Clinical outcomes resulting from telemedicine interventions: a systematic review

Abstract

BackgroundThe use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based.MethodsData sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence.ResultsA total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery.ConclusionsDespite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

Use of an Internet Portal to Improve Community-Based Pediatric ADHD Care: A Cluster Randomized Trial

“…In addition to being effective for most care outcomes, the intervention was well accepted by pediatricians, who largely expressed high levels of satisfaction with the intervention model and would recommend it to other pediatricians. The intervention model was designed to be able to be disseminated widely, by combining quality improvement methods, 15 telemedicine, 16,17 and an innovative, Internet-based interface. This is the first randomized trial to demonstrate the efficacy of a quality improvement intervention in improving community-based pediatricians' ADHD assessment and treatment practice behaviors.…”

Effectiveness of telemedicine: A systematic review of reviews

“…There is also a debate about appropriate research methodologies. For example, economic analysis of telemedicine has not yet met accepted standards [5]; there is a relative lack of exploration of the socio-economic impact of telemedicine [7]; evidence on factors promoting uptake of telemedicine is lacking [8]; there is relatively undeveloped use, at the time, of qualitative methods [9]; many studies have not been well-designed [4] [10]; and, considering perceived difficulties of building a robust evidence base for recent innovations, researchers have argued that simulation modelling needs further development [11].…”

Clinical Management and Patient Outcomes Among Children and Adolescents Receiving Telemedicine Consultations for Obesity

“…[23][24][25][26] Although there is a growing body of literature on the clinical effectiveness and outcomes of telemedicine, applications in the fields of obesity and nutrition have only recently been described. [27][28][29][30][31] Moreover, most research into the effectiveness and outcomes of telemedicine interventions has been conducted in adults. [29][30][31] To assess whether clinical consultations delivered by telemedicine improve quality of care, the effect of consultations on objective measures, namely, diagnostic and management decisions and clinical outcomes, must be measured.…”

“…[27][28][29][30][31] Moreover, most research into the effectiveness and outcomes of telemedicine interventions has been conducted in adults. [29][30][31] To assess whether clinical consultations delivered by telemedicine improve quality of care, the effect of consultations on objective measures, namely, diagnostic and management decisions and clinical outcomes, must be measured. 29,30 Hence, the first goal of this study was to investigate the effects of telemedicine consultations for pediatric obesity on the above fundamental outcomes.…”

“…[29][30][31] To assess whether clinical consultations delivered by telemedicine improve quality of care, the effect of consultations on objective measures, namely, diagnostic and management decisions and clinical outcomes, must be measured. 29,30 Hence, the first goal of this study was to investigate the effects of telemedicine consultations for pediatric obesity on the above fundamental outcomes. The second goal of this study was to determine whether telemedicine-driven changes in diagnosis and management decisions were associated with improvements in clinical outcomes in patients who had more than one consultation.…”