Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 72

Telemedicine is having an increasingly important role in the current healthcare system. More than 60% of all healthcare institutions and up to 50% of all hospitals in the US currently use some form of telehealth [53]. As technology continuously evolves, we anticipate that future telemedicine models will include a rich array of data information garnered from wearable sensors and mobile diagnostic systems. In addition to frequent virtual visits from physicians, nurses, social workers, and therapists, telemedicine will be used to educate patients and local providers. We described the Fred Hutch/SCCA as one type of telemedicine model where local providers can request a consultation with a LTFU expert to help manage late effects of transplant recipients. Another example OF where telehealth may be used to improve survivorship care is Project ECHO (Extension for Community Healthcare Outcomes). Established at the University of New Mexico Health Sciences Center (UNM‐HSC), Project ECHO trains and supports local providers to deliver high‐quality care for chronic and complex conditions to patients in their own communities while monitoring outcomes to ensure quality of care [54]. This type of tele‐educational service, in conjunction with virtual visits with the patient, may have value in LTFU.

Engagement of local providers and delivery of long‐term transplant care through telemedicine is anticipated to have more precedence as more than 200,000 allogeneic HCT survivors are expected by 2030[55] and may exceed the capacity of small and large transplant centers to provide frequent and ongoing long‐term care. This growth in number, as well as projected shortages in the BMT workforce, the continuous innovation in the telecommunication and technology market, the advancement in integration of telehealth services into electronic health records and clinical‐decision support systems, the reorganization in the delivery and financing of medical care, and the growth of consumerism in healthcare with increasing expectations for convenience and real‐time access to health services, will accelerate telemedicine adoption into the delivery of LTFU care [56]. At this time, there has yet to be a prospective, randomized clinical trial comparing long‐term survival, quality‐of‐life, financial burden, and other patient‐reported outcomes between a LTFU telemedicine model to the dedicated LTFU clinic model. While the evidence to support the efficacy of the LTFU telemedicine model does not yet exist, we believe that telemedicine has profound value in the healthcare delivery of care for our long‐term transplant survivors.