits by nurses Cooperation GP Peer Groups

4 Telemedical Management Concepts

5 Fast and effective blood pressure adjustment

6 Chances

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

8 Number of patients per practicing Medical Doctor (Decline of 2.4% p.a. from 1970-2005) Quelle: Das Gesundheitswesen der Schweiz, Pharma Information 4 In 200 years 1 MD per family!

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

10 The Big Five are the same in Europe: Medically there are no differences Heart failure COPD Asthma bronchiale Diabetes mellitus Hypertension Diabetes kit

11 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 mortality Clarc 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 BP Artinian 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

12 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 life Cherry 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

13 Challenges and open questions

14 The balance of risk determines the insurers incentive to provide DMP 0 100 200 300 400 500 600 700 19- 25 26- 30 31- 35 36- 40 41- 45 46- 50 51- 55 56- 60 61- 65 66- 70 71- 75 76- 80 81- 85 86- 90 91+ } } } } } } } } } }} } }} } Mean Costs per insured and month (CHF) risk groups: age and sex Redistribution

15 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

16 Do TDMP really save costs? Disease progression Therapy costs Without Disease Management Program With Disease Management Program Improved Compliance Reduction of risk group Improved medical therapy Decrease of costs Increase of costs Increase of costs Delay of disease progression and reduction of complications Decrease of mortality

17 Which intervention models have which advantages? Anamnesis Clinical signs, Symptoms Studies Diagnosis Risk-Stratification Therapy-Plan Follow-up goals Adjustment phase Monitoring phase New clinical symptomsStable Situation Follow-up Biomarker Doctor Follow-up Biomarker Self management Doctor Telebiomonitoring/ Feedback Recruiting Basic investigation and Treatment planning Basic training Cont. therapy adjustment OBC Management 24h Service Home visits by nurses Cooperation GP Peer Groups

18 How shall we recruit patients? Method of recruitingSuccess of recruiting Data mining by the insurer and selective addressing of the target customer 2.9% Information letter from the insurer3.0% Information letter to the general practitioner 4.0%

19 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

20 European and International Collaboration

21 Even Europe has remote valleys...

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