A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study
Identifieur interne : 000714 ( Ncbi/Merge ); précédent : 000713; suivant : 000715A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study
Auteurs : Agathe Le N [Espagne] ; César Cáceres [Espagne] ; Emma Fernández [Espagne] ; Paloma Chausa [Espagne] ; Maite Martin [Espagne] ; Carles Codina [Espagne] ; Araceli Rousaud [Espagne] ; Jordi Blanch [Espagne] ; Josep Mallolas [Espagne] ; Esteban Martinez [Espagne] ; Jose L. Blanco [Espagne] ; Montserrat Laguno [Espagne] ; Maria Larrousse [Espagne] ; Ana Milinkovic [Espagne] ; Laura Zamora [Espagne] ; Neus Canal [Espagne] ; Josep M. Mir [Espagne] ; Josep M. Gatell [Espagne] ; Enrique J. G Mez [Espagne] ; Felipe García [Espagne]Source :
- PLoS ONE [ 1932-6203 ] ; 2011.
Abstract
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.
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.
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.
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.
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DOI: 10.1371/journal.pone.0014515
PubMed: 21283736
PubMed Central: 3024968
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Mir</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Gatell, Josep M" sort="Gatell, Josep M" uniqKey="Gatell J" first="Josep M." last="Gatell">Josep M. Gatell</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="G Mez, Enrique J" sort="G Mez, Enrique J" uniqKey="G Mez E" first="Enrique J." last="G Mez">Enrique J. G Mez</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Garcia, Felipe" sort="Garcia, Felipe" uniqKey="Garcia F" first="Felipe" last="García">Felipe García</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University 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type="wicri:Area/Ncbi/Merge">000714</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study</title><author><name sortKey="Le N, Agathe" sort="Le N, Agathe" uniqKey="Le N A" first="Agathe" last="Le N">Agathe Le N</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Caceres, Cesar" sort="Caceres, Cesar" uniqKey="Caceres C" first="César" last="Cáceres">César Cáceres</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Fernandez, Emma" sort="Fernandez, Emma" uniqKey="Fernandez E" first="Emma" last="Fernández">Emma Fernández</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Chausa, Paloma" sort="Chausa, Paloma" uniqKey="Chausa P" first="Paloma" last="Chausa">Paloma Chausa</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Martin, Maite" sort="Martin, Maite" uniqKey="Martin M" first="Maite" last="Martin">Maite Martin</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Pharmacy Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pharmacy Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Codina, Carles" sort="Codina, Carles" uniqKey="Codina C" first="Carles" last="Codina">Carles Codina</name><affiliation wicri:level="3"><nlm:aff id="aff3"><addr-line>Pharmacy Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Pharmacy Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Rousaud, Araceli" sort="Rousaud, Araceli" uniqKey="Rousaud A" first="Araceli" last="Rousaud">Araceli Rousaud</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Blanch, Jordi" sort="Blanch, Jordi" uniqKey="Blanch J" first="Jordi" last="Blanch">Jordi Blanch</name><affiliation wicri:level="3"><nlm:aff id="aff4"><addr-line>Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Mallolas, Josep" sort="Mallolas, Josep" uniqKey="Mallolas J" first="Josep" last="Mallolas">Josep Mallolas</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Martinez, Esteban" sort="Martinez, Esteban" uniqKey="Martinez E" first="Esteban" last="Martinez">Esteban Martinez</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Blanco, Jose L" sort="Blanco, Jose L" uniqKey="Blanco J" first="Jose L." last="Blanco">Jose L. Blanco</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Laguno, Montserrat" sort="Laguno, Montserrat" uniqKey="Laguno M" first="Montserrat" last="Laguno">Montserrat Laguno</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Larrousse, Maria" sort="Larrousse, Maria" uniqKey="Larrousse M" first="Maria" last="Larrousse">Maria Larrousse</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Milinkovic, Ana" sort="Milinkovic, Ana" uniqKey="Milinkovic A" first="Ana" last="Milinkovic">Ana Milinkovic</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Zamora, Laura" sort="Zamora, Laura" uniqKey="Zamora L" first="Laura" last="Zamora">Laura Zamora</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Canal, Neus" sort="Canal, Neus" uniqKey="Canal N" first="Neus" last="Canal">Neus Canal</name><affiliation wicri:level="3"><nlm:aff id="aff5"><addr-line>Health Economics and Outcomes Research, IMS Health, Inc., Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Health Economics and Outcomes Research, IMS Health, Inc., Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Mir, Josep M" sort="Mir, Josep M" uniqKey="Mir J" first="Josep M." last="Mir">Josep M. Mir</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="Gatell, Josep M" sort="Gatell, Josep M" uniqKey="Gatell J" first="Josep M." last="Gatell">Josep M. Gatell</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author><author><name sortKey="G Mez, Enrique J" sort="G Mez, Enrique J" uniqKey="G Mez E" first="Enrique J." last="G Mez">Enrique J. G Mez</name><affiliation wicri:level="3"><nlm:aff id="aff2"><addr-line>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Garcia, Felipe" sort="Garcia, Felipe" uniqKey="Garcia F" first="Felipe" last="García">Felipe García</name><affiliation wicri:level="3"><nlm:aff id="aff1"><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>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.</p></sec><sec><title>Methodology</title><p>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.</p></sec><sec><title>Findings</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec><sec><title>Trial Registration</title><p>Clinical-Trials.gov: <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/ct2/show/NCT01117675">NCT01117675</ext-link>.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Martin, Dk" uniqKey="Martin D">DK Martin</name></author><author><name sortKey="Thiel, Ec" uniqKey="Thiel E">EC Thiel</name></author><author><name sortKey="Singer, Pa" uniqKey="Singer P">PA Singer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Palella, Fj" uniqKey="Palella F">FJ Palella</name></author><author><name sortKey="Delaney, Km" uniqKey="Delaney K">KM Delaney</name></author><author><name sortKey="Moorman, Ac" uniqKey="Moorman A">AC Moorman</name></author><author><name sortKey="Loveless, Mo" uniqKey="Loveless M">MO 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21283736</article-id><article-id pub-id-type="pmc">3024968</article-id><article-id pub-id-type="publisher-id">10-PONE-CT-18678R2</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0014515</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline"><subject>Infectious Diseases</subject><subject>Infectious Diseases/Epidemiology and Control of Infectious Diseases</subject><subject>Infectious Diseases/HIV Infection and AIDS</subject><subject>Infectious Diseases/Viral Infections</subject></subj-group></article-categories><title-group><article-title>A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study</article-title><alt-title alt-title-type="running-head">Online HIV Care</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>León</surname><given-names>Agathe</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cáceres</surname><given-names>César</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fernández</surname><given-names>Emma</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Chausa</surname><given-names>Paloma</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Martin</surname><given-names>Maite</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Codina</surname><given-names>Carles</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Rousaud</surname><given-names>Araceli</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Blanch</surname><given-names>Jordi</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Mallolas</surname><given-names>Josep</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Martinez</surname><given-names>Esteban</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Blanco</surname><given-names>Jose L.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Laguno</surname><given-names>Montserrat</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Larrousse</surname><given-names>Maria</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Milinkovic</surname><given-names>Ana</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zamora</surname><given-names>Laura</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Canal</surname><given-names>Neus</given-names></name><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Miró</surname><given-names>Josep M.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gatell</surname><given-names>Josep M.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gómez</surname><given-names>Enrique J.</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>García</surname><given-names>Felipe</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Infectious Diseases Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Pharmacy Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Health Economics and Outcomes Research, IMS Health, Inc., Barcelona, Spain</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Kaul</surname><given-names>Rupert</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1">University of Toronto, Canada</aff><author-notes><corresp id="cor1">* E-mail: <email>aleon@clinic.ub.es</email></corresp><fn fn-type="con"><p>Conceived and designed the experiments: AL C Caceres PC C Codina AR JB NC JMM JMG EJG FG. Performed the experiments: AL C Caceres EF PC MM C Codina AR JB JM EM JLB M Laguno M Larrouse AM LZ JMM EJG FG. Analyzed the data: AL PC C Codina AR JB LZ JMG EJG FG. Contributed reagents/materials/analysis tools: AL EF MM C Codina AR JB NC JMG EJG FG. Wrote the paper: AL C Codina AR JB JMM JMG FG.</p></fn></author-notes><pub-date pub-type="collection"><year>2011</year></pub-date><pub-date pub-type="epub"><day>21</day><month>1</month><year>2011</year></pub-date><pub-date pub-type="ecorrected"><day>02
</day><month>2</month><year>2011</year></pub-date><volume>6</volume><issue>1</issue><elocation-id>e14515</elocation-id><history><date date-type="received"><day>7</day><month>5</month><year>2010</year></date><date date-type="accepted"><day>1</day><month>12</month><year>2010</year></date></history><permissions><copyright-statement>León et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</copyright-statement></permissions><abstract><sec><title>Background</title><p>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.</p></sec><sec><title>Methodology</title><p>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.</p></sec><sec><title>Findings</title><p>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.</p></sec><sec><title>Conclusions</title><p>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.</p></sec><sec><title>Trial Registration</title><p>Clinical-Trials.gov: <ext-link ext-link-type="uri" xlink:href="http://clinicaltrials.gov/ct2/show/NCT01117675">NCT01117675</ext-link>.</p></sec></abstract><counts><page-count count="12"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>Espagne</li></country><region><li>Catalogne</li><li>Communauté de Madrid</li></region><settlement><li>Barcelone</li><li>Madrid</li></settlement></list><tree><country name="Espagne"><region name="Catalogne"><name sortKey="Le N, Agathe" sort="Le N, Agathe" uniqKey="Le N A" first="Agathe" last="Le N">Agathe Le N</name></region><name sortKey="Blanch, Jordi" sort="Blanch, Jordi" uniqKey="Blanch J" first="Jordi" last="Blanch">Jordi Blanch</name><name sortKey="Blanco, Jose L" sort="Blanco, Jose L" uniqKey="Blanco J" first="Jose L." last="Blanco">Jose L. Blanco</name><name sortKey="Caceres, Cesar" sort="Caceres, Cesar" uniqKey="Caceres C" first="César" last="Cáceres">César Cáceres</name><name sortKey="Canal, Neus" sort="Canal, Neus" uniqKey="Canal N" first="Neus" last="Canal">Neus Canal</name><name sortKey="Chausa, Paloma" sort="Chausa, Paloma" uniqKey="Chausa P" first="Paloma" last="Chausa">Paloma Chausa</name><name sortKey="Codina, Carles" sort="Codina, Carles" uniqKey="Codina C" first="Carles" last="Codina">Carles Codina</name><name sortKey="Fernandez, Emma" sort="Fernandez, Emma" uniqKey="Fernandez E" first="Emma" last="Fernández">Emma Fernández</name><name sortKey="G Mez, Enrique J" sort="G Mez, Enrique J" uniqKey="G Mez E" first="Enrique J." last="G Mez">Enrique J. G Mez</name><name sortKey="Garcia, Felipe" sort="Garcia, Felipe" uniqKey="Garcia F" first="Felipe" last="García">Felipe García</name><name sortKey="Gatell, Josep M" sort="Gatell, Josep M" uniqKey="Gatell J" first="Josep M." last="Gatell">Josep M. Gatell</name><name sortKey="Laguno, Montserrat" sort="Laguno, Montserrat" uniqKey="Laguno M" first="Montserrat" last="Laguno">Montserrat Laguno</name><name sortKey="Larrousse, Maria" sort="Larrousse, Maria" uniqKey="Larrousse M" first="Maria" last="Larrousse">Maria Larrousse</name><name sortKey="Mallolas, Josep" sort="Mallolas, Josep" uniqKey="Mallolas J" first="Josep" last="Mallolas">Josep Mallolas</name><name sortKey="Martin, Maite" sort="Martin, Maite" uniqKey="Martin M" first="Maite" last="Martin">Maite Martin</name><name sortKey="Martinez, Esteban" sort="Martinez, Esteban" uniqKey="Martinez E" first="Esteban" last="Martinez">Esteban Martinez</name><name sortKey="Milinkovic, Ana" sort="Milinkovic, Ana" uniqKey="Milinkovic A" first="Ana" last="Milinkovic">Ana Milinkovic</name><name sortKey="Mir, Josep M" sort="Mir, Josep M" uniqKey="Mir J" first="Josep M." last="Mir">Josep M. Mir</name><name sortKey="Rousaud, Araceli" sort="Rousaud, Araceli" uniqKey="Rousaud A" first="Araceli" last="Rousaud">Araceli Rousaud</name><name sortKey="Zamora, Laura" sort="Zamora, Laura" uniqKey="Zamora L" first="Laura" last="Zamora">Laura Zamora</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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