Background Recent scientific advancements, particularly in the medical field, combined with prevention campaigns and personalized therapies, have significantly altered the population pyramid, manifesting in a marked increase in life expectancy. However, this has also led to a rise in the prevalence of chronic diseases, often characterized by recurrent hospitalizations, inadequate quality of life, and a need for prolonged and continuous care, as well as substantial resource allocation. Specifically, in the case of end-stage renal disease, the average annual cost per patient requiring dialysis is estimated at approximately €34,000. Recognizing the necessity of developing new care models and in alignment with the " Piano Nazionale Cronicità "- which identifies as a primary goal the management of chronic conditions by keeping patients within their daily life context and minimizing, if not avoiding, the risk of institutionalization - this study was conducted to evaluate the use of telemedicine in supporting peritoneal dialysis clinics. Objective The primary goal of this study on telemedicine applied to peritoneal dialysis is to increase the adoption of peritoneal dialysis among the dialysis population while reducing the prevalence of patients undergoing hemodialysis. The evaluated outcomes include: patients’ quality of life, the number of emergency department visits, hospitalizations, management of medical and nursing resources, and cost analysis. Materials and Methods This observational study was conducted from September 2021 to November 2023, involving 27 patients who collectively participated in 103 telemedicine sessions. The system was tested for the purposes of training, support during dialysis procedures, and remote consultations. The equipment employed consisted of TOTEM®-TESISQUARE, a control station, a centralized IT control center, eViSuS Biocare®-TESISQUARE, and Sharesource®-BAXTER, USA. Results During the study period, there were no cases of exit-site infections, tunnel infections, or peritonitis; no emergency visits were recorded, with only one hospitalization due to bilateral pneumonia and one instance of converting a teleconsultation to an in-person visit. The average duration of a telemedicine session was approximately 26 minutes. Conclusion The use of telemedicine in peritoneal dialysis proved advantageous for patient management and the monitoring of potential complications, enabling more appropriate and timely referrals to outpatient clinics or hospital facilities. It also demonstrated efficiency in the organization of healthcare resources. Remote support during dialysis procedures enhanced patients’ confidence with the method, improved patient eligibility, and facilitated proper assistance to patients and caregivers, resulting in improved patient quality of life and reduced complications and unnecessary hospital visits.
Introduzione Il progresso scientifico di quest’ultimi anni, e in particolare le innovazioni in campo medico, allineati alle campagne di prevenzione e terapie sempre più personalizzate, hanno contribuito nettamente alla modifica della piramide demografica, delineando in essa un evidente aumento dell’aspettativa di vita. Questo però si traduce anche in aumento dell’incidenza e della convivenza con più malattie croniche, caratterizzate da ricoveri ricorrenti, una qualità di vita spesso inadeguata, nonché richiedono una continuità assistenziale per periodi di lunga durata oltre ad un notevole impegno di risorse. Nello specifico dell’insufficienza renale in fase terminale, si stima una spesa media di circa 34,000 euro/anno per ogni paziente con necessità di dialisi. Prendendo atto della necessità di pensare a nuovi modelli di assistenza, e in linea con il “Piano Nazionale Cronicità” - che suggerisce come obiettivo primario nella gestione della cronicità, quello di mantenere la persona malata all’interno del suo contesto di vita quotidiana e impedire, o ridurre al minimo, il rischio di istituzionalizzare il paziente - si è svolta la seguente esperienza nell’utilizzo della telemedicina a supporto dell’ambulatorio di dialisi peritoneale. Obiettivo L’obiettivo principale di questo studio sulla Telemedicina applicata alla dialisi peritoneale è incentrato all’incremento dell’utilizzo della dialisi peritoneale nella popolazione dialitica, riducendo l’incidenza di pazienti in trattamento emodialitico. Gli outcomes valuti sono: Qualità di vita dei pazienti, Il numero di accessi in pronto soccorso, il numero di ricoveri, la gestione delle risorse mediche e infermieristiche, e l’analisi dei costi. Materiali e metodi Questo studio di tipo osservazionale è stato svolto da settembre 2021 a novembre 2023; sono stati arruolati 27 pazienti con un totale di 103 prestazioni di telemedicina. Il sistema è stato sperimentato con le finalità di training, assistenza durante le procedure dialitiche e visite a distanza. La strumentazione utilizzata è composta da TOTEM ®-TESISQUARE, stazione di controllo, centrale di controllo informatico, eViSuS Biocare®-TESISQUARE e Sharesource®-BAXTER, USA. Risultati Nel periodo in esame sono stati riscontrati 0 infezioni dell'exit-site, 0 infezioni del tunnel, 0 casi di peritonite, 0 accessi in Pronto Soccorso, 1 solo ricovero ospedaliero per polmonite bilaterale e 1 conversione in visita di persona. La Televisita aveva una durata media di circa 26 Minuti. Conclusione L’utilizzo della telemedicina in dialisi peritoneale si è rilevato vantaggioso nella gestione del paziente e monitoraggio di eventuali problematiche, permettendo di indirizzare i pazienti verso gli ambulatori o il presidio ospedaliero con maggior appropriatezza e tempestività il paziente. Si è rilevata inoltre efficiente nell’organizzazione delle risorse sanitarie. L’assistenza a distanza durante le procedure dialitiche ha permesso di aumentare la confidenza con la metodica e l’eleggibilità dei pazienti. Ha permesso di assistere in modo coretto pazienti e caregiver con effetto un miglioramento della qualità di vita del paziente e minor insorgenza di complicanze e accessi ospedalieri impropri.
Dialisi peritoneale: i vantaggi della telemedicina nella gestione e monitoraggio del paziente
NATOIMADINE MANKO, DJIMINGUEBAYE
2023/2024
Abstract
Background Recent scientific advancements, particularly in the medical field, combined with prevention campaigns and personalized therapies, have significantly altered the population pyramid, manifesting in a marked increase in life expectancy. However, this has also led to a rise in the prevalence of chronic diseases, often characterized by recurrent hospitalizations, inadequate quality of life, and a need for prolonged and continuous care, as well as substantial resource allocation. Specifically, in the case of end-stage renal disease, the average annual cost per patient requiring dialysis is estimated at approximately €34,000. Recognizing the necessity of developing new care models and in alignment with the " Piano Nazionale Cronicità "- which identifies as a primary goal the management of chronic conditions by keeping patients within their daily life context and minimizing, if not avoiding, the risk of institutionalization - this study was conducted to evaluate the use of telemedicine in supporting peritoneal dialysis clinics. Objective The primary goal of this study on telemedicine applied to peritoneal dialysis is to increase the adoption of peritoneal dialysis among the dialysis population while reducing the prevalence of patients undergoing hemodialysis. The evaluated outcomes include: patients’ quality of life, the number of emergency department visits, hospitalizations, management of medical and nursing resources, and cost analysis. Materials and Methods This observational study was conducted from September 2021 to November 2023, involving 27 patients who collectively participated in 103 telemedicine sessions. The system was tested for the purposes of training, support during dialysis procedures, and remote consultations. The equipment employed consisted of TOTEM®-TESISQUARE, a control station, a centralized IT control center, eViSuS Biocare®-TESISQUARE, and Sharesource®-BAXTER, USA. Results During the study period, there were no cases of exit-site infections, tunnel infections, or peritonitis; no emergency visits were recorded, with only one hospitalization due to bilateral pneumonia and one instance of converting a teleconsultation to an in-person visit. The average duration of a telemedicine session was approximately 26 minutes. Conclusion The use of telemedicine in peritoneal dialysis proved advantageous for patient management and the monitoring of potential complications, enabling more appropriate and timely referrals to outpatient clinics or hospital facilities. It also demonstrated efficiency in the organization of healthcare resources. Remote support during dialysis procedures enhanced patients’ confidence with the method, improved patient eligibility, and facilitated proper assistance to patients and caregivers, resulting in improved patient quality of life and reduced complications and unnecessary hospital visits.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/78890