title: Tele-assistance in chronic respiratory failure: patients' characterization and staff workload of 5-year activity.
abstract: BACKGROUND
  The issue of how to optimize the routine use of tele-assistance (TA) in the clinical care remains to be addressed. Skills and costs of human resources represent the major component to care for chronic patients with TA.
  
  
  METHODS
  We investigated (1) the change in patient population, mortality, and staff utilization/cost during the first 5-year activity of a TA program (24-h availability of a call center, pulse oxygen device, and second medical opinion) dedicated to chronic respiratory failure patients and (2) the staff time dedicated to each new patient admitted to the service.
  
  
  RESULTS
  Three-hundred and ninety-six patients (age 64 +/- 17 years; 296 men) were reviewed across 5 years of activity. Patients followed/year increased over time, particularly for amyotrophic lateral sclerosis subjects. Calls/month dramatically increased from 60 to 290, with a 5-year number of calls equal to 12.952. The doctor's time dedicated to TA decreased over time, whereas the nurse's time increased allowing a cost saving of 39% when compared with budgeted salary costs. The number of home ventilated patients did not change, remaining over 78%. The mortality rate increased over time (from 6% to 11%). Both chronic obstructive pulmonary disease (COPD) and No-COPD patients used the TA service more frequently during the winter, and COPD used it also in the summer.
  
  
  CONCLUSIONS
  A stable TA service dedicated to chronic respiratory failure may be reached after 4 years. Across years, (1) number of patients increased, with COPD and ventilated subjects being the most representative; (2) calls varied during seasons; (3) doctor's workload decreased, saving salary costs; and (4) each new enrolled patient may require 73 and 27 min/month of nurse and doctor, respectively.
authors.affiliation: Pneumology Division, Salvatore Maugeri Foundation, IRCCS, Via Giuseppe Mazzini 129, Lumezzane, Brescia, Italy. michele.vitacca@fsm.it
authors.forename: Michele
authors.initials: M
authors.lastname: Vitacca
authors.forename: Abramo
authors.initials: A
authors.lastname: Bazza
authors.forename: Luca
authors.initials: L
authors.lastname: Bianchi
authors.forename: Sonia
authors.initials: S
authors.lastname: Gilè
authors.forename: Giuliano
authors.initials: G
authors.lastname: Assoni
authors.forename: Roberto
authors.initials: R
authors.lastname: Porta
authors.forename: Enrica
authors.initials: E
authors.lastname: Bertella
authors.forename: Domenico
authors.initials: D
authors.lastname: Fiorenza
authors.forename: Luca
authors.initials: L
authors.lastname: Barbano
authors.forename: Laura
authors.initials: L
authors.lastname: Comini
authors.forename: Simonetta
authors.initials: S
authors.lastname: Scalvini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007558:Italy; D008297:Male; D008485:Medical Audit; D008503:Medical Staff; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000191:economics / Q000401:mortality / Q000628:therapy; D012131:Respiratory Insufficiency / Q000191:economics / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D017216:Telemedicine; D016526:Workload