a new telemedicine approach for chronic hiv/aids patient

University of Calgary

PRISM: University of Calgary's Digital Repository

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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


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

(Fauci et al., Ann Intern Med 1996)


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


Change on AIDS treatment paradigm

AIDS terminal patientPalliative care

HIV chronic patientNormal life(with special needs)

Antiretroviral drugs


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


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


HIV/AIDS framework

Partner

Family

Friends

H.I.V.Pharmacist

G.P.

NurseSocialworker

PsychologistVolunteers

PublicHospitals

Primary careDrug centers

Penitentiarysystem

Civil serviceRegionsLaboratories

NGOs

Other services


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)


VIHrtual Hospital Description


System architecture

DMZ

InternetInternet

Patient PC

VIHrtualDB

Intranet

ADSL

PHARMACYDB

Administrator PC

Professional PC

VPNFirewall

VIHrtualWeb Server

Router

AIDSDB

Hospital Patient’s home


VIHrtual Hospital Services


Users

Professional user

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

Patient user


Security issues

Anonimize data

Cipher database

Backup copies

Use of certificates

VPN

Secure access through fingerprints

Checking forms

Access registry

Fast and secure maintenance


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)


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


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)


Shared care example


Virtual consultation: “present”


Virtual consultation: videoconference


Virtual consultation: chat


Virtual consultation: messages


Managing appointments


Adapting the existing EPR


EPR management


Including the psychological history


Including the social history


Including the nursing history


Evolution graphs


Telepharmacy


Treatments


Virtual communities


Virtual library

a new telemedicine approach for chronic hiv/aids patient

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