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DOI: 10.1055/s-0038-1675575
Smart Medication ™, an Electronic Diary for Surveillance of Haemophilia Home Care and Optimization of Resource Distribution
Acknowledgements Special thanks to the late Dr. Hartmut Pollmann, who co-founded the VFTH e.V. for fundraising, thus enabling research for and development of smart medication ™. His vision was a vital inspiration and contribution to this publication. The authors would like to thank Dr. Andreas Rösch and Dr. David Schmoldt for the development and hosting of smart medication ™ as well as Janet Collins (ICCC Rhein-Main, Frankfurt, Germany) for the assistance in preparing the manuscript.Publication History
18 October 2017
02 May 2018
Publication Date:
08 January 2019 (online)
Zusammenfassung
Im Folgenden wird das elektronische Substitutionstagebuch smart medication ™ vorgestellt, sowie eine Analyse der damit erhobenen Echtzeitdaten. Seit 2012 wurde smart medication ™ von 663 Patienten in 30 Deutschen Hämophilie Zentren (HZ) genutzt. Daten aus 9 HZ wurden für die nachfolgende Analyse zusammengeführt. Entsprechend der Mittelwerte des jährlichen Faktorenverbrauchs und der Anzahl von Gelenkblutungen wurden vier Gruppen gebildet. Die größte Gruppe (A, 42%) war die mit unterdurchschnittlichem Faktorenverbrauch und weniger als 2,25 Gelenkblutungen pro Jahr. Die zweitgrößte Gruppe (B, 32%) zeigte ähnlich niedrige Blutungsraten bei überdurchschnittlichem Faktorenverbrauch. Eine Reduktion des Faktorenverbrauchs bei einigen dieser Patienten wäre ggf. möglich. Hingegen könnten andere Patienten mit häufigen Gelenkblutungen bei gleichzeitig niedrigem Faktorenverbrauch (D, 13%), von einer Erhöhung der Dosis profitieren. Patienten mit häufigen Gelenkblutungen trotz überdurchschnittlichem Faktorenverbrauch (C, 13%) benötigen eine intensivierte Behandlung jenseits einer Dosisanpassung, wie pharmakokinetisch adaptierte Dosisanpassungen oder orthopädische Maßnahmen. Mit Hilfe von smart medication ™ können Patienten, die eine Änderung ihrer laufenden Behandlung benötigen, lange vor der nächsten Vorstellung im HZ identifiziert werden. Der ständig wachsende Datenpool erlaubt zudem eine kontinuierliche Analyse von Echtzeitdaten und damit eine Optimierung der zur Verfügung stehenden Ressourcen.
Abstract
This report describes the technical features and potential advantages of the application of electronic haemophilia treatment diary smart medication ™ and an evaluation of real-life electronic treatment data collected from haemophilia patients. Since 2012, a total of 663 patients from 30 German haemophilia treatment centres (HTCs) have used the device. Data of nine HTCs were merged for real-life data analysis. Patients were divided into four subgroups according to above versus below mean values for annual factor consumption (AFC) and annual joint bleeds (AJB), respectively. The largest subgroup comprised patients with low mean AFC and AJB less than 2.25 (group A: 42%). Second largest was the group with low mean AJB but high AFC (group B: 32%), suggesting that resources could be saved in some patients. The group with low AFC but high AJB may need increased factor dosing (group D: 13%). Patients who showed a high mean AJB despite high AFC (group C: 13%) may require special medical attention, such as pharmacokinetic-adapted treatment modification or orthopaedic measures. Smart medication ™ enables the HTC to quickly identify patients in need of treatment changes and, thus, to plan individualized therapy modifications prior to patient visits. The growing pool of real-life data facilitates data analysis and may play an important role in the optimization of resource distribution.
Schlüsselwörter
Telemedizin - Hämophilie Hausbehandlung - Online-Monitoring - elektronische DokumentationDisclosure
Wolfgang Mondorf is the head of a non-profit organization for research and development of telemedicine in Haemostaseology (Verein zur Förderung der Telemedizin in der Hämostaseologie, VFTH e.V., Frankfurt/Main, Germany). This organization has received funding from pharmaceutical companies (Baxalta Deutschland GmbH, Bayer Vital GmbH, Biotest AG, CSL Behring GmbH, Novo Nordisk Pharma GmbH, Octapharma GmbH, Pfizer Pharma GmbH) for research performed in this work. Wolfgang Mondorf and Ronald Fischer have received reimbursement for attending and speaking at symposia concerning issues related to the submitted manuscript. Outside of this study and without reimbursement to the VFTH e.V., smart medication ™ was employed by Baxter/Baxalta and Bayer for post-licensing studies.
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