Anna Giulia Cattaneo, DBSM, University of Insubria, Varese,
The term telemedicine is the neologism used to indicate
the exchange of health information with electronic means,
involving different programs, technologies and persons.
The use of electronic means to communicate between general
practitioners and specialized centers (the referral and medical
education services) or the consultation of a doctor by a outpatient
or its care givers via telecommunications is the simplest
and oldest area in this field.
Newer technologies are available or under study, their exploitation
appears in some cases of interest for the geriatric care.
The simplest case involves common media - radio, television
- or, more focused on patient's needs, personal phone calls
and relationships with the web. The aged person, or its care
givers, can use the phone or be instructed to use special
web connection to obtain standard or personalized instructions
for improving welfare. While useful, this kind of "distance
learning" can eventually suffer from insufficient control,
for the privacy in managing sensitive data and for the quality
of the services, if not given by a sufficiently qualified
A further step is the use of tele-rehabilitation after discharge
from acute care at the hospital, for example after bone surgery
or cardiovascular events, when the limited mobility added
to the age can seriously affect the ability to reach the outpatient
clinic for periodical updating.
More sophisticated are the systems for continuous monitoring
of patients with unstable conditions, whose health conditions
can eventually promptly became critical and life threatening.
The telemedicine offers for the first time a non invasive
technique to keep in constant contact outpatients with unstable
conditions, and those at risk of rapidly evolving and life
threatening conditions and their care givers, without interfering
with the daily activities of the patient. Thus, this last
can attend to its normal activity, including eventual job
and leisure without interrupting the contact with the care
An increasing number of vital or metabolic parameters can
be registered, the marketed sensor systems more diffuse at
the present are those monitoring the cardiovascular conditions
(as pulse, blood pressure, electrocardiography, oxygen saturation
in blood), and those for metabolic control, especially dedicated
The simplest model of a telemedicine system includes a miniaturized,
portable sensor (e.g. electrodes, glycaemia and metabolite
automatic meter) with a transmitter, carried by the patient,
a receiving antenna placed in the central (e.g. the emergency
room of a hospital) and an intervention team, resident (e.g.
a consultant physician or nurse) or mobile (e.g. an ambulance).
The portable devices became more and more sophisticated and
easy to carry, the transmitter is often incorporated to send
automatically data, without the need of a manual intervention.
It can also be independently built: for example the patient
or the care giver can send data through a personal computer,
when needed. Data are collected periodically or in real time
by a central, and the medical team alerted when a prompt intervention
is needed, or simply notified about the health conditions
of the subjects taken in care. The team can intervene directly
or plan an update of the therapy discussing it with the subject.
The USA database of clinical trials, freely accessible, lists
a considerable number of trials aimed to the evaluation of
the advantages, if any, of these technology in comparison
with more traditional schemas for care, several of them admit
older subjects or are especially designed for the geriatric
The previously described main fields of exploitations of telemedicine
are validated by consulting this database: most trials are
aimed to evaluate the goodness of remote care for orthopaedic
consultation and follow-up, follow-up of subjects affected
by chronic obstructive pulmonary diseases or sleep apnea,
or the successfulness of the cure of pressure sores. Special
devices are tested to monitor subjects affected by hypertension,
chronic heart failure, or type 2 diabetes mellitus. Rehabilitation
after stroke and acute heart failure are also considered as
remote, education, therapy control and updating.
A newer area of interest is the remote control of the home
environment for aged person suffering from dementia or visual
impairment. The field presents some rational, and however
it seems to be of ethical concern. The noise of continuous
control of the every-day life should be carefully evaluated,
especially for poorly adaptive and poorly consentient individuals,
as patients affected by dementia.
While the telemedicine seems to be of particular interest
in countries with rural or poorly populated regions, the geographical
distribution of trials involves also industrialized regions,
especially in the USA. One of the most active countries seems
to be the South Korea, whose government has recently validated
the adequacy of the resources o telemedicine for the needs
of its territory. In Europe the field is followed with interest
by France, Norway and Russia, among others. While not being
a remote rural region, the heavy populated Italy should not
be absent from the largest multicentered trials, to avoid
the flourishing of self-made, poorly controlled and poorly
validated habits in a medical area involving an increasing
number of its inhabitants.
Anna Giulia Cattaneo, DBSM, University of
Insubria, Varese, Italy
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