ABSTRACT
BACKGROUND: A change in healthcare systems is needed, due to the increased prevalence of chronic diseases. Patient empowerment improves results in terms of patient quality of life (QoL) and satisfaction. INTRODUCTION: We have developed a telehealth program Control Telehealth Claudication Intermittent (CONTECI) for patients with peripheral arterial disease (PAD), aimed at enhancing patient satisfaction and QoL, while improving health system efficiency. MATERIALS AND METHODS: We conducted a randomized clinical trial of patients with PAD, at the intermittent claudication stage. Study subjects were randomized into either (1) an intervention arm (IA), which utilized our CONTECI program for promoting patient self-management, or (2) a control arm (CA), utilizing the familiar system of in-person patient visits. All patients were followed up at 1 year. RESULTS: The trial included 150 patients, 75 in each arm. Complications were diagnosed more quickly in the IA (7.85 days standard deviation (SD) 9.95 vs. 53.89 days SD 41.56; p = 0.016) compared with the CA. Rest pain decreased (1.4% vs. 8.4%; p = 0.05) in the IA group, as did the number of scheduled visits-decreased by 95.95%-and the number of emergency visits (p = 0.017). QoL scores in IA patients improved from baseline (67.87 vs. 72.25; p = 0.047), as did patient satisfaction (67.36 vs. 76.78; p = 0.03). DISCUSSION: Telemedicine can improve health results and aid communication and visit scheduling. Our e-Health programs are financially viable. CONCLUSIONS: Self-management using the CONTECI telehealth program is feasible for patients with PAD. The program promotes patient expertise, encourages proactivity, increases QoL and satisfaction with disease control, and improves health resource use, with no evidence of clinical inferiority to conventional practices.
Subject(s)
Intermittent Claudication/therapy , Patient Participation/methods , Patient Satisfaction , Quality of Life/psychology , Self-Management/methods , Chronic Disease , Female , Humans , Male , Telemedicine/methodsABSTRACT
This article contains a review of major new developments in drug treatment and the impact they could have for the general cardiologist. New treatments for arrhythmias, chronic ischemic heart disease, and secondary prevention are changing the practice of clinical cardiology. In addition, recent publications on treatment adherence and therapeutic inertia are discussed. Finally, the work of the Clinical Cardiology and Outpatient Section of the Spanish Society of Cardiology during the last year is described.
Subject(s)
Cardiology/trends , Cardiovascular Agents/therapeutic use , Heart Diseases/drug therapy , Ambulatory Care , Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Humans , Myocardial Ischemia/drug therapy , Secondary PreventionABSTRACT
Se revisan las principales novedades en tratamiento farmacológico y el impacto que pueden tener en la actividad clínica del cardiólogo generalista. Los nuevos tratamientos en el campo de las arritmias, la cardiopatía isquémica crónica y la prevención secundaria están cambiando la forma de actuar del cardiólogo clínico. Se revisa la literatura reciente sobre adherencia al tratamiento y sobre inercia terapéutica. Se describe la actividad que la Sección de Cardiología Clínica y Extrahospitalaria ha realizado en el último año (AU)
This article contains a review of major new developments in drug treatment and the impact they could have for the general cardiologist. New treatments for arrhythmias, chronic ischemic heart disease, and secondary prevention are changing the practice of clinical cardiology. In addition, recent publications on treatment adherence and therapeutic inertia are discussed. Finally, the work of the Clinical Cardiology and Outpatient Section of the Spanish Society of Cardiology during the last year is described (AU)
Subject(s)
Humans , Cardiovascular Agents/therapeutic use , Cardiovascular Diseases/drug therapy , Medication Adherence/statistics & numerical data , Atrial Fibrillation/drug therapy , Myocardial Ischemia/drug therapy , Arrhythmias, Cardiac/drug therapy , Secondary Prevention/methodsABSTRACT
El cardiólogo clínico se enfrenta de forma periódica con la utilización de nuevos tratamientos, normalmente con un incremento importante de los costes sanitarios. En un sistema de recursos limitados ha de saber no sólo identificar los que comportan una mejoría basada en pruebas científicas, sino también ha de tener en cuenta los análisis económicos que indiquen si la mejoría que comporta justifica el coste incurrido. Se revisan los principales conceptos de economía de la salud, así como algunos ejemplos de tratamientos cardiovasculares de reciente introducción (AU)
Clinical cardiologists have to deal regularly with the implementation of new therapeutic techniques, most of which involve a significant increase in healthcare costs. Being in a situation in which resources are limited, physicians must not only identify therapies that improve patient outcome, as shown by scientific evidence, but also take into account economic analyses that indicate whether the improvement gained justifies the cost incurred. This article presents a review of the basic principles of health economics, and illustrates them with some examples involving recently introduced cardiovascular therapies (AU)
