远程医疗对降低医疗条件薄弱地区患者心血管危险的作用课件

Telemedicine Impact on Reducing Cardiovascular Risk in Underserved Patients? William P. Santamore, PhD, Carol Homko, PhD, Robert Cross, MD, Michele Masucci, PhD, Philip Berger, Alfred A. Bove, MD, PhD Temple University, Philadelphia, PA 15th GW-ICC 2004 Temple Telemedicine Research Center 远程医疗研究中心 我愿借此机会向盛情邀请我为本次长城会议 主席团成员的胡大一先生表示由衷的感谢。 同时也对那些为此而付出辛勤劳动的工作人员表 示感谢。 我还要感谢我的同事们： Bove, Homko, Masucci, and Cross 医生, 以及我们的试验员 Philip Berger What is Telemedicine? nUse of medical information exchanged from one site to another via electronic communications for the health and education of the patient or health care provider for the purpose of improving patient care Telemedicine - Approaches Non-Face-to-Face Transactions Traditional Approach Image, X-rayMailed Medical Specialists Reviews and Sends a Report Telemedicine Approach Electronic Transfer Image, X-ray Medical Specialists Reviews and Sends a Report Examples - Radiology, Dermatology, Pathology Telemedicine - Approaches Traditional Face-to-Face Patient (+ Doctor) Patient (+ Doctor) Doctor or Specialists Doctor or Specialists Via Video Conferencing In Same Room Traditional Approach Telemedicine Approach Examples Office Visit, Consultation Telemedicine - Approaches Non-Traditional Asynchronous Doctor not in direct contact with Patient Examples Letter to Doctor Telephone Call to Nurse E-mail Telemedicine - Approaches Non-Traditional Asynchronous Telemedicine Approach BP, Weight, Steps PatientDoctor Internet Secure Telemedicine System Internet Outline nElements Driving Design nNational Priority Computerize Medical System nHigh Rate of CVD Risk Factors nObesity nCost Increased Risk for Cardiovascular Disease in African-Americans nCompared with white women, African-American women are more likely to live in poverty, and have less education; nExperience greater weight gain during childhood, and have lower resting metabolic rates, physical activity energy expenditures. nAbout half of African-American women are considered obese (BMI 30), nmore than 15% between 40 to 59 yrs old have extreme obesity (BMI 40) Increased Risk for Cardiovascular Disease in African-Americans nAAs have a prevalence of diabetes: n19% for AA women compared to 7% for white women, and n16% for AA men compared to 8% for white men nAAs have a 40% greater prevalence of hypertension compared to whites. nRoughly 1 in 3 AAs has hypertension. nAAs have a rate of multiple risk factors. Implications nAfrican-American have a high prevalence of CVD risk factors. nThese risk factors can be effective treated with current medical therapy. nSuboptimal control of risk factors contributes to the excess CVD mortality among AAs. Main Study nTest if a Telemedicine System nby Frequent Communication with Health Care Providers and nby Education nCan Decrease Cardiovascular Disease Risk in Underserved Patient Populations. Main Study nDesign 450 patients with 10% or Greater CVD Risk & with treatable CVD Risk Factors nGoal 5% in CVD Risk nSubjects - AA and Rural White PA Patients nExpected Outcome 25% Controls in CVD Risk 37.5% Telemedicine in CVD nWhy in Medication Better Control of HTN, Hyerlipidermia Less Tobacco Abuse Diabetes Control Timing Office Visits, Lab Testing Telemedicine Study Design Recruitment Questionnaire, Training, Randomization Standard Care Standard Care +Telemedicine Monitoring / Feedback / Education / Communication BP, Weight, Steps, Medication Final Visit / Questionnaire Primary End-Point 5% or Greater in CVD Risk at 1 year Quarterly Assessments Increased Risk Telemedicine Intervention Change in Behavior Reduced Risk Cognitive Change Patient Factors Doctor Factors Baseline Assessment nBlood Pressure, Lipids, Smoking, Diabetes nQuestionnaires nMedical Knowledge, nHealth Locus of Control, nSelf-Efficacy, nDiabetes Empowerment nSix Minute Walk Test CVD Risk at Baseline Age62.6 yrsTotal Cholesterol 201.8 Male / Female 64% / 36%HDL49.1 Race59% AALDL116.8 BMI30.1Smokers19% Systolic BP136.6 Diabetes43% Diastolic BP79.0CVD Risk Min - Risk 15.7 4.3 SexAgeHTNTobaccoLipidsDiabetesCVD Risk Optimal Risk * M50-+-20%2% F49-+12%2% F62+-+14%2% M67+-+29%6% M54+-21%2% Typical CVD Risk at Baseline * Circulation 97:1837- Telemedicine Screens nPatientDoctor nInput DataPt Review nMedicationsMedications nCurrent RiskLab Data nTrendsScheduler nEducationUser Log Feedback to Practice TTRC Telemedicine System DoctorPatient Monthly and Quarterly Reports Sent to Both Patient and Doctor Feedback to Practice “Your patient has been provided with a copy.” Framingham CVD Risk Score: 12% Blood Pressure (mmHg) 167/86*Weight (lbs) 137 Pulse (beats/min) 102*Body Mass Index 25.1 SpO2 (%) 986 minute walk test (ft) 936 Cigarettes per Day 0 Fasting Blood glucose (mg/dl) 324*Total Cholesterol (mg/dl) 267* HDL (mg/dl) 40* Hbg A1c (%) 12.9*LDL (mg/dl) 130* Triglycerides (mg/dl) 486* Urine microalbumin (mg/L) 30.1* Urine microalbumin/creatinine ratio (mg/g) 80* Telemedicine Current Use Sending DataPercent of Patients At least Weekly64% Every 2 Weeks14% 2 Weeks11% Never11% Requested Retraining11% Telemedicine Patient Trends Telemedicine Patient Trends Telemedicine Patient Trends Expected Outcomes nTelemedicine Group CVD Risk than the Control Group nWhy Better control of BP, Lipids, Smoking Cessation nDetermine Factors Contributing to Success and to Failure Planned Updates Temple