A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study.

Abstract

BACKGROUND:

Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.

METHODOLOGY:

We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.

FINDINGS:

Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.

CONCLUSIONS:

Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection.

TRIAL REGISTRATION:

Clinical-Trials.gov: NCT01117675.

• Authors: Agathe León, César Cáceres, Emma Fernández, Paloma Chausa, Maite Martin, Carles Codina, Araceli Rousaud, Jordi Blanch, Josep Mallolas, Esteban Martinez, Jose L Blanco, Montserrat Laguno, Maria Larrousse, Ana Milinkovic, Laura Zamora, Neus Canal, Josep M Miró, Josep M Gatell, Enrique J Gómez, Felipe García
• Journal: PloS one (PLoS One) Vol. 6 Issue 1 Pg. e14515 (Jan 21 2011) ISSN: 1932-6203 [Electronic] United States
• PMID: 21283736 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Antiretroviral Therapy, Highly Active
• CD4 Lymphocyte Count
• Chronic Disease
• Female
• HIV Infections (therapy, virology)
• HIV-1 (physiology)
• Home Care Services (standards)
• Humans
• Male
• Standard of Care
• Telemedicine (instrumentation, methods, standards)
• Viral Load