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Telemonitoring in patients with chronic respiratory insufficiency: expectations deluded?
  1. Michele Vitacca
  1. Correspondence to Dr Michele Vitacca, Respiratory Rehabilitation Division, Fondazione Salvatore Maugeri, Via Giuseppe Mazzini, 129, Lumezzane (Brescia) 25066, Italy; michele.vitacca{at}

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Chronic respiratory insufficiency represents the advanced stage of a heterogeneous group of respiratory diseases, including COPD, which have an associated high cost burden.1 Modern information communication technologies offer new options to deliver remote specialised healthcare, among which telemonitoring, a complex intervention that includes both the electronic transmission of patient information to the healthcare system and the follow-up response by a healthcare professional. The rationale for telemonitoring development in patients presenting with chronic respiratory insufficiency with or without home mechanical ventilation need is related to: (1) progressive ageing of the patient population carrying with it an increased burden of care at home; (2) technological advances; (3) increased healthcare consumption and the need to cut costs; (4) the increasing number of home mechanical ventilation patients across Europe;2 (5) difficulties associated with hospital discharge, with tremendous physical and psychological burden for caregivers of home mechanical ventilation patients;3 and (6) the opportunity that telemonitoring offers of early remote detection of signs and symptoms of chronic respiratory insufficiency decompensation,4 and at-distance tailoring and monitoring of mechanical ventilation and education reinforcement for the patient and caregiver. Given the cost of telemonitoring in terms of human resources, equipment and patients’ time, strong evidence of its cost-effectiveness is required, in particular as regards the impact of an earlier detection of relapses of chronic conditions. Unfortunately, decision makers, for example, the healthcare authorities, are rushing to introduce telemonitoring in response to the pressure to reduce hospitalisations among patients with chronic diseases, without first carefully weighing up all the evidence. In the last decade, several studies focusing on the effects of various tele-management programmes for patients with chronic respiratory insufficiency (with COPD being the main diagnosis) have been published.5–8

A few years ago, Wooton9 concluded that the evidence base for telemedicine in managing chronic …

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