Home long terms oxygen treatment in Italy : the additional value of telemedicine

The development of new therapeutic strategies and the minimization of both direct and indirect costs represent crucial goals in the management of chronic diseases, particularly when these are characterized by a high degree of disability. Chronic respiratory insufficiency (CRI) represents an example of a persistent disease worldwide, for which home management (i.e., daily nursing and treatment) was introduced more than two decades ago according to traditional operating protocols. Home long-term oxygen treatment (H-LTOT) was expected to produce significant clinical improvements, together with a substantial drop in CRI social costs (e.g., hospital admissions, number of exacerbations, pharmaceutical costs, and patienta (TM)s reduced productivity). The present volume describes the evolution in the home management of severe CRI over the last two decades in Italy. It reviews a range of topics including the epidemiological aspects, complicating events, current systems for oxygen delivery with the most convenient interfaces, changing approaches to the patient--caregiver relationship, and the economic burden. Particular attention is paid to the new trends in telemedicine, which is regarded as the future step in respiratory medicine for home-assisted and home-ventilated patients. Data concerning the new role of nursing, the patienta (TM)s expectation of life, and the patienta (TM)s, family's, and doctora (TM)s perspective are also reported, together with an update on the economic impact of telemedicine and the continuing improvements in the quality of telematic H-OTLT As an American, I recently began extending visits to friends in Italy by meeting families providing "agriturismo". My Italian speaking wife Evi (Eveline Faure, MD, FCCP, a graduate of the Università Italiana per Stranieri, Perugia) made this p- sible. During one visit in 1994,we were sitting around the table in Pisa with friends who were fellow critical care physicians. They were remarking how specialists needed more patients. We told them that we were going south beyond Naples, a concept which they could not understand, considering the beauty of Tuscany. We had a marvelous time in southern Italy, meeting warm and welcoming people, surely one of the greatest resources of all Italy. While in Calabria, I noted there were so many people on the streets joyfully communicating on their cell phones. (This was before cellular technology became so popular in the USA). Evi commented how tele-communication had advanced in Italy; she remembered how it took three hours to make a phone call with a jetton only a few years before. Later, in a small town (Revello, Basilicata), we met a w- derful young family who told us how difficult it was to get medical care. Yes, they had good general physicians, but it was hard to reach specialists many kilometers away. At the time, we were staying on a farm with an elderly couple, who invited us to join them to share meals. During conversation, I learned that the farmer had chronic lung disease and required long-term oxygen. He, too, found it difficult to get the care he needed in rural Italy Introduction....Pages 1-2 Telemedicine in Respiratory Care....Pages 3-14 Home Long-Term Oxygen Treatment (H-LTOT): Why, Where, and How....Pages 15-26 From National to Regional Criteria for H-LTOT....Pages 27-41 Systems for Oxygen Delivery....Pages 43-57 The Interfaces....Pages 59-67 Telemedicine and LTOT in Italy: a 20-Year Experience....Pages 69-83 New Telemonitoring Technologies in Italy....Pages 85-94 The Changing Role of Nursing in Telemetric LTOT at Home....Pages 95-100 Home LTOT: Patient—Caregiver Compliance and Adhesion....Pages 101-108 Complications in LTOT patients....Pages 109-117 LTOT Outcomes: Patient’s and Doctor’s Perspectives....Pages 119-132 Telemedicine for Home-Ventilated Patients....Pages 133-146 Economic Evaluation of Treating Patients with Long-Term Oxygen Therapy with or without Telemetric Monitoring....Pages 147-150 Continuing Quality Improvement in the Management of H-LTOT....Pages 151-162