THE DRUG-DEVICE COMBINATION PRODUCTS ARE THERAPEUTIC AND DIAGNOSTIC PRODUCTS THAT COMBINE DRUGS, DEVICES, AND BIOLOGICAL PRODUCTS, LEADING TO SAFER AND EFFICIENT TREATMENT OF PATIENT. THESE DEVICES PROVIDE CAREFUL AND PRECISE DRUG TARGETING, LOCAL ADMINISTRATION, AND INDIVIDUALIZED THERAPY. FOR INSTANCE, IN SEPTEMBER 2020, BOSTON SCIENTIFIC ANNOUNCED THE GRANT FOR NEW TECHNOLOGY ADD-ON PAYMENT (NTAP) FOR THE ELUVIA DRUG-ELUTING VASCULAR STENT SYSTEM AS PART OF THE 2021 INPATIENT PROSPECTIVE PAYMENT SYSTEM (IPPS) FROM THE U.S. CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). IT IS EXPECTED TO SIGNIFICANTLY IMPROVE THE DIAGNOSIS OR TREATMENT OF MEDICARE BENEFICIARIES, AND PROVIDE ELIGIBLE HOSPITALS WITH INCREMENTAL REIMBURSEMENT FOR THE ELUVIA STENT SYSTEM FOR THREE YEARS. FURTHER, WITH GROWING GERIATRIC POPULATION PREVALENCE OF CARDIOVASCULAR DISEASES IS EXPECTED TO GROW, PROVIDING GROWTH OPPORTUNITY FOR THE MARKET TO GROW. ACCORDING TO THE UNITED STATES DEPARTMENT OF ECONOMIC AND SOCIAL AFFAIRS, GLOBALLY THERE WERE 727 MILLION PEOPLE AGED 65 YEARS OR MORE IN 2020. THE SHARE OF THE GLOBAL POPULATION AGED 65 YEARS OR ABOVE IS EXPECTED TO INCREASE FROM 9.3% IN 2020 TO 16% BY 2050.
DURING THE TIME OF THE PANDEMIC, THE HEALTH SYSTEMS IN MAJOR ECONOMIES HAVE BEEN IMPACTED. THE INTENSIVE, INTERMEDIATE, AND EMERGENCY CARE UNITS IN SEVERAL HOSPITALS HAVE BEEN CONVERTED TO COVID CARE UNITS. ALSO, THE PLAYERS OPERATING IN THE GLOBAL DRUG-DEVICE COMBINATION PRODUCTS MARKET ARE CONFRONTING MAJOR CHALLENGES DUE TO THE COVID-19 PANDEMIC SUCH AS THE SUPPLY OF RAW MATERIALS FOR MANUFACTURING DRUG INVENTIONS DUE TO IRREGULARITIES IN TRANSPORTATION FACILITIES. MOREOVER, THE DISTRIBUTORS OF PRODUCTS ARE FACING IMPROPER DEMAND FOR PRODUCTS FROM THE RETAILERS DUE TO THE INCREASING PATIENT POPULATION SUFFERING FROM COVID-19 AND OTHER LIFE-THREATENING DISORDERS.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR THE DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE SERVICES, WHERE
DISTANCE IS A CRITICAL FACTOR, BY ALL HEALTH CARE PROFESSIONALS
USING INFORMATION AND COMMUNICATIONS TECHNOLOGIES FOR
THE EXCHANGE OF VALID INFORMATION FOR DIAGNOSIS, TREATMENT
AND PREVENTION OF DISEASE AND INJURIES, RESEARCH AND
EVALUATION, AND FOR THE CONTINUING EDUCATION OF HEALTH
CARE PROVIDERS, ALL IN THE INTERESTS OF ADVANCING THE HEALTH
OF INDIVIDUALS AND THEIR COMMUNITIES.
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
TELEMEDICINE CAN BE DETERMINED AS AN INTEGRATION
OF SEVERAL COMPONENTS INCLUDING INFORMATION AND
COMMUNICATION TECHNOLOGIES, HARDWARE AND SO?WARE
TECHNOLOGIES AND MEDICAL SERVICES OPERATING TOGETHER IN
ORDER TO PROVIDE REQUIRED FEATURES OR SERVICES TO USERS
AS SHOWN IN FIG 1. ?E UNDERLYING TECHNOLOGIES ARE SEEN
AS A BLACK BOX TO THE USERS AND THEY ARE RESPONSIBLE FOR
FACILITATING PROCESSES OF EACH PROPOSED SERVICE
.......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...........
....................................... ................................
EDUCATION AND PRACTICE FUNDAMENTALS
" INTRODUCTION TO THE PRACTICE OF TELEMEDICINE
JOHN CRAIG* AND VICTOR PATTERSON*
W
?
DEPARTMENT OF NEUROLOGY, ROYAL VICTORIA HOSPITAL, BELFAST, UK;
W
CENTRE FOR ONLINE HEALTH, UNIVERSITY OF QUEENSLAND, BRISBANE,
AUSTRALIA
SUMMARY
TELEMEDICINE IS THE DELIVERY OF HEALTH CARE AND THE EXCHANGE OF HEALTH-CARE INFORMATION ACROSS DISTANCES. IT IS NOT
A TECHNOLOGY OR A SEPARATE OR NEW BRANCH OF MEDICINE. TELEMEDICINE EPISODES MAY BE CLASSI?ED ON THE BASIS OF:
(1) THE INTERACTION BETWEEN THE CLIENT AND THE EXPERT (I.E. REALTIME OR PRERECORDED), AND (2) THE TYPE OF
INFORMATION BEING TRANSMITTED (E.G. TEXT, AUDIO, VIDEO). MUCH OF THE TELEMEDICINE WHICH IS NOW PRACTISED IS
PERFORMED IN INDUSTRIALIZED COUNTRIES, SUCH AS THE USA, BUT THERE IS INCREASING INTEREST IN THE USE OF TELEMEDICINE
IN DEVELOPING COUNTRIES. THERE ARE BASICALLY TWO CONDITIONS UNDER WHICH TELEMEDICINE SHOULD BE CONSIDERED:
(1) WHEN THERE IS NO ALTERNATIVE (E.G. IN EMERGENCIES IN REMOTE ENVIRONMENTS), AND (2) WHEN IT IS BETTER THAN
EXISTING CONVENTIONAL SERVICES (E.G. TELERADIOLOGY FOR RURAL HOSPITALS). FOR EXAMPLE, TELEMEDICINE CAN BE EXPECTED
TO IMPROVE EQUITY OF ACCESS TO HEALTH CARE, THE QUALITY OF THAT CARE, AND THE EF?CIENCY BY WHICH IT IS DELIVERED.
RESEARCH IN TELEMEDICINE INCREASED STEADILY IN THE LATE 1990S, ALTHOUGH THE QUALITY OF THE RESEARCH COULD BE
IMPROVED - THERE HAVE BEEN FEW RANDOMIZED CONTROLLED TRIALS TO DATE.
INTRODUCTION
ONE OF THE GREAT CHALLENGES FACING HUMANKIND IN THE
21ST CENTURY IS TO MAKE HIGH-QUALITY HEALTH CARE AVAILABLE
TO ALL. SUCH A VISION HAS BEEN EXPRESSED BY THE WORLD
HEALTH ORGANIZATION (WHO) IN ITS HEALTH-FOR-ALL STRATEGY
IN THE 21ST CENTURY.
1
REALIZING THIS VISION WILL BE DIF?CULT,
PERHAPS IMPOSSIBLE, BECAUSE OF THE BURDENS IMPOSED ON
A GROWING WORLD POPULATION BY OLD AND NEW DISEASES,
RISING EXPECTATIONS FOR HEALTH, AND SOCIOECONOMIC
CONDITIONS THAT HAVE, IF ANYTHING, INCREASED DISPARITIES IN
HEALTH STATUS BETWEEN AND WITHIN COUNTRIES.
TRADITIONALLY, PART OF THE DIF?CULTY IN ACHIEVING
EQUITABLE ACCESS TO HEALTH CARE HAS BEEN THAT THE
PROVIDER AND THE RECIPIENT MUST BE PRESENT IN THE SAME
PLACE AND AT THE SAME TIME. RECENT ADVANCES IN
INFORMATION AND COMMUNICATION TECHNOLOGIES,
HOWEVER, HAVE CREATED UNPRECEDENTED OPPORTUNITIES FOR
OVERCOMING THIS BY INCREASING THE NUMBER OF WAYS THAT
HEALTH CARE CAN BE DELIVERED. THIS APPLIES BOTH TO
DEVELOPING COUNTRIES WITH WEAK OR UNSTABLE ECONOMIES
AND TO INDUSTRIALIZED COUNTRIES. THE POSSIBILITIES FOR
USING INFORMATION AND COMMUNICATION TECHNOLOGIES TO
IMPROVE HEALTH-CARE DELIVERY ( HEALTH TELEMATICS ) ARE
INCREASINGLY BEING RECOGNIZED. THE WHO HAS STATED THAT
WITH REGARD TO ITS HEALTH-FOR-ALL STRATEGY IT RECOMMENDS
THAT THE WHO AND ITS MEMBER STATES SHOULD:
INTEGRATE THE APPROPRIATE USE OF HEALTH TELEMATICS IN
THE OVERALL POLICY AND STRATEGY FOR THE ATTAINMENT OF
HEALTH FOR ALL IN THE 21ST CENTURY, THUS FUL?LLING THE
VISION OF A WORLD IN WHICH THE BENE?TS OF SCIENCE,
TECHNOLOGY AND PUBLIC HEALTH DEVELOPMENT ARE MADE
EQUITABLY AVAILABLE TO ALL PEOPLE EVERYWHERE.
2
SUCH A COMMITMENT TO IMPROVE HEALTH-CARE DELIVERY,
BY UTILIZING INFORMATION AND TELECOMMUNICATIONS
TECHNOLOGIES, IS ALSO BEING CONSIDERED BY THOSE WITH THE
?NANCIAL MEANS TO DO SO, FOR EXAMPLE, THE PARTICIPANTS
IN VARIOUS EUROPEAN COMMISSION PROJECTS. AT THE
NATIONAL AND SUBNATIONAL LEVEL, THERE IS ALSO EVIDENCE OF
GOVERNMENTAL INTEREST IN THE BENE?TS THAT THESE
TECHNOLOGIES MIGHT BRING TO HEALTH CARE. FOR EXAMPLE,
IN THE UK, INFORMATION TECHNOLOGY INCLUDING
TELEMEDICINE IS AT THE HEART OF THE GOVERNMENT S
STRATEGY TO MODERNIZE AND IMPROVE THE NHS.
3
TELEMEDICINE, THE AREA WHERE MEDICINE AND INFOR-
MATION AND TELECOMMUNICATIONS TECHNOLOGY MEET, IS
PROBABLY THE PART OF THIS REVOLUTION THAT COULD HAVE THE
GREATEST IMPACT ON HEALTHCARE DELIBASED ON SERVICE, THE MARKET IS FRAGMENTED INTO TELE-CONSULTING, TELE-MONITORING, AND TELE-EDUCATION. THE TELE-CONSULTING SEGMENT GENERATED MORE THAN 45% REVENUE IN 2020. THE MARKET IS EXPECTED TO GROW AT A SIGNIFICANT RATE DURING THE FORECAST PERIOD. AS IT PERMITS PATIENTS TO HAVE APPOINTMENTS WITH EXPERTS AT ANY INSTANCE OF TIME, WITHOUT ANY WAITING PERIOD.
BASED ON PRODUCTS, THE MARKET IS BIFURCATED INTO DRUG-ELUTING STENT, INFUSION PUMP, PHOTOSENSITIZERS, PREFILLED SYRINGE, WOUND CARE COMBINATION PRODUCTS, ORTHOPAEDIC COMBINATION PRODUCTS, DRUG-ELUTING BALLOON, INHALERS, TRANSDERMAL DELIVERY SYSTEMS, AND OTHERS. THE TRANSDERMAL DELIVERY SYSTEMS SEGMENT DOMINATED THE MARKET IN 2020. AS THE PATCH PROVIDES A CONTROLLED RELEASE OF MEDICATION INTO THE PATIENT, USUALLY VIA A POROUS MEMBRANE OR THROUGH BODY HEAT MELTING THIN LAYERS OF MEDICATION EMBEDDED IN THE ADHESIVE. BASED ON APPLICATION, THE MARKET IS BIFURCATED CARDIOVASCULAR DISEASE, DIABETES, RESPIRATORY PROBLEM, CANCER TREATMENT, ANTIMICROBIAL APPLICATIONS, AND OTHERS. THE CARDIOVASCULAR DISEASE SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020, OWING TO THE INCREASING AWARENESS OF PEOPLE ABOUT NEW DRUG-DEVICE COMBINATION PRODUCTS.
BASED ON THE DISTRIBUTION CHANNEL, THE MARKET IS BIFURCATED INTO HOSPITAL PHARMACIES, RETAIL PHARMACIES, AND ONLINE PHARMACIES. THE RETAIL PHARMACIES SEGMENT ACCOUNTED FOR THE MAJOR REVENUE PORTION IN 2020. AS IT IS THE MOST WIDELY USED DISTRIBUTION CHANNEL AND THE RETAIL PHARMACY S GENERATE MAJOR REVENUE FROM SELLING PRESCRIPTION DRUGS, OVER-THE-COUNTER DRUGS, VITAMINS, COSMETICS, AND OTHER MERCHANDISE. BASED ON END-USER, THE MARKET IS BIFURCATED INTO HOSPITALS & CLINICS, AMBULATORY SURGICAL CENTERS, HOME CARE SETTINGS, AND OTHERS. THE HOSPITALS & CLINICS CENTER SEGMENT IS ANTICIPATED TO OBSERVE LUCRATIVE GROWTH DURING THE FORECAST PERIOD, AS HOSPITALS PROVIDE SUPERIOR CARE TO THEIR PATIENTS AND OFFER SIGNIFICANT COMPENSATIONS.
FOR A BETTER UNDERSTANDING OF THE MARKET ADOPTION OF THE DRUG-DEVICE COMBINATION PRODUCTS, THE MARKET IS ANALYZED FOR MAJOR REGION INCLUDING NORTH AMERICA (US, CANADA, AND THE REST OF NORTH AMERICA), EUROPE (GERMANY, FRANCE, ITALY, SPAIN, UK AND REST OF EUROPE), ASIA-PACIFIC (CHINA, JAPAN, INDIA, AUSTRALIA, AND REST OF APAC), AND REST OF WORLD. NORTH AMERICA DOMINATED THE MARKET IN 2020, WITH XX% SHARE IN VALUE TERMS. SOME OF THE MAJOR PLAYERS OPERATING IN THE MARKET INCLUDE MEDTRONIC PLC, ABBOTT LABORATORIES, SMITH & NEPHEW PLC, BOSTON SCIENTIFIC CORPORATION, GLAXOSMITHKLINE PLC, BECTON DICKINSON AND COMPANY, JOHNSON & JOHNSON, NOVARTIS AG, BAYER AG, BAXTER INTERNATIONAL, INC, ETC. SEVERAL M&AS ALONG WITH PARTNERSHIPS HAVE BEEN UNDERTAKEN BY THESE PLAYERS TO EXPAND THEIR REACH IN MAJOR DEVELOPING REGIONS.
THE GLOBAL DRUG-DEVICE COMBINATION PRODUCTS MARKET WAS GROWING AT A SIGNIFICANT RATE IN 2020 AND IS PROJECTED TO EXPAND CONSIDERABLY FROM 2021F TO 2027F. THE MARKET IS EXPECTED TO WITNESS A BOOST ON ACCOUNT OF THE INCREASING PREVALENCE OF CHRONIC DISEASES AND RISING DEMAND FOR HOME-BASED CARE SERVICE. ALSO, THE KEY PLAYERS WORLDWIDE ARE INTRODUCING ADVANCED DRUG-DEVICE COMBINATION TECHNOLOGIES, TO CATER MIDDLE-INCOME GROUPS. THIS IS EXPECTED TO BOOST THE GROWTH OF THE DRUG-DEVICE COMBINATION PRODUCTS MARKET.
