Abstract
Background
Management of adults with congenital heart disease (ACHD) requires quaternary centres
with cardiologists and cardiac surgeons who have expertise in the diagnosis and management
of this patient population. We report on the feasibility of the management of ACHD
patients using videoconferencing and streaming through 1 regional referral centre
covering 4 western Canadian provinces, roughly 30% of Canada's land and population.
Methods
Videoconferencing sessions from January 2008 to December 2010 were systematically
reviewed. Case presentations were classified as successful or unsuccessful. All patients
were followed to assess whether the recommendations were acted upon. The hosting institution
used the Alberta Health Services internet protocol network, while other connections
used integrated service digital network. The videoconference equipment at the different
sites includes Polycom HDX 9000 (Polycom, San Jose, CA), Tandberg Edge 95 (Tandberg,
San Jose, CA), and Tandberg 990 (Tandberg).
Results
From January 2008 to December 2010 there were 26 sessions, 213 case presentations,
and 177 patients discussed with an average 8.2 case presentations per session. Thirty-two
case presentations were deferred, 10 of which were because of transmission errors
and the remainder were because of unavailability of staff or images. Of the 177 recommendations,
124 procedures (91 surgical, 29 percutaneous, and 4 electrophysiological) were booked
directly at the regional referral centre. Only 6 recommendations were not carried
out (4 because of premature deaths, and 2 because of patient logistic issues).
Conclusions
The results of this study illustrate that telehealth is a feasible medium for arriving
at consensus recommendation in the management of ACHD patients living in a geographically
diverse area.
Résumé
Introduction
La prise en charge de la cardiopathie congénitale de l'adulte (CCA) requiert des centres
quaternaires disposant de cardiologues et de chirurgiens cardiologues qui possèdent
une expertise dans le diagnostic et la prise en charge de cette population de patients.
Nous présentons la faisabilité de la prise en charge de patients ayant une CCA en
utilisant la vidéoconférence et la diffusion en mode continu dans 1 centre de référence
régional couvrant les 4 provinces de l'Ouest canadien, soit environ 30 % de la superficie
et de la population du Canada.
Méthodes
Les séances par vidéoconférence de janvier 2008 à décembre 2010 ont été systématiquement
passées en revue. Les observations ont été classifiées comme réussies ou non réussies.
Tous les patients ont été suivis pour évaluer si les recommandations ont été observées.
L'établissement hôte a utilisé le réseau IP (Internet Protocol) de l'Alberta Health Services (services de santé de l'Alberta), tandis que d'autres
connexions ont utilisé le réseau numérique à intégration de services. L'équipement
de vidéoconférence des différents sites inclut le Polycom HDX 9000 (Polycom, San Jose,
CA), le Tandberg Edge 95 (Tandberg, San Jose, CA) et le Tandberg 990 (Tandberg).
Résultats
De janvier 2008 à décembre 2010, il y a eu 26 séances, 213 observations et 177 patients
discutés pour une moyenne de 8,2 observations par séance. Trente-deux (32) observations
ont été reportées, dont 10 l'ont été en raison d'erreurs de transmission, et les autres
en raison de l'indisponibilité du personnel ou des images. Parmi les 177 cas recommandés,
124 interventions (91 interventions chirurgicales, 29 interventions percutanées et
4 interventions électrophysiologiques) ont été effectuées directement au centre de
référence régional. Seuls 6 cas recommandés n'ont pas eu de suite (4 en raison de
décès prématurés et 2 en raison de problèmes de logistiques liés au patient).
Conclusions
Les résultats de cette étude illustrent que la télésanté est un média réalisable pour
parvenir à une recommandation consensuelle sur la prise en charge des patients ayant
une CCA qui vivent dans des régions géographiques diverses.
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Article info
Publication history
Published online: August 27, 2012
Accepted:
June 6,
2012
Received:
April 25,
2012
Footnotes
See page 877 for disclosure information.
Identification
Copyright
© 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
