University of Calgary
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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
[email protected] 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
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Virtual consultation: “present”
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Virtual consultation: videoconference
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Virtual consultation: chat
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Virtual consultation: messages
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Managing appointments
25A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care
Adapting the existing EPR
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EPR management
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Including the psychological history
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Including the social history
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Including the nursing history
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Evolution graphs
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Telepharmacy
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Treatments
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Treatments
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Virtual communities
35A New Telemedicine Approach for Chronic HIV/AIDS Patient Home Care
Virtual library