P1047Confirmation of patients satisfaction with real-time echocardiography and cardiac consultation at a distance.


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Abstract

Purpose: Echocardiography is seldom performed in primary care centers (PCCs). A remote controlled robotic arm has been developed to which an ultrasound probe is connected together with a mobile ultrasound unit and placed at the PCC. A broadband link is required between the PCC and the ultrasound operator at the hospital. Three cameras are needed to view the patient and the exact position of the probe. The system also includes a microphone, monitors and loudspeaker. The operator controls the robotic arm remotely with a trackball and with the aid of newly developed IT-technology. A virtual keyboard remotely controls the ultrasound machine. Consultation between the CARdiologist, general practitioner (GP), operator and patient is done directly after the echocardiographic examination at a DISTAnce. This concept is named CARDISTA. The first tests with CARDISTA have been completed between PCC (Norsjö) and Skellefteå Hospital, a distance of 80 km and repeated in a second test from PCC (Arvidsjaur), a distance of 130 km.Our aim is to report patients' and GP's first subjective experiences with CARDISTA.Methods: From Norsjö we examined 27 elderly patients (17 women, 10 men) mean age 72,4 years and from Arvidsjaur 33 patients (18 women, 15 men) mean age 72,8 years, all with a variety of heart diseases. Questionnaires were completed by the patients and GP's about their experiences from the examination.Results: The questionnaires were answered by 21 from Norsjö and 29 patients from Arvidsjaur. Fifteen and twenty seven patients (71% and 93%) were satisfied with information about the examination. Patients reported problems (0%) and (10%) with the examination but in general, all patients were pleased with the specialist consultation.We received 24 and 30 responses respectively from the GP's. Most consultations (83%) and (13%) were felt to be equivalent to the usual standard of practice, while 17% and 67% felt it to be an improvement. The real-time contact also facilitated GP's work with heart patients (88%) and (78%), respectively. The GP's thought that their medical competence was improved to a great extent (79%) and (67%) respectively by CARDISTA. The GP's overall impression (71%) and (80%) was that CARDISTA was feasible and ready for introduction in general practice.Conclusions: The experiences with CARDISTA from the first PCC demonstrated encouraging results both from the patients' and the GP's point of view and were confirmed by the next PCC. To establish the real clinical value of this concept we are now doing a study where patients are randomised to either CARDISTA or usual procedure.

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