Telemedicine in integrated care (example: asthma treatment)

PURPOSE: Medical impact of telemetric management on patients with asthma. CONTEXT: Sectoral boundaries still cause problems in supervising chronically Ill patients in Germany. Integrated care models by means of modern telemedicine can help. Since the beginning of 2008, an agreement between the Techniker Krankenkasse (TK) and the German Foundation for the Chronically Ill has enabled a telemedical programme for asthma (see below). CASE DESCRIPTION: Adult TK insured asthmatics are enrolled by participating doctors. Supervision by a telemedical support centre differs according to the severity of their condition and in coordination with participating doctors. All patients receive electronic peak flow meters and training documents, and are phoned regularly by medically trained coaches. Major elements include information and training courses on asthma, self-management, target agreements, collection of medical data and regularly written reports to participants and doctors. High-risk patients also undergo telemonitoring of medical data via mobile phone. If values become critical, early intervention prevents escalation and medical emergencies. RESULTS AND CONCLUSIONS: 1. Over 1500 patients enrolled since programme launch. 2. Pre-post comparison (n=1455) shows significant medical results. 3. Increased percentage of participants receiving PRN medication (+10.6%) and long-term medication (by up to 40%) according to guidelines. 4. Influenza vaccination rate increased by 18%; pneumococcal vaccination rate by 43%. Percentage of patients with self-management plan doubled. Sixty-four percent could prevent episodes of shortness of breath; 66% no longer suffered from asthma-related coughing. DISCUSSION: Integrated care models by means of modern telemedicine suitable for other chronic diseases and for multimorbid patients (whole patient management)?