Changes in Diagnosis, Treatment, and Clinical Improvement Among Patients Receiving Telemedicine Consultations

Abstract

The aim of this study was to determine whether outpatient telemedicine specialty consultations to primary care clinicians result in changes in a patient's diagnosis, treatment management, and clinical outcomes. Medical records of patients who received two or more clinical telemedicine consultations in dermatology, psychiatry, and endocrinology were evaluated in a nonconcurrent retrospective analysis. Three indicators were used to measure changes in the processes of care and clinical outcomes: change in diagnosis, change in treatment, and patient clinical improvement. A retrospective review of 223 individual telemedicine patient medical records was conducted. Specialty telemedicine consultations were found to result in changes in diagnoses in 48% of the cases, changes in treatment therapy in 81.6% of the cases, and clinical improvement in 60.1%. These results are consistent with previous literature that has assessed changes in processes of care and outcomes from face-to-face specialty consultations in outpatient clinics. Changes in diagnosis and treatment therapy were found to be associated with clinical improvement with odds ratios (ORs) of 2.66 (95% confidence interval [CI]: 1.47-4.83) and 11.22 (95% CI: 4.49-31.48), respectively. This study found that telemedicine consultations resulted in changes in diagnosis and treatment regimens and also are associated with clinical improvements.

Pediatric teledermatology: Observations based on 429 consults

“…17,18 They are lower than the published concordance values obtained when comparing diagnoses between office dermatologists and teledermatologists (64%-88%) as specialists would be expected to make similar diagnoses more frequently than nonspecialists compared with specialists (the situation in this study). [19][20][21][22][23] The use of nonspecific terms such as ''rash'' or ''dermatitis'' as provisional diagnoses by the referring nondermatologist providers was frequently applied across a spectrum of nosologically unrelated skin diseases including insect bites, folliculitis, molluscum, and nevi.…”

Telehealth at UC Davis—A 20-Year Experience

“…3 In 2002, CHT researchers reported improved quality from outpatient telemedicine specialty consultations to primary care clinicians. 4 This study also found that telemedicine consultations resulted in changes in diagnosis and treatment regimens as well as improvement in clinical outcomes, 4 demonstrating that telemedicine has the potential to increase the quality of healthcare in local communities. …”

Addressing health disparities in rural communities using telehealth

“…Review and cardiology and has consistently led to strong patient, caregiver, and provider satisfaction (21,24,(45)(46)(47)(48). Telemedicine has also successfully reduced the costs of healthcare and time related to physician travel in addition to reducing the time and out of pocket expenses for patients and families who may need to travel from remote or hard-to-reach locations for their care (49)(50)(51).…”