Means and Resources
Role of information technology
successful IT solutions in ambient assisted living and smart housing
COUNTRY / LOCATION: Spain
Keywords: LTC management, telemonitoring, home medical care, COPD management, quality of life
Keywords: LTC management, telemonitoring, home medical care, COPD management, quality of life
AMICA – Telemonitoring system for COPD patients
Summary
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD causes high levels of disability and care needs and it has a great epidemiological, clinical, social and economical impact.
New technologies enable the development of tools and systems to achieve a better management of chronic diseases. In this line, the Spanish University of Cadiz is promoting a research project to construct and validate a telemedicine system for COPD patients. The project has been funded by the European Ambient Assisted Living Joint Programme.
The AMICA solution aims to provide home care for older people affected by COPD. The technological support will allow for self-management of the disease, medical monitoring as well as the enhancement of the social interaction of the patients.
The potential impact is to predict and prevent exacerbation, to reduce hospitalisation and healthcare costs, and to improve patients’ and informal caregivers’ quality of life.
What is the main benefit for people in need of care and/or carers?
The main benefit is the early detection of COPD exacerbations and increased self-management of the disease by the patients in their own home. But in general, the AMICA supports the possibility of ageing well at home, by enjoying a longer, healthier, and higher quality of daily life assisted by technology to maintain a high degree of independence, autonomy and dignity.
What is the main message for practice and/or policy in relation to this sub-theme?
The main message for policy makers is that the use of ICT at home can make the health and social resource network more affective and efficient, with a reduction in health costs.
Why was this example implemented?
The Autonomy Motivation & Individual Self-Management for COPD patients’ (AMICA) project develops disease management and medical care of chronic obstructive pulmonary disease (COPD) patients through the use of information and communication technologies (ICT).
COPD is the major cause of mortality and increased levels of disability and dependency, particularly amongst older people. Symptoms include breathlessness, dyspnoea, abnormal sputum and chronic cough (Global Initiative for Chronic Obstructive Lung Disease, 2008).
Telemedicine has been identified as an appropriate system to manage and control chronic diseases, such as COPD, as they cover two main gaps in the long term care of COPD patients: prevention and medical care at home. On one hand, prevention for COPD patients is focused mainly on the prevention of exacerbations. COPD exacerbations can lead to severe clinical consequences for the patients and generate high expenditures for the health care system. More precisely, frequent exacerbations are associated with impaired quality of life and a rapid decline in lung function (Seemungal et al, 1998; 2000). Telemedicine can demonstrate a reduction in the number of hospitalisations and in the number of exacerbations (Pare et al, 2006; Pare et al, 2007; Jaana et al, 2009). On the other hand, telemedicine allows the patient to be maintained at home longer, providing them with health and social care. As a result, patients will have more autonomy, thus increasing both their quality of life and reducing the burden on their informal caregivers.
The target group of the AMICA solution are people affected by COPD and their informal caregivers.
Description
AMICA provides disease management and medical care to patients suffering from COPD by means of an integrated telemedicine system:
- A multifunctional biomedical sensor records breathing and monitors the heart rate, physical activity and tracheal sounds. It also displays variables and physiological parameters relevant to COPD and respiratory-related dysfunctions.
- AMICA service counts using a telemedicine platform especially adapted for disease management and also to fit with the needs of older people. This platform is designed to be used at home by the patients and their informal caregivers, with a monitoring and recording system remotely available for the health care professionals. Organisation and funding systems are being studied at this stage of the project.
The AMICA system is being developed under a user-centred design process with an emphasis on early end-user inclusion (Crespo et al, 2009).
The project has been co-funded by the European Ambient Assisted Living Joint Program, by each participant’s national funds and by the seven project partners. The initial idea was launched from Spain and the inclusion of Germany and Greece are, respectively, due to its more advanced implementation of telemedicine in the health care system and their specific engineering knowledge on telemedicine.
A German telemedicine provider and a Spanish hospital are testing the system with health care professionals and end-users affected by COPD. In addition, various health care professionals and experts in telemedicine are contributing to the development of the system with their knowledge.
The project started in April 2009 and has a total budget of €2.7 million for a period of 3 years.
What are/were the effects?
The evaluation process follows two steps. The first is a demonstration of the telemedicine system focusing on short term evaluation of aspects such as usability and end-user acceptance. The second includes a long term pilot application of the entire disease management solution. Some of the aspects that will be addressed are effects on disease progression, quality of life, patients’ compliance and sustainability of business models.
All data obtained during the evaluation will contribute to the assessment of the potential impacts of the system in COPD patients, including the prevention of the worsening of the illness and the efficiency in the management of the disease by the patients at their own home.
Even thought there is not clear evidence about the impact until the evaluation is performed, some expected benefits can be defined:
- Early detection of COPD exacerbations. This fact will help to avoid hospitalisation and to enhance quality of life of older COPD patients.
- High acceptance of the AMICA service between patients, their relatives, health and social care professionals and those responsible for health and social care services thanks to its user-centred design focus.
- Remote monitoring and home-based care by the integration of a technical solution with a holistic service approach.
- Increased prevention and self-management.
- Increased levels of therapy compliance.
- Reduction of public health care costs.
What are the strengths and limitations?
Strengths
- The increasing use of ICTs in society means that patients, health and social care professionals and policy-makers are gradually becoming more accepting of these sorts of approaches.
- Support the possibility of ageing well at home, that is, enjoying a healthier and higher quality of daily life for longer, assisted by technology, while maintaining a high degree of independence, autonomy and dignity. The system will give, in this sense, a higher control of disease, reducing the number of hospitalisations and use of health care system and promoting care at home.
- Increased professional provision of social and health care.
- The transferability from one country to another is high, even more if countries have an active market of telemedicine companies.
- Based on the use of a simple and easy-to-use sensor at home for monitoring COPD patients.
Weaknesses
- Lack of integration of telemedicine systems based on new technologies within public institutions in Spain.The technology already exists, but the government has not taken a policy decision to widely use it.
- Scarce existing legislation and regulation regarding telemedicine systems.
- Absence of specific training of health care professionals for using and managing telemedicine systems.
- Low awareness of the availability of these kinds of products and services.
- Reluctance, especially of older people, to use ICT (digital divide).
- Concern about the replacement of care provided by a real doctor with the care provided by technological system.
- Especially at the beginning, the system may be expensive for the users.
Opportunities
- Improving quality of care: avoiding isolation, preventing hospitalisation, reducing length-of-stay in hospitals, reducing therapeutic errors.
- Reduction of health costs: automation of health care at home, integrating applications, increasing productivity and reducing costs of communication services.
Threats
- Reluctance in the use of the system by the patients, due to lack of knowledge and understanding on how it operates.
- The lack of understanding of market mechanisms that makes it difficult to integrate telemonitoring services in the existing health and social care systems.
- Lack of organisational procedures and interaction with current models of health services.
- The system’s benefits are not always perceived by end users and their relatives.
Credits
Author: Laura CorderoReviewer 1: Hannelore Jani
Reviewer 2: Satu Meriläinen
Verified by:
Links to other INTERLINKS practice examples
- E-health unit
- Quality management of integrated stroke services
- Smart Call: Monitoring and signalization technologies within integrated LTC measures
External Links and References
Contact:
Peer reviewed journals/systematic reviews:
- Crespo, L.F./Sanchez, D./Crespo, M./Gross, N./Kunze, C./Giokas, K./ Jiménez, J.A. (2009) ‘AMICA telemedicine platform: a design for management of elderly people with COPD’ in: Proceedings for the 9th International Conference on Information Technology and Applications in Biomedicine (ITAB 2009), Larnaca, Cyprus.
- Jaana, M./Pare, G./Sicotte, C. (2009) ‘Home Telemonitoring for Respiratory Conditions: A Systematic Review’ in: The American Journal of Managed Care 15(5): 313-320.
- Pare, G./Jaana, M./Sicotte, C. (2007) Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base. Journal of the American Medical Informatics Association 14(3): 269-277.
- Pare, G./Sicotte, C./St-Jules, D./Gauthier, R. (2006) ‘Cost-Minimization Analysis of a Telehomecare Program for Patients with Chronic Obstructive Pulmonary Disease’ in: Telemedicine Journal and e-Health: The Official Journal of the American Telemedicine Association, 12(2): 114-121.
- Seemungal, T.A./Donaldson, G.C./Bhowmik, A./Jeffries, D.J./Wedzicha, J.A. (2000) ‘Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease’ in: Am J Respir Crit Care Med. 161: 1608-13.
- Seemungal, T.A./Donaldson, G.C./Paul, E.A./Bestall, J.C./Jeffries, D.J./Wedzicha, J.A. (1998) ‘Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease’ in: Am J Respir Crit Care Med. 157:1418-1422
Unpublished/web-based documents:
- Global Initiative for Chronic Obstructive Lung Disease (2008) Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Medical Communication Resources, Inc.
