Telemedicine and home care: controversies and opportunities

Key points

• The costs for care assistance in chronic disease patients are dramatically increasing.

• Telemedicine may be a very useful application of information and communication technologies in high-quality healthcare services.

• The efficacy of respiratory disease telemedicine projects is promising (i.e. to tailor therapeutic intervention; to avoid useless hospital and emergency department admissions, reduce GP visits and specialised visits; and to involve the patients and their families).

• The nurse practitioner is common to all the trials and appears to have a key role in the management of chronic disease.

• Different programmes based on specific and local situations, on specific diseases and levels of severity with a high level of flexibility should be utilised.

• Respiratory team members and the ERS need to identify the ideal candidates and the most appropriate systems to deliver telemedicine with an acceptable cost/efficacy and costs/benefits balance.

Educational aims

• To motivate the interest of chest physicians in a new approach to delivering medical care.

• To define the different types of telemedicine: telecare and telesurveillance.

• To provide information on the main clinical results in this field and give examples of case studies.

• To provide details on the recommendations and limitations of telemedicine programmes.

Summary This review focuses on the prospects, and possible drawbacks, of a new innovative instrument of care known as “home telehealth”, “telecare” or “telemedicine”. The main results from utilising telemedicine in respiratory diseases (asthma and chronic obstructive pulmonary disease (COPD) as the illustrative conditions) are presented. A principal goal of telemedicine is to improve access to healthcare services. During this process, savings in time and travel costs should be achieved, thereby rationalising access to medical care. The field of telemedicine is relatively new and expanding. In order to establish evidencebased guidelines for the design and implementation of disease management plans that employ telemedicine, further research is required. Telemedicine is not simply “technology” but an innovative medical approach (based more on a dedicated healthcare team than on high-tech instruments) that will help the medical team to care for patients and their families. In the future, it is hoped that telemedicine will form a valuable part of the disease management process, because, when used intelligently, home telehealth should supplement conventional delivery techniques and not replace them.