in pulmonology and cardiology in Varese the treatment is remote

Better cared for and healthier but staying at a distance. In the future of healthcare, technology will play a growing role. The PNRR provides substantial funding for telemedicine which will allow doctors to visit, monitor and consult with colleagues to ensure that the patient is well for a long time.

THE TELEMACO REMOTE SURVEILLANCE PROJECT

They are already at Asst Sette Laghi some experiences lasting over ten years which, although not strictly related to telemedicine, rely on technology for follow patients remotely, through monitoring systems, readings of recorded parameters and telephone consultations: « We started with the Telemachus Project financed by the Lombardy Region – explains the Dr. Cinzia Gambarini director of pneumology at the Circolo di Varese hospital – Doctor Fausto Colombo activated it for patients being treated at the Cuasso hospital. The service allows patients to be monitored very closely, especially those with chronic pathologies. THEIn pulmonology we talk about respiratory failure and moderate/severe COPD. These patients are monitored weekly by telephone by the nursing team. It is a model that allows doctors to monitor the progress of the disease so as to avoid imbalances, exacerbations and, therefore, visits to the emergency room. A clinic, with a dedicated doctor one day a week, is used for the first and final visits, as well as any other ones, for particular situations during the six months of taking charge”.

REMOTE TAKING CHARGE THAT REASSURES THE PATIENT

There is a dedicated nursing team that establishes a direct relationship with the patient: « We have two types of routes, one low and one high intensity – explains Dr. Gambarini – The patient is included in one of the two programs after the specialist’s visit, if the required characteristics are present based on the results obtained from some tests. He is enrolled in agreement with his general practitioner. Weekly or every 15 days, the patient receives a phone call in which he is asked for some parameters that he can obtain on his own using a simple device, the oximeter. Here, the organizational part requires a minimum of health education: our nurses explain how to use the device and give advice for a better quality of life. I assure you that this constant control and responsibility lead the patient to respect the rules, take care of themselves and collaborate with the result.”

Remote management lasts approximately 6 months: “The moment of separation is always difficult – comments the head doctor – because the assistance network, even distant, creates security”.


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250 PATIENTS FOLLOWED EVERY YEAR BUT THE OBJECTIVE IS TO EXPAND THE AUDIENCE

The results obtained in these 10 years demonstrate that the model is effective, both from the point of view of the progress of the pathology, given that the decompensation in cases of COPD is often very serious, and for the adoption of correct lifestyles: « Our goal is to increase patient recruitment. Today we have a standard number of cases that we can follow – adds Dr. Gambarini – but regional discussions are underway to strengthen the platform and broaden the caseload. Today we are unable to follow cases of mild COPD and this is because it is very difficult to detect it. It is a pathology that is not recognised, it is defined as an orphan because, even on the part of patients, there is no awareness. They think they have a bit of a cough, chronic bronchitis, and it’s trivialized.”

At the moment pneumology follows approximately 250 patients per year and among these there is also a small number of heart patients.

TELE SURVEILLANCE ALSO FOR PATIENTS WITH HEART FAILURE

The teleconsultation involves all the people Cardio thorax vascular department. The dedicated nursing team is identical: « Multidisciplinarity leads to the construction of integrated models and paths – explains the Dr. Battistina Castiglioni Director of the Department – a cardiologist is always on a team with the pulmonologists. At the moment, teleconsultation for heart failure is a niche, which concerns a low number of patients compared to what our plans would like to be. Among the objectives there is a platform capable of recruiting all patients discharged from cardiology so as to include them in the heart failure path. In community homes we have already created a path for the chronic and fragile decompensated patient who sees a dedicated doctor, on a particular day of the week, for check-ups or first visits. You work for intercept the onset of unstable clinical pictures early avoiding visits to the emergency room. Being able to expand the telemedicine service would allow us to achieve this result in a more structured and probably numerically greater way because we would be able to intercept a much higher number of patients.”

REMOTE CONTROL OF THE DEVICES IMPLANTED IN THE HEART

For telemedicine to become a strategic asset of healthcare, some steps are still missing, both of a bureaucratic, administrative and technological nature: « Cardiology also has years of remote control of implanted devices behind it , monitored by cardiology technicians qualified in electrophysiology. They are checks on the progress of the devices both with regards to the arrhythmia profile and for heart failure.”

TELEMEDICINE WILL ALLOW INTEGRATION BETWEEN CENTRAL AND PERIPHERAL HOSPITALS, SPECIALIST AND GENERAL PRACTICE DOCTORS

For the future, Dr. Castiglioni sees greater integration between central and peripheral hospitalsbetween specialists and general practitioners who will be able to consult directly, with shared data so as to promptly define the path and keep the patient under control: «Everyone will be part of the model, even the patients called to be responsible, aware of why they follow the treatments and investigations, to maintain appropriate lifestyles and not to make autonomous decisions”.

THE CENTRAL ROLE OF NURSES

A more present medicine even if from a distance: « We discovered this with Covid and now a model is being refined which, in the long run, will also allow staff to be better organised. All healthcare workers will be involved, starting with nurses whose role will become even more central and professional – comments Dr. Giamberini – Today there is a lack of staff but we can count on a specialized nursing team of 4 people which is an excellent result. In the future, evolution will allow us to review models and paths, integrating the entire system, so as to rationalize and make everything more efficient.”

PERSONALIZED MEDICINE AND PRESCRIPTIVE APPROPRIATENESS

And another fundamental effect will also derive from the synergy: «It is expected greater prescriptive appropriateness, adherence to needs in a shared way – underlines Dr. Castiglioni – Tests and checks will be carried out when there is a reason. We will arrive at personalized medicine and in personalization there will be greater appropriateness of the therapeutic path. But patient empowerment will be fundamental in this process. When he is brought on board, it will be necessary to give him the technical tools but also information, education, nursing counseling for an awareness of the pathology that strengthens the relationship of trust between doctor and patient, built on the awareness that monitoring is able to alert the structure available for any instability of the clinical picture”.

Sharing, appropriateness, technology and patient empowerment: medicine will have to change in the future. Starting with the patients.

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