Role of a telemedicine network provided by local pharmacies in the prevention and early management of cardiovascular events
Notice bibliographique
Résumé
Abstract Background As traditional healthcare systems face increasing demand, telemedicine, leveraging telecommunications to deliver healthcare remotely, has emerged as a promising alternative to enhance accessibility and reduce costs. However, evidence supporting its effectiveness in real-world applications remains limited. Purpose The aim of our study was to assess the feasibility and effectiveness of a pharmacy-based telemonitoring network evaluating its potential role in chronic as well as in the acute setting, by enhancing the appropriateness of referrals to the emergency department (ED). Methods Our Department of Cardiology, in collaboration with our National Association of Pharmacists and the Italian National Institute of Health, has implemented a telematic network currently involving 7056 pharmacies throughout the country connected to a single telemedicine platform (Health Telematic Network - HTN). Pharmacies are equipped to perform 12-lead ECGs, ABPM, and Holter ECGs. Exams are performed either for routine check-ups or when a patient presents with cardiac symptoms. Demographic and clinical data are collected, and then transmitted through the platform for real-time cardiological evaluation: if any abnormalities are detected, pts are referred either for further diagnostic investigations or clinical evaluation, or, in cases of life-threatening conditions, to the ED. We analyzed all the ECGs performed from February 2022 to 2023 totalling 266602 procedures and then conducted a retrospective review of ED referrals due to chest pain to assess the appropriateness of ED referral. Results Out of 266602 ECGs analyzed 89% were performed for routine check-ups, 11% were prompted by specific cardiac symptoms. Common abnormalities identified included: AV blocks (1st degree: 5849 pts; 2nd degree: 78 pts, 3rd degree: 40 pts); bundle branch block (LBBB: 2768 pts; RBBB 1522 pts); bifascicular block (1072 pts); atrial fibrillation (AF) (3988 pts); severe QT prolongation ( > 500 msec) (195 pts); ST segment depression (176 pts) and ST segment elevation (151 pts). Referral to the ED was required in 1987 cases. The most common reason for ED referral was AF, accounting for 49.6% of the total; chest pain was identified as the second most prevalent cause (29.6% of the total). The retrospective analysis of ED referrals due to chest pain indicated that 71.2% of the cases had been appropriate. Finally, cost-effectiveness analysis estimated potential savings of 2’219’661 € for the hospital, based on an average cost of 207 € for each chest pain diagnostic work-up in the ED. Conclusion Our findings highlight the potential role of pharmacy-based telemonitoring network both in chronic care (primary and secondary prevention) as well as in the acute setting, by enhancing the appropriateness of referrals to the emergency department (ED).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».