A New Telemedicine Approach for Chronic HIV/AIDS Patient

University of Calgary

PRISM: University of Calgary's Digital Repository

Research Centres, Institutes, Projects and Units E-Health Resource Repository

2005-04-06

A New Telemedicine Approach for Chronic HIV/AIDS

Patient Home Care

Caceres, C; Gomez, E.J.; Garcia, F.; Chausa, P.; Gatell, J.M.; Del

Pozo, F.

Presented at Med-e-tel 2005 Conference in Luxembourg.

http://hdl.handle.net/123456789/3505

Presentation

Downloaded from PRISM: https://prism.ucalgary.ca

A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

César Cáceres1,2, Enrique J. Gómez1, Felipe García3, Paloma Chausa1, José M. Gatell3, Francisco del Pozo1

1Bioengineering and Telemedicine Unit (GBT)Univ. Politécnica de Madrid (Madrid)

2Artificial Intelligence Unit – Univ. Rey Juan Carlos (Madrid)3Infectious Diseases Unit – Hospital Clínic (Barcelona)

2A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

SummaryIntroduction

HIV/AIDSProject goals

System descriptionVIHrtual Hospital ServicesMain innovations

Clinical trialConclusions

3A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

HIV/AIDS: IntroductionWhat’s HIV/AIDS?Typical course of HIV infection

(Fauci et al., Ann Intern Med 1996)

4A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

AIDS Cases (European Union)

0

50

100

150

200

1986 1988 1990 1992 1994 1996 1998 2000 2002Year of diagnosis

Cases permillion

Spain

ItalyFrance

UK

Portugal

Germany

From HIV/AIDS Surveillance in Europe

5A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Change on AIDS treatment paradigm

AIDS terminal patientPalliative care

HIV chronic patientNormal life(with special needs)

Antiretroviral drugs

6A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Complexity of the treatmentsSide effects

Numerous and some quite seriousCompliance

High compliance (>95%) is demandedHelp from other professionals: pharmacists and mental healthAppearance of resistance

InteractionsBetween drugs, food, herbs products, alcohol…

Expensive

7A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Psychological and Social aspects

Phases an HIV patient goes through:Shock Negation Acceptance

Associated states: anxiety, depression, etc.Stigmatization and social discrimination

Family refusalLabour problemsSexual problemsEconomical problems

QUALITY OF LIFE

DeathChronic

8A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

HIV/AIDS framework

Partner

Family

Friends

H.I.V.Pharmacist

G.P.

NurseSocialworker

PsychologistVolunteers

PublicHospitals

Primary careDrug centers

Penitentiarysystem

Civil serviceRegionsLaboratories

NGOs

Other services

9A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

VIHrtual Hospital Project GoalsImprove quality of life and HIV/AIDS patients care (clinical, psychological, and social factors)Definition and development of a telemedicine service that:

Empowers the patient self-careImproves communication with healthcare professionalsOptimizes hospital visits, improves attention, and manages the treatmentsReduces costs of health care

Telemedicine services integrationClinical implementation in the Clínic Hospital in Barcelona (Spain)

10A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

VIHrtual Hospital Description

11A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

System architecture

DMZ

InternetInternet

Patient PC

VIHrtualDB

Intranet

ADSL

PHARMACYDB

Administrator PC

Professional PC

VPNFirewall

VIHrtualWeb Server

Router

AIDSDB

Hospital Patient’s home

12A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

VIHrtual Hospital Services

13A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Users

Professional user

• Doctor• Nurse• Psychologist• Psychiatrist• Pharmacist• Social worker• Quality of life

Patient user

14A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Security issues

Anonimize data

Cipher database

Backup copies

Use of certificates

VPN

Secure access through fingerprints

Checking forms

Access registry

Fast and secure maintenance

15A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Clinical trial of the system

Clinical trial in the Clinic Hospital in Barcelona:

November 2004 – June 2007 (2 years)50 patients using the system + 50 patients withconventional careRandomized, prospective, and cross-over study

Evaluation of the Telemedicine Service(technical, clinical, economical, andorganizational aspects)

16A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Conclusions

Telemedicine system that improves HIV infection controlInnovative services for both patients and professionalsLow cost system makes easier the scalability of the implementationFirst results will be available in Nov - 2005

17A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Research teamsCésar Cáceres Enrique J. GómezJorge GuzmánFrancisco del Pozo

Paloma ChausaFernando SetiénJorge MaquedaIñaki Aldasoro

Carlos NietoPedro MartínSusana PérezVirginia Álvarez

Médicos: Felipe García, Emilio Fumero, Pedro Castro,José Luis Blanco, Esteban Martínez, Josep Mallolas,Montse Loncá, Agata León, Montse Laguno,Ana Milinkovic, María Larrouse, José María Gatell

Enfermería: Marta Sala, Cristina CasadesusFarmacia: Montse Tuset, Maite Martín, Elena Cacho, Carlos CodinaSalud mental: Araceli Rousaud, Jordi BlanchTrabajo social: Menchu LanaspaCalidad de vida: Xavier BadíaAdministradora: Laura Zamora

A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

César Cáceres1,2, Enrique J. Gómez1, Felipe García3, Paloma Chausa1, José M. Gatell3, Francisco del Pozo1

cesar.caceres@urjc.es1Bioengineering and Telemedicine Unit (GBT)

Univ. Politécnica de Madrid (Madrid)2Artificial Intelligence Unit – Univ. Rey Juan Carlos (Madrid)

3Infectious Diseases Unit – Hospital Clínic (Barcelona)

19A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Shared care example

20A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual consultation: “present”

21A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual consultation: videoconference

22A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual consultation: chat

23A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual consultation: messages

24A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Managing appointments

25A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Adapting the existing EPR

26A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

EPR management

27A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Including the psychological history

28A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Including the social history

29A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Including the nursing history

30A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Evolution graphs

31A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Telepharmacy

32A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Treatments

33A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Treatments

34A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual communities

35A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care

Virtual library