MANAGEMENT OF AKV BY TELEMEDICINE : STUDY ABOUT 200 PATIENTS

1. Heart CenterAVICENNA UHC Rabat. 2. HematologyAVICENNA UHC Rabat. 3. Cardiology-AVICENNA HospitalMarrakech. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 30 November 2019 Final Accepted: 31 December 2019 Published: January 2020

One year later, the evaluation of the management quality was based on: 1. One-year INR assessments:our study was carried out in collaboration with the hematology laboratory, all our patients carried out their biological testsat the hospital laboratory under the same conditions. 2. Presented complications: the evaluation of complications was based on the number, severity and rapidity of management of com plications particularly hemorrhagic and embolic accidents. 3. Patients' personal expenses: transportation expenses were judged on the number of trips made by each patient, and expenses of clinical managementparticularly hospital stay costs and management of complications.  Patients of the 2nd group (group followed by telephone) were well anticoagulated most of the times with more frequent INR tests; 1305 INR performed by the 2nd group (1.09 per patient per month) compared with 500 INR by the 1st group (0.41 per patient per month). The number of complications was lower in the 2nd group as 5 patients presented a symptomatic overdose to anticoagulants and have evolved well, versus 12 for the 1st group, 4 of whom required hospitalization in the Intensive Care Unit for serious bleeding events, one of them has deceasedand another had a hemostasis gastrectomy.Four patients in the first group had embolic events: 1 ischemic stroke with sequelae, 1 transient ischemic attack (TIA), and 2 prosthetic thromboses with one treated medically and the other surgically. Transportation expenses of the 2nd group were much smaller.

Discussion:-
Even by simple means, telemedicine has shown its potential contribution in terms of mortality, morbidity, and in number of avoided hospitalizations. Its impact in terms of health economics is documented. [1] A close monitoring of patients improves the prognosis of chronic diseases and ensures the proper use of chronic treatments. Based on monitoring by telephone messaging and social networks, our study showed a clear reduction in hemorrhagic and embolic complications and a good efficacy and safety in the use of oral anticoagulants in the group followed by telemedicine, with also better economic savings in therapeutic expenditure. [2] Through this experience of our study, we may be witnessing the birth of the "medicine of tomorrow". Indeed, in the field of chronic diseases, in terms of their epidemiology and the foreseeable deficit of time and resources, we need to better monitor and educate.
Telemedicine based on social networks and messaging platforms is more comfortable for the treating physician than telephone calls.
In their review on follow-up by telephone or telemonitoring of HF patients, Inglis et al. show that telemedicine has an effect on all-cause mortality, with a significant reduction of 34% (p <0.0001). In this study, it is also put forward a reduction in re-hospitalizations for HF of 20%, an improvement in the quality of life of patients, costs of care, and a good acceptability of the system. [3.4] In the meta-analysis of Anker et al. studies were analyzed as part of a comparison between the effects of telemonitoring compared to usual care (non-invasive telemedicine). [4,5] In this work, telemonitoring showed the reduction of the following elements: all-cause mortality (10.4% versus 15.4%; p <0.0001), admission to hospital for all causes (47.2% versus 52.1%; p = 0.02), hospitalization linked to chronic HF (22.4% versus 28.5%; p = 0.008). [5,6,7] Conclusion:-Telemedicine based on social networks and messaging platforms is more comfortable for the treating physician than telephone calls.
Health policy should consider telemedicine as a solution for a better managementof the Moroccan population and as a solution for health problems in the framework of the citizen approximation initiative.