Telemonitoring of Type 2 Diabetes Mellitus in Italy.

BACKGROUND: Type 2 diabetes mellitus (DM) affects 382 million people worldwide. INTRODUCTION: This study aimed at assessing whether telemonitoring (TM) of DM patients improves health-related quality of life (HRQoL). MATERIALS AND METHODS: As part of the RENEWING HEALTH project, 299 DM patients with HbA1c >7.0% were enrolled in a randomized controlled trial, with 208 patients in the TM group and 91 patients in the usual-care group. TM electronically transmitted glucose measurements to physicians during a 12-month follow-up. The SF-36v2 questionnaire was used to assess HRQoL. RESULTS: In a total of 243 patients analyzed, the study did not identify any clinically important improvement in HRQoL, our primary endpoint. There was no statistically significant difference in HbA1c between the two groups; however, outpatient visits and planned hospitalizations were significantly reduced in the TM group (p < 0.0001 and p = 0.02). DISCUSSION: The results regarding HRQoL might be, at least in part, an artifact stemming from the criteria used to select patients. TM reduced ambulatory visits and planned hospital admissions, an important result that plausibly reflects the fact that clinicians can strictly monitor their patients' health status without face-to-face contacts. CONCLUSIONS: Enhancement of HRQoL should represent the most critical goal of DM healthcare delivery. Effects of TM on HRQoL of diabetic patients should be studied further.

The neurosurgical telecounseling network in the Veneto Region: 4 years of experience of HEALTH OPTIMUM.

BACKGROUND: Neurosurgery is a highly specialized service that, because of high costs, is often centralized. Since 2005, a neurosurgical telecounseling service was defined and then deployed in the Veneto Region. It was aimed at creating the same range of services for head trauma by using standardized protocols at regional levels and at rationalizing the use of human and technological resources by providing a network of services that manages patients at the local level. The main objective of the study was to evaluate the use of this service. MATERIALS AND METHODS: Interoperability and flexibility were granted by creating a technological framework based on international standards. Physicians of local hospitals electronically transmit patients' clinical data and images to neurosurgeons located at a central hospital. These physicians respond to the requesting physicians by providing all the necessary recommendations. RESULTS: The outcomes were collected over a period of 41 months. The service is now available in 34 hospitals. Every year 3,181 telecounselings are conducted for patients with an average age of 65.5 years (55% male, 45% female) whose health status is mainly not serious. Within 30 min from the request of telecounseling, 49% of responses are sent. In 84% of cases the patient was not moved. The overall appreciation of clinicians is positive (4.3/5). Intervention time was reduced, and resources were optimized. CONCLUSIONS: The service brought remarkable benefits at the organizational level. The reorganization of the processes and patient management leads to rationalization of both human and technological resources.