Diabetes is a disease, which may easily cause difficult foot ulcers that are deep and both time and resource demanding to heal. To spare the patient of numerous visits to the hospital with related transport time, the Region of Southern Denmark offers to treat the patients at home by means of telemedicine.
Throughout the telemedical treatment, only every third control consultation of diabetic foot ulcers takes place at the hospital, and the two additional consultations take place at home. A municipal nurse, who has specialized in complex foot ulcers, treats the patient’s ulcer at home, and sends pictures of the ulcer into an electronic journal. Afterwards, specialists from the centre for ulcers at the hospital are able to view the pictures in the journal and instruct the continued care and treatment without the patient having to visit the centre for ulcers as often as in the past.
In the Region of Southern Denmark, it was decided that the launch of the offer was to be coupled with a clinical randomized research project, in which results of the telemedical treatment were compared to the traditional physical appearance at the ulcer centre. In addition, the telemedical ulcer treatment was used as a Danish case in a large international research project, in which the financial, organizational and patient related aspects of the introduction of telemedical consultations were analyzed.
By the lauch of the telemedical treatment, in which pictures of ulcers combined with manual measures of the size of the ulcer are of essential meaning for the treatment, an idea emerged for developing a special camera that couples regular pictures with 3D technology and thereby providing accurate information about the size and depth. Because of this, the researchers at the ulcer centre initiated a side project on developing a special 3D scanner in collaboration with a local company simultaneously with the launch of the telemedical treatment.
The launch of the telemedical ulcer treatment for patients with diabetic foot ulcers was nationally decided, and the aim was to provide the patients with a more flexible solution and spare them of numerous trips to the ulcer outpatient clinic at the hospital.
In the Region of Southern Denmark, the launch of the offer was to be coupled with a clinical randomized research project, in which results of the telemedical treatment were compared to the traditional physical appearance at the ulcer centre to examine if the telemedical treatment was of as good quality as the traditional treatment at the ulcer centre.
Furthermore, the research project had a side aim of developing a 3D scanner for the diagnostics and assessment of diabetic foot ulcers. The 3D scanner was to allow identifying the size and depth of the foot ulcer faster and more accurate than by the existing manual methods for measuring.
The clinical research project of the telemedical ulcer treatment in the Region of Southern Denmark received significant attention due to the detection of the group receiving the telemedical ulcer treatment having a higher death rate. Reviews of the results were not able to provide an explanation to the cause of the increased death rate of the telemedicine group, or if it could be set in direct relation to the ulcer treatment or if other factors in the pathological picture played a role for these patients. But there is no doubt that the results give reason for precautions in relation to which patients that are offered the telemedical treatment in the future.
In relation to the actual ulcer treatment and the healing of foot ulcers, there was no difference between the telemedicine group and the patients receiving treatment at the ulcer centre at the hospital.
In the side project of the 3D scanner, results showed that the prototype of the 3D scanner provided a high accuracy in relation to the size and surface of the foot ulcer. Therefore, it was a usable method for photo documenting the development or healing of the foot ulcer. Especially in relation to the telemedical treatment of foot ulcers, a potential use of the 3D scanner for ensuring a more accurate diagnosis and referral of patients was proven.
The development of the 3D scanner from a prototype to a solution ready for marketing is still in the works at OUH and at the company, and a PhD study on the next version of the scanner and the clinical effect of introducing the technology into the ulcer treatment is currently being carried out.
In collaboration with PhD student Benjamin S. Rasmussen, the clinical, organizational and economic effects were studied in a randomized study based on the MAST model.
Kristian Kidholm Jane Clemensen
The project was a PhD project by Benjamin Schnack Rasmussen.