Effect of teleradiology on the diagnosis, treatment and prognosis of patients in a primary care centre

Abstract

A prospective study was carried out to evaluate the effect of teleradiology on the diagnosis, treatment and prognosis of patients in primary care. A university hospital was sent 685 plain film examinations via an ISDN connection from a primary care centre, for a radiological report. The study was conducted in two phases: during phase 1 (446 cases) general practitioners (GPs) selected the examinations, and during phase 2 (239 cases) all consecutive examinations were transmitted. In phase 1, 40% of the examinations were of the chest and 24% were of the spine; the remaining 36% were mainly bone and sinus examinations. In phase 2, 28% of the examinations were of the chest and 19% were of the spine. The sensitivity and specificity of the GPs' interpretations (compared with the radiologists') were 0.85 and 0.62 respectively in the first phase, and 0.90 and 0.86 in the second. In at least one-third of all cases, teleradiology helped with the diagnosis, although completely new diagnoses were less common. An effect on treatment was noted in 15% of cases and on prognosis in 5%. However, an appropriate consultation level is required for these positive effects. Adequate accuracy and patient safety cannot be achieved if the examinations sent for radiological reporting are preselected by a GP.

Evaluation of the Effect of Consultant Characteristics on Telemedicine Diagnosis and Treatment

“…Few studies have been performed to assess the effect of telemedicine on changes in the patient's diagnosis and treatment plan [1, 4, 5, 8–13]. Results of this study are consistent with previous studies that found changes in the patients' diagnoses and treatment plans as a result of telemedicine consultations.…”

“…Findings from a prospective study indicated that teleradiology ( n = 685 cases) changed the treatment in 22 cases out of the 42 cases with a false interpretation [4]. In almost two-thirds of the cases the teleradiology consultation helped with the diagnosis, and a new diagnosis was made in 4% of cases.…”

“…Quality of medical care for patients in remote areas may be improved by using telemedicine in the delivery of specialty medical care for these patients [3, 4]. Clinical outcomes in telemedicine must be assessed to determine whether this technology improves quality of care.…”

“…Increased access to a specialty medical care through telemedicine may alter the patient's diagnosis and treatment plan. Previous studies have concluded that changes in the patient's diagnosis and treatment plan, as a result of the telemedicine consultation, can have an impact on clinical outcomes and patients' costs for medical care [3, 4, 7]. These studies reported that changes in diagnoses and treatment plans through telemedicine consultations can avoid morbidity, costly and inappropriate treatment, patient transfers, and patients' costs for traveling to see a specialist.…”

“…Few studies have been performed to assess the effect of telemedicine on changes in patients' diagnoses and treatment plans [1, 4–6, 8–13]. Only one of the previous studies assessed the effect of teleconsultant characteristics on changes in diagnoses and treatment plans [5].…”