HIV care process from Telemedicine to # mHealth

In this post I want to share with you an example of a healthcare reality which is taking advantage of all the potential of new mobile technologies on which I speak since I started this blog, for a long time.

I recently had the opportunity to learn in detail how is organized the process of care for infected patients by human immunodeficiency virus (HIV) in the hospital where I work, the Hospital Clínic of Barcelona.

“The Clinic is the referral hospital for a large part of the city of Barcelona, specifically for Integral Health Area of Barcelona Esquerra, comprising a total of 4 municipal districts with a population around 500,000 inhabitants”

I can assure that this care process is one of the pioneers in implementing new technologies on patient care, and therefore allows me to illustrate and argue in this post, something that I’ve been thinking and now want to share with you about #mHealth.

“I think it’s already clear that #mHealth is the natural evolution of telemedicine, hence probably many healthcare processes have been supported in the latter, naturally will evolve towards a virtual dimension relying on Apps, Mobile Websites or Responsive Websites, and substantially will improve access for end users, allowing them the gift of ubiquity and almost total connectivity.”

HIV care process

Nowadays, HIV infection, which is the cause of acquired immunodeficiency syndrome in humans, is considered a chronic disease, thus requiring prolonged follow-up time of those who suffer.

This disease can be diagnosed from different levels of care, primary care, specialty care or hospital care or from non-governmental organizations related to it.

When a patient is diagnosed with HIV in our care area, it is referred to the Hospital Clínic where makes a first visit with a specialized nurse. She is responsible for making the debut process. It is a patient oriented education visit in the management of their disease, which opens the clinical history, and where the steps to follow are very protocolised. The visit ends up with the demand of, following the protocol, the established medical tests ahead of the visit to the doctor 15 days later.

With the medical tests results, the doctor visits the patient previously to begin treatment and monitoring in the Day Hospital. Once it is considered that the patient is already autonomous in managing their disease (after 2 or 3 visits), the possibility to include the patient in the process of virtual monitoring through the platform of virtual Hospital is considered.

Schematically the process would be something like this:

HIV Assistential Workflow

It’s at this moment when everything starts changing, from now on the patient goes into another assistential dimension, allowing it to have the support of a multidisciplinary team of professionals and to access information about their pathology, or even if the patient need it, he can get in touch with other patients to share their concerns, questions, etc …
The communication between hospital and primary care is essential in the management of chronic patients. So far in our country, the care of HIV-infected patients has been performed only in hospitals.

However, patients have new needs (simplification and integration of care) and health systems too,  having to cope with an annual increase of 10% in new patients.

According to these premises, with political approval and mimicking what was done in other chronic diseases, the Shared Care Unit of HIV-infected patients (SCU) in chronic stage of their illness (most of them) was created by the Hospital Clínic’s infections service and three primary care centers from the Integrated Health Area fo Barcelona’s Eixample Esquerra (CAPSE Les Corts, Casanova and Borrell).

The SCU’s physicians (both primary care and specialty care), rely on the Virtual Hospital, a computer system through which all of them share the same electronic records and relevant information for patients.
Between 2005 and 2007, a prospective case control study was performed during 1.5 years with 30 patients, with results regarding clinical parameters similar to hospital standard control. This unit has been expanded to other primary care teams in Barcelona as are the South Raval, and is planned to do the same in the 4 centers also within the AISBE.

Web Pacienten Hospital Virtual VIH

From Telemedicine to #mHealth

The Virtual Hospital, in addition to health care activity that supports, also allows developing activities such as Teaching and Research.

For Teachers standard platform is used for online sessions with different health centers territory if possible. If not, the medical team moves to the center for clinical meeting in person.

In terms of research, the database on which the program activity develops, enables the approach of research by providing a significant amount of information.

In terms of usability, the Virtual Hospital provides professionals 96% of the information they need about the patient on one screen, making it possible to access 100% of the information by opening additional tabs.

Briefly it is about a Shared Care Unit focus on patients with HIV, where different levels of care are coordinated through the Virtual Hospital System. This is additionally complemented by the possibility of face to face visits if estimated necessary.

Usually, the patients included in this process are visited twice with their referring physician at the primary care level, and another visit with a physician at the hospital level annually.
Being able to visit patients virtually by hospital specialist, has a very positive impact on productivity thereof, attending a volume of patients near the 20 patients in two hours of consultation.

The final objective of this new healthcare dynamic so innovative, is aimed at helping these patients to keep a good control of their disease, which otherwise would impact negatively on their health and those around them.

What I just explained is a reality that has been operating in the Integral Health Area of Barcelona Esquerra since 2010, which can be defined as pure Telemedicine.

However, as expected, this medical team is still working to improve daily this care process, and they are actually working on the jump to #mHealth, which obviously involves the development of a APP focused on patients involved and followed through the Virtual Hospital, empowering them with the ubiquity and the 24/7/365 accessibility and providing them in the near future, the possibility to carry wherever they go, their the Vitual Hosptial’s team ;-D.





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