Spanish Online HIV Clinic Works
posted: 25/05/2011
A ‘Virtual HIV Clinic’ providing a full HIV care service online is a safe and feasible option for people with stable HIV, a new Spanish study from Barcelona shows.
People found their online HIV care satisfactory, and outcomes were comparable to people whose HIV care was provided in person at the clinic. It saved everyone time and money.
“The study shows that Virtual Hospital constitutes a feasible, fairly satisfactory and safe tool for the clinical care of stable HIV-infected patients,” write the authors; “it has no deleterious effect on HIV clinical parameters, antiretroviral compliance, quality of life, or psychological and emotional status.”
The future of HIV care for some here?
Online support looks promising development as another way of providing HIV care for some people. Many people in the UK already keep in contact with their clinic by email, and it can save time (and money for the NHS) to have home delivery of your anti-HIV drugs.
Rising clinic demand drives online clinic experiment
The outlook of many HIV-positive people has been transformed by antiretroviral therapy. However, this means an ever rising number of people being seen by HIV clinics and with the number of new people diagnosed each year means that many clinics are struggling to cope and keep costs for the NHS under control. Regular clinic appointments are inconvenient for some people, especially because of the distance and cost of travel and where there is a need to take time off work.
Clinically stable patients typically have check-ups every three to four months. These visits usually involve seeing a number of healthcare professionals including a specialist HIV doctor, nurse, phlebotomist and pharmacist. This means considerable time for both staff and people with HIV.
The hospital in Barcelona decided to see if providing routine HIV care by internet would help save everyone time and costs. They set up a Virtual Hospital to provide comprehensive HIV care by internet.
Video visits to the clinic doctor
Consultations with doctors were provided via video conferencing, and other healthcare professionals were also available via electronic media. HIV drugs were sent to people’s homes by courier.
Was it acceptable and safe?
They checked this by studying 83 patients. All were clinically stable and had a CD4 above 250. People taking HIV therapy who had a detectable viral load were not allowed to use the online clinic, nor were people who had cancers or active opportunistic infections.
To join the online experiment people had to have a home computer and broadband internet. They gave everyone 20 minutes training.
They randomly split the people into two groups. Half tried the online clinic and the other half carried on visiting the hospital. After a year, everyone swopped places – the people visiting the hospital trying the online clinic and vice versa, for another year.
People’s satisfaction, clinical outcomes, quality of life and psychological and emotional wellbeing were all measured.
Results good
Most (93%) were employed and 38% had a university degree. At the start, 55% were taking HIV treatments. 75 people completed both years in the study.
Satisfaction with the Virtual Hospital was high, and 85% of patients considered that it improved their access to clinical data compared to standard care. A similar proportion were comfortable with video conferencing as a way of consulting their HIV doctor. This system was rated as an easy way to communicate by 82% of users.
Overall, 69% of patients were satisfied with the online clinic.
There was no difference in clinical outcomes between users of the online clinic and regular clinic visitors. CD4 cell counts were comparable between both groups, as was the proportion of people with an undetectable viral load.
Some treatment switchers and starters
Just over a quarter of patients (28%) switched therapy, and 6% of individuals started HIV treatment for the first time. Rates of switching and starting treatment were comparable between the two study groups.
Treatment adherence rates were high, and did not differ between the two groups.
Quality of life and health constant
Use of the online clinic did not harm overall quality of life, or emotional and psychological wellbeing.
Setting up costs
Installing the hardware and software cost the clinic 50,000 euro, and the annual cost of the for each person was 120 euros.
Time savings
The investigators calculated that the average consultation using the online clinic took ten minutes, compared to the 60 to 90 minutes needed for a visit to the clinic.
“The Virtual Hospital has been shown to be a feasible and safe tool for providing multidisciplinary home care to chronic HIV patients,” comment the investigators, concluding: “telemedicine should be considered an appropriate support service for the entire management of chronic HIV infection, [and] is likely to prove extremely useful in settings with poor access to the health system.”
Source with reference details
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