In spite of promising projects, telemedicine is still not part of regular care. However, a study which for the first time has proven that telemedicine can extend the lives of heart patients could now put an end to the waiting. Telemedicine is synonymous with technical progress like no other area of health care. Yet in spite of the lack of doctors, e.g. in rural areas, and overworked ER departments, treatments based solely on telemedicine are still not allowed.
At the beginning of the year, the German Medical Assembly at least relaxed this ban. In the future, doctors will be able to treat their patients 'in individual cases' via telephone or the Internet with no need for initial personal contact beforehand.
There are far fewer restrictions abroad. According to its own figures, the London-based Internet portal DrEd provided remote treatment for 200,000 German patients last year. Medgate in Basel receives more than twelve million calls a year. Evidently, interest in such services is growing quickly.
In Germany, only a few telemedicine projects have got beyond model status – in spite of all the lip service paid to them. At the end of last year, a study carried out by the IGES Institute on behalf of the Bertelsmann Foundation revealed that such projects are successful if they are promoted by well-respected experts or institutions and supported by politically powerful players.
The Federal Ministry of Education and Research (BMBF) is calling for remote treatment to be made part of mainstream care services. The reason – the results of the recent Fontane Study (TIM-HF2) carried out by the Uniklinik Charité in Berlin.
For the first time, it has been proven that telemedicine care as part of an overall care plan can extend the lives of heart patients. The five-year study in which more than 1,500 patients took part was carried out with various partners and in close consultation with two major health insurance companies.
Half of the participants received telemedicine care, while the other half were treated conventionally. Medical care for patients in their homes throughout Germany was provided by 113 cardiology and 87 general care facilities.
The aim of the study was to treat patients outside a hospital for as long as possible while increasing their life expectancy and improving their quality of life. Another aim was to check whether telemedicine could make up for structural deficits in medical care in the countryside compared to urban areas.
The results of the study show that telemedicine patients needed to spend fewer days in hospital owing to unplanned cardiovascular events and lived longer. Over the one-year study period, they “lost” 17.8 days compared to 24.2 days in the control group.
Furthermore, around 11 out of 100 heart failure patients died under regular conditions in one year. With additional telemedicine care, this figure was around eight patients. The telemonitoring group also had fewer unplanned days in hospital owing to heart failure – 3.8 days compared to 5.6 days.
Whether the patient lives in a rural area with a poor infrastructure or in a city had no influence on the results. Telemedicine can therefore make up for regional differences in care between urban and rural areas and can improve the quality of overall care.
Telemedicine – the hardware
The simple, everyday technology also played a significant part in the success of the project. Patients were given just four measuring devices: an electrocardiograph (ECG) with a finger clip for measuring oxygen saturation, a blood pressure monitor, scales and a tablet for assessing their own state of health and automatically transferring the measurements to the Charité’s Center for Cardiovascular Telemedicine.
Doctors and care personnel assessed the data 24 hours a day, seven days a week. In the event of a deterioration in the values, they changed the patient’s medication, recommended outpatient treatment from a doctor or arranged an admission to hospital.
The study shows that telemedicine improves the quality of patient care regardless of where the patient lives. This could pave the way for broad use of telemedicine in Germany in the future.