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?
Use 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-ray
Mailed
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
Patient
Doctor
Internet
Secure Telemedicine System
Internet
Outline
Elements Driving Design
National Priority – Computerize Medical System
High Rate of CVD Risk Factors
Obesity
Cost
Increased Risk for Cardiovascular Disease in African-Americans
Compared with white women, African-American women are more likely to live in poverty, and have less education;
Experience greater weight gain during childhood, and have lower resting metabolic rates, physical activity energy expenditures.
About half of African-American women are considered obese (BMI > 30),
more than 15% between 40 to 59 yrs old have extreme obesity (BMI > 40)
Increased Risk for Cardiovascular Disease in African-Americans
AA’s have a ? prevalence of diabetes:
19% for AA women compared to 7% for white women, and
16% for AA men compared to 8% for white men
AA’s have a 40% greater prevalence of hypertension compared to whites.
Roughly 1 in 3 AA’s has hypertension.
AA’s have a ? rate of multiple risk factors.
Implications
African-American have a high prevalence of CVD risk factors.
These risk factors can be effective treated with current medical therapy.
Suboptimal control of risk factors contributes to the excess CVD mortality among AA’s.
Main Study
Test if a Telemedicine System
by Frequent Communication with Health Care Providers and
by Education
Can Decrease Cardiovascular Disease Risk in Underserved Patient Populations.
Main Study
Design – 450 patients with 10% or Greater CVD Risk & with treatable CVD Risk Factors
Goal – 5% ? in CVD Risk
Subjects - AA and Rural White PA Patients
Expected Outcome – 25% Controls ? in CVD Risk
37.5% Telemedicine ? in CVD
Why – ? in Medication
Better Control of HTN, Hyerlipidermia
Less Tobacco Abuse
Diabetes Control
Timing Office Visits, Lab Testing
Increased Risk
Telemedicine Intervention
Change in
Behavior
Reduced Risk
Cognitive
Change
Patient Factors
Doctor Factors
Baseline Assessment
Blood Pressure, Lipids, Smoking, Diabetes
Questionnaires –
Medical Knowledge,
Health Locus of Control,
Self-Efficacy,
Diabetes Empowerment
Six Minute Walk Test
CVD Risk at Baseline
Typical CVD Risk at Baseline
* Circulation 97:1837-
Telemedicine Screens
Patient Doctor
Input Data Pt Review
Medications Medications
Current Risk Lab Data
Trends Scheduler
Education User Log
Feedback to Practice
TTRC
Telemedicine System
Doctor
Patient
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%
Telemedicine – Current Use
Telemedicine – Patient Trends
Telemedicine – Patient Trends
Telemedicine – Patient Trends
Expected Outcomes
Telemedicine Group > ? CVD Risk than the Control Group
Why – Better control of BP, Lipids, Smoking Cessation
Determine Factors Contributing to Success and to Failure
Planned Updates
Temple Telemedicine Research Center
Thank You
Williamsantamore@hotmail.com
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