Editorial
Pros and Cons of Telemedicine in the Management of Patients with Chronic Respiratory Diseases
Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias
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"titulo" => "Pros and Cons of Telemedicine in the Management of Patients with Chronic Respiratory Diseases" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "575" "paginaFinal" => "576" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gonzalo Segrelles-Calvo, Daniel López-Padilla, José Ignacio de Granda-Orive" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Gonzalo" "apellidos" => "Segrelles-Calvo" "email" => array:2 [ 0 => "gsegrelles@hotmail.com" 1 => "gsegrelles@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Daniel" "apellidos" => "López-Padilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José Ignacio" "apellidos" => "de Granda-Orive" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Rey Juan Carlos, Universidad Rey Juan Carlos I, Móstoles, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years there has been a growing interest in telemedicine and its applications in respiratory medicine.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Although most studies have been performed in patients with chronic obstructive pulmonary disease, telemedicine in other conditions, such as asthma and lung transplantation, has also been explored. Results have been very promising, not only from a clinical point of view<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> (fewer admissions and visits to the emergency room, tele-hospitalization programs, etc.), but also logistically, in terms of e-consultations in smoking cessation programs or the follow-up of compliance in the treatment of tuberculosis, polysomnography with telemonitoring,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> or telespirometry.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> One of the most interesting areas is home-based telemonitoring, whereby different parameters, such as spirometry, vital signs, pulse oximetry, telemonitored respiratory sounds,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a> podometry, etc., are measured remotely in the patient's home and can contribute to the early detection of clinical worsening. Other more ambitious programs in patients with lateral amyotrophic sclerosis have managed to remotely monitor ventilator graphics and modify parameters accordingly, resulting in fewer admissions with no impact on clinical outcomes.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Telemedicine has consistently led to reductions in the number of admissions and visits to the emergency room, while the costs of this intervention are covered by savings generated from reductions in unnecessary hospital visits. Telemedicine, moreover, improves communication between healthcare professionals (HP) and new roles are being defined for “telemedicine specialists”. These are advantages that impact not only on the patient and the caregiver, but also on the HP and healthcare payers.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, despite the potential advantages, uptake has been slow and several obstacles have been encountered. To understand why, we must analyze telemedicine programs from the perspective of each of the stakeholders.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Roig and Saigi<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a> list 4 factors necessary for a successful telemedicine program:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">(1)</span><p id="par0030" class="elsevierStylePara elsevierViewall">a clearly established objective, designed to respond to the perceived needs of the HPs in a defined setting. We know that one of the reasons telemedicine programs have not become widespread is the failure to adapt the strategy to the particular needs of each setting, producing clashes between organizational aspects, internal relationship models, and sector-specific networks of interest;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">(2)</span><p id="par0035" class="elsevierStylePara elsevierViewall">a leader, defined as a professional with mid-to-long-term vision and clinical experience to be able to detect needs and opportunities for improvement;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">(3)</span><p id="par0040" class="elsevierStylePara elsevierViewall">external partnerships; and</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">(4)</span><p id="par0045" class="elsevierStylePara elsevierViewall">a project that is sustainable beyond the pilot study.</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall">Very few studies have evaluated the disadvantages of telemedicine from the perspective of HPs, although they all agree that overwork is the main obstacle.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Clearly, much of the enormous daily data output generated by telemedicine programs is not necessarily clinically significant, and if not correctly classified can result in a heavy workload. For this reason, it is essential to form multidisciplinary groups with well-defined roles. Jódar-Sanchez et al.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a> found that a screening switchboard, manned by nurses trained in telemedicine programs, resolved most alerts received, and only 2% of cases required evaluation by a physician. Other drawbacks, in the opinion of HPs, were lack of planning, insufficient training in the devices and technological problems.</p><p id="par0060" class="elsevierStylePara elsevierViewall">An important point to take into consideration is telemedicine as a specialty field. This not only defines new professional profiles such as the nurse manager or the health coach, but would also allow HPs to devote part of their working day to telemedicine, instead of “doing it when they’ve got a moment”. The “got a moment” scenario is the one most likely to generate a negative response to these new technologies.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients, on the other hand, refer to problems with the use of devices and concerns about the confidentiality of data submitted. The recently published Valcrónic study<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">8</span></a> found that users did not wish to participate because they were unwilling to assume the obligations involved in the program, they doubted whether they would be able to use the devices, and they had misgivings about the program itself. The main reason for discontinuing the study was the patient's anxiety about taking the measurements incorrectly, or the caregiver's general misgivings about the program.</p><p id="par0070" class="elsevierStylePara elsevierViewall">We must bear in mind that the majority of potential users are elderly individuals with multiple comorbidities who are unfamiliar with new technologies. Although advanced age and concomitant disease burden do not seem to limit participation in a telemedicine program, these features should be taken into account and the most user-friendly devices must be selected, excessively complicated protocols should be avoided and patients must not be expected to invest significant amounts of time. Training patients and caregivers to correctly record the measurements has been associated with improved adherence to telemedicine programs.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Another aspect to remember is cultural bias. Some patients, particularly the elderly, prefer a conventional face-to-face visit rather than a virtual visit, although both have been shown to be equally effective.</p><p id="par0080" class="elsevierStylePara elsevierViewall">From a provider's point of view, telemedicine is an opportunity to recoup costs and optimize human and professional resources. Several studies have been published demonstrating the cost-effectiveness of these programs,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> but no data are available on other administrative aspects, and our information is derived from the personal opinion of managers.</p><p id="par0085" class="elsevierStylePara elsevierViewall">An interesting project, “The Hospital of the Future” (available on the website <a id="intr0010" class="elsevierStyleInterRef" href="http://clubgertech.unavarra.es/public/hospital_futuro_libro.pdf">http://clubgertech.unavarra.es/public/hospital_futuro_libro.pdf</a>), discusses the opinions of healthcare managers on telemedicine and its use in the future. All participants agree that telemedicine can improve the efficiency and efficacy of medical care by generating alternatives to routine hospitalization, and welcome the opportunity to develop technological platforms that can meet the need for health information and provision of chronic care. Dr Luis Carretero makes an interesting point on public-private sector collaboration agreements when he suggests that the latter has some responsibility for renewing and maintaining technologies. Dr Javier Colás, meanwhile, believes that technological innovation is essential in the treatment of chronic diseases, and describes the 3 keystones of this approach as: (1) the patient can be actively involved; (2) different healthcare levels can be integrated in a single system that can stratify the risk of the patient population, and (3) care is transferred to the patient's home.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, a growing body of evidence supports telemedicine, although we still have to overcome resistance to change from both patients and HPs. Education, training in the use of medical devices, well-structured programs with defined roles, and longer studies that confirm the economic sustainability and duration of the protective effect in patients are key elements in the future implementation of telemedicine.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Segrelles-Calvo G, López-Padilla D, de Granda-Orive JI. Ventajas e inconvenientes de la telemedicina en el manejo de pacientes con enfermedades crónicas respiratorias. Arch Bronconeumol. 2016;52:575–576.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review of telemonitoring in COPD: an update" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Pedone" 1 => "D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 57 | 21 | 78 |
| 2024 September | 69 | 25 | 94 |
| 2024 August | 65 | 36 | 101 |
| 2024 July | 56 | 16 | 72 |
| 2024 June | 68 | 32 | 100 |
| 2024 May | 119 | 35 | 154 |
| 2024 April | 56 | 28 | 84 |
| 2024 March | 65 | 17 | 82 |
| 2024 February | 43 | 31 | 74 |
| 2023 June | 0 | 1 | 1 |
| 2023 March | 11 | 3 | 14 |
| 2023 February | 54 | 27 | 81 |
| 2023 January | 41 | 33 | 74 |
| 2022 December | 61 | 42 | 103 |
| 2022 November | 80 | 24 | 104 |
| 2022 October | 49 | 41 | 90 |
| 2022 September | 44 | 41 | 85 |
| 2022 August | 55 | 28 | 83 |
| 2022 July | 34 | 40 | 74 |
| 2022 June | 49 | 43 | 92 |
| 2022 May | 42 | 27 | 69 |
| 2022 April | 65 | 36 | 101 |
| 2022 March | 60 | 44 | 104 |
| 2022 February | 86 | 34 | 120 |
| 2022 January | 121 | 48 | 169 |
| 2021 December | 108 | 47 | 155 |
| 2021 November | 72 | 59 | 131 |
| 2021 October | 90 | 57 | 147 |
| 2021 September | 67 | 62 | 129 |
| 2021 August | 72 | 48 | 120 |
| 2021 July | 83 | 34 | 117 |
| 2021 June | 77 | 35 | 112 |
| 2021 May | 91 | 42 | 133 |
| 2021 April | 259 | 89 | 348 |
| 2021 March | 139 | 42 | 181 |
| 2021 February | 91 | 29 | 120 |
| 2021 January | 97 | 35 | 132 |
| 2020 December | 86 | 35 | 121 |
| 2020 November | 121 | 31 | 152 |
| 2020 October | 105 | 26 | 131 |
| 2020 September | 121 | 15 | 136 |
| 2020 August | 78 | 21 | 99 |
| 2020 July | 88 | 31 | 119 |
| 2020 June | 136 | 36 | 172 |
| 2020 May | 119 | 31 | 150 |
| 2020 April | 93 | 19 | 112 |
| 2020 March | 50 | 13 | 63 |
| 2020 February | 59 | 19 | 78 |
| 2020 January | 52 | 19 | 71 |
| 2019 December | 54 | 24 | 78 |
| 2019 November | 48 | 29 | 77 |
| 2019 October | 37 | 7 | 44 |
| 2019 September | 48 | 8 | 56 |
| 2019 August | 28 | 20 | 48 |
| 2019 July | 27 | 15 | 42 |
| 2019 June | 37 | 12 | 49 |
| 2019 May | 49 | 23 | 72 |
| 2019 April | 65 | 32 | 97 |
| 2019 March | 64 | 26 | 90 |
| 2019 February | 42 | 34 | 76 |
| 2019 January | 36 | 15 | 51 |
| 2018 December | 31 | 13 | 44 |
| 2018 November | 69 | 24 | 93 |
| 2018 October | 77 | 26 | 103 |
| 2018 September | 43 | 13 | 56 |
| 2018 August | 4 | 0 | 4 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 35 | 2 | 37 |
| 2018 April | 34 | 8 | 42 |
| 2018 March | 54 | 9 | 63 |
| 2018 February | 52 | 9 | 61 |
| 2018 January | 55 | 11 | 66 |
| 2017 December | 47 | 7 | 54 |
| 2017 November | 40 | 12 | 52 |
| 2017 October | 30 | 9 | 39 |
| 2017 September | 23 | 10 | 33 |
| 2017 August | 31 | 9 | 40 |
| 2017 July | 27 | 13 | 40 |
| 2017 June | 29 | 14 | 43 |
| 2017 May | 39 | 15 | 54 |
| 2017 April | 48 | 24 | 72 |
| 2017 March | 23 | 12 | 35 |
| 2016 December | 1 | 0 | 1 |
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