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Pietrantonio F, Florczak M, Kuhn S, Kärberg K, Leung T, Said Criado I, Sikorski S, Ruggeri M, Signorini A, Rosiello F, Drago C, Vinci A, Barreto V, Montano N, Dicker D, Gomez Huelgas R. Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health. Front Public Health 2024; 12:1370555. [PMID: 39005984 PMCID: PMC11239350 DOI: 10.3389/fpubh.2024.1370555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024] Open
Abstract
Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.
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Affiliation(s)
- F Pietrantonio
- Medical Area Department, Internal Medicine Unit, Castelli Hospital, Rome, Italy
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - M Florczak
- Department of Immunology, Transplantology and Internal Medicine. Medical University of Warsaw, Warsaw, Poland
| | - S Kuhn
- Institute of Digital Medicine, University Hospital of Giessen and Marburg, Phillips-University Marburg, Marburg, Germany
| | - K Kärberg
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - T Leung
- Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Internal Medicine (Adjunct), Southern Illinois University School of Medicine, Springfield, IL, United States
| | - I Said Criado
- Palliative Care Unit, Internal Medicine Department, Pontevedra-El Salnés Healthcare Area, Institute of Healthcare Research, Vigo, Spain
| | - S Sikorski
- Institute of Law Studies, Faculty of Law and Administration, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland
| | - M Ruggeri
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - A Signorini
- Saint Camillus International University of Health Sciences, Rome, Italy
| | - F Rosiello
- Saint Camillus International University of Health Sciences, Rome, Italy
- Department of Public Health and Infectious Disease, Sapienza-University of Rome, Rome, Italy
| | - C Drago
- University Niccolò Cusano. Department of Economics, Psichology and Communication Sciences, Rome, Italy
| | - A Vinci
- Local Health Authority ASL Roma 1, Health Management Unit, Rome, Italy
| | - V Barreto
- Pedro Hispano Hospital, Porto, Portugal
| | - N Montano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - D Dicker
- Internal Medicine Department and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - R Gomez Huelgas
- Internal Medicine Department, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
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Pietrantonio F, Vinci A, Maurici M, Ciarambino T, Galli B, Signorini A, La Fazia VM, Rosselli F, Fortunato L, Iodice R, Materazzo M, Ciuca A, Cicerchia LCM, Ruggeri M, Manfellotto D, Rosiello F, Moriconi A. Intra- and Extra-Hospitalization Monitoring of Vital Signs-Two Sides of the Same Coin: Perspectives from LIMS and Greenline-HT Study Operators. SENSORS (BASEL, SWITZERLAND) 2023; 23:5408. [PMID: 37420575 DOI: 10.3390/s23125408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND In recent years, due to the epidemiological transition, the burden of very complex patients in hospital wards has increased. Telemedicine usage appears to be a potential high-impact factor in helping with patient management, allowing hospital personnel to assess conditions in out-of-hospital scenarios. METHODS To investigate the management of chronic patients during both hospitalization for disease and discharge, randomized studies (LIMS and Greenline-HT) are ongoing in the Internal Medicine Unit at ASL Roma 6 Castelli Hospital. The study endpoints are clinical outcomes (from a patient's perspective). In this perspective paper, the main findings of these studies, from the operators' point of view, are reported. Operator opinions were collected from structured and unstructured surveys conducted among the staff involved, and their main themes are reported in a narrative manner. RESULTS Telemonitoring appears to be linked to a reduction in side-events and side-effects, which represent some of most commons risk factors for re-hospitalization and for delayed discharge during hospitalization. The main perceived advantages are increased patient safety and the quick response in case of emergency. The main disadvantages are believed to be related to low patient compliance and an infrastructural lack of optimization. CONCLUSIONS The evidence of wireless monitoring studies, combined with the analysis of activity data, suggests the need for a model of patient management that envisages an increase in the territory of structures capable of offering patients subacute care (the possibility of antibiotic treatments, blood transfusions, infusion support, and pain therapy) for the timely management of chronic patients in the terminal phase, for which treatment in acute wards must be guaranteed only for a limited time for the management of the acute phase of their diseases.
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Affiliation(s)
- Filomena Pietrantonio
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Antonio Vinci
- Local Health Authority Roma 1, 00193 Rome, Italy
- Doctoral School in Nursing Science and Public Health, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Tiziana Ciarambino
- Department of Internal Medicine, Luigi Vanvitelli University, 81100 Caserta, Italy
| | - Barbara Galli
- Casa Circondariale Rebibbia, Nuovo Complesso Prison, 00185 Rome, Italy
| | - Alessandro Signorini
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
| | - Vincenzo Mirco La Fazia
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
- Department of Systems Medicine, Division of Cardiology, Tor Vergata University, 00133 Rome, Italy
| | - Francescantonio Rosselli
- Cardiology and Coronary Intensive Therapy Unit, San Francesco di Paola Hospital, 87027 Paola, Italy
| | | | | | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, 00100 Rome, Italy
- PhD Program in Applied Medical-Surgical Sciences, Breast Oncoplastic Surgery, University of Rome Tor Vergata, 00100 Rome, Italy
| | - Alessandro Ciuca
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
| | | | - Matteo Ruggeri
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- National Centre for Health Technology Assessment, National Health Institute, 00153 Rome, Italy
| | - Dario Manfellotto
- UOC Medicina Interna, Fatebenefratelli Isola Tiberina-Gemelli Hospital, 00186 Rome, Italy
- "Centro Studi" FADOI, 20123 Milan, Italy
| | - Francesco Rosiello
- Internal Medicine Unit, Castelli Hospital, Asl Roma 6, 00072 Rome, Italy
- Departmental Faculty of Medicine, St. Camillus University of Medicine and Health Sciences, 00131 Rome, Italy
- Department of Infectious Disease and Public Health, Sapienza University of Rome, 00185 Roma, Italy
- Department of Hystological, Anatomical Sciences and Legal Medicine, Sapienza-University of Rome, 00196 Rome, Italy
| | - Andrea Moriconi
- Department of Business and Management, LUISS University, 00197 Rome, Italy
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Heupink LF, Peacocke EF, Sæterdal I, Chola L, Frønsdal K. Considerations for transferability of health technology assessments: a scoping review of tools, methods, and practices. Int J Technol Assess Health Care 2022; 38:e78. [PMID: 36321421 DOI: 10.1017/s026646232200321x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Health technology assessment (HTA) is commonly used to guide evidence-informed decisions to optimize resource use, prioritize policies, and support countries to achieve universal health coverage. Producing HTAs requires time, scientific expertise, and political commitment, but these are not available in all settings - especially in low- and middle-income countries (LMIC) where HTA processes may be less institutionalized. Transferring and adapting existing HTAs to local settings may offer a solution while reducing duplication efforts. This scoping review aims to provide an overview of tools, methods, approaches, and considerations which can aid HTA transfers. We systematically searched (from 2005 to 2020) six databases and, using predefined inclusion criteria, included twenty-two studies. Data extraction followed a structured process, while synthesis was more iterative. We identified a common approach for HTA transfers. It follows the de novo process of undertaking original HTAs, but with additional steps to assess relevance (applicability), quality, and transferability, as well as steps to adapt parameters where necessary. The EUnetHTA Adaptation Toolkit was the only tool that provided guidance for adapting multiple HTA domains. Other tools were specific to systematic reviews (n = 1) or economic evaluations (n = 12), where one provided guidance for systematic reviews of economic evaluations. Eight papers reported transferring an HTA, with only one transferring to an LMIC. Finally, we reported issues that may facilitate or hinder transferability. In conclusion, we identified fourteen transfer approaches in the form of guidance or checklists, but harmonized and pragmatic guidance for HTA transfers to suit settings with limited HTA capacity seems warranted.
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Affiliation(s)
- Lieke Fleur Heupink
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | | | - Ingvil Sæterdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Lumbwe Chola
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
| | - Katrine Frønsdal
- Norwegian Institute of Public Health, Global Health, Division for Health Services Oslo, Norway
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Deligianni CI, Mitsikostas DD, Ashina M. Safety and tolerability evaluation of erenumab for the preventive treatment of migraine. Expert Opin Drug Saf 2021; 20:867-876. [PMID: 34037500 DOI: 10.1080/14740338.2021.1933941] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Erenumab, a monoclonal antibody targeting the receptor of calcitonin gene related peptide (CGRP), is the first disease-specific and mechanism-based treatment approved for the prevention of migraine. Although the safety and tolerability data from randomized trials are clear, the physiological effects of CGRP rise reasonable concerns. We aimed to evaluate the current evidence for safety and tolerability related to erenumab use in migraine. Areas covered: This review outlines the severe adverse events (AEs), common AEs, AEs leading to treatment discontinuation and AEs of special interest, reported in all phase 2, phase 3, open label, and observational studies with erenumab in migraine. Individual safety reports were also included in the systematic review of evidence. Expert opinion: No safety and tolerability flags were detected in this review. The most common AE are local skin reactions and constipation. No severe AEs, or frequent AEs leading to treatment discontinuation were detected. Treatment is well tolerated. The only AE of interest that may play a role in decision making and treatment monitoring is constipation. These findings are in line with previous safety reports, further highlighting the substantial tolerability and safety profile of the modern anti-CGRP monoclonal antibodies for the prevention of migraine.
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Affiliation(s)
- Christina I Deligianni
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Dimos D Mitsikostas
- 1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Messoud Ashina
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Copenhagen, Denmark
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Steiner TJ, Linde M, Schnell-Inderst P. A universal outcome measure for headache treatments, care-delivery systems and economic analysis. J Headache Pain 2021; 22:63. [PMID: 34210258 PMCID: PMC8247243 DOI: 10.1186/s10194-021-01269-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/26/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments. CONCEPTION AND DELINEATION A literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD's years lived with disability (YLDs). UTILITY ASSESSMENT Acute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric. CONCLUSIONS The new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.
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Affiliation(s)
- Timothy J Steiner
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway.
- Division of Brain Sciences, Imperial College London, London, UK.
| | - Mattias Linde
- Department of Neuromedicine and Movement Science, NTNU Norwegian University of Science and Technology, Edvard Griegs gate, Trondheim, Norway
- Norwegian Advisory Unit on Headache, Department of Neurology and Clinical Neurophysiology, St Olavs University Hospital, Trondheim, Norway
- Tjörn Headache Clinic, Rönnäng, Sweden
| | - Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT - University for Health Sciences, Hall in Tirol, Austria
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