Telemedicine in the management of chronic pain: a cost analysis study

Pronovost, Antoine; Peng, Philip; Kern, R.

doi:10.1007/s12630-009-9123-9

Cited by 38 publications

(22 citation statements)

References 12 publications

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“…Excluding the single study that reported only on the patient perspective, the results from the health service perspective were 17 (49%) found telehealth more costly, 16 (46%) less costly, 1 (3%) found costs changed from more to less over time, and 1 (3%) found costs to be the same. These differences are largely accounted for because in delivering services to rural areas, the health services paid more for telehealth, but the societal perspective demonstrated cost savings due to reductions in patient travel[28,31-34]. In studies where both the societal and the health services perspective showed lower costs, the health services were paying for health care workers to travel[30,35].…”

Section: Resultsmentioning

confidence: 99%

“…Five studies, all of which were home care, used the PSTN (Public Switched Telephone Network), which is the standard low-bandwidth telephone line supplied to households, and three studies did not specify the connectivity. One study reported using "broadband"[31], and it was assumed that this meant Digital Services Lines (DSL). Connectivity was a significant cost for many telehealth services, with Bishai[62] reporting T1 line charges as their largest single cost, and Chua[36] noting that the hourly cost of ISDN communication was almost identical to the hourly pay of a consultant neurologist.…”

Section: Resultsmentioning

confidence: 99%

“…The studies in this review do not reflect the recent advances in connectivity produced by widespread rollout of fast broadband or Digital Services Lines (DSL) with only one recent study utilising DSL[31]. This may be because of quality and reliability issues with DSL.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of economic analyses of telehealth services using real time video communication

Wade

Karnon

Elshaug

et al. 2010

BMC Health Serv Res

276

227

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BackgroundTelehealth is the delivery of health care at a distance, using information and communication technology. The major rationales for its introduction have been to decrease costs, improve efficiency and increase access in health care delivery. This systematic review assesses the economic value of one type of telehealth delivery - synchronous or real time video communication - rather than examining a heterogeneous range of delivery modes as has been the case with previous reviews in this area.MethodsA systematic search was undertaken for economic analyses of the clinical use of telehealth, ending in June 2009. Studies with patient outcome data and a non-telehealth comparator were included. Cost analyses, non-comparative studies and those where patient satisfaction was the only health outcome were excluded.Results36 articles met the inclusion criteria. 22(61%) of the studies found telehealth to be less costly than the non-telehealth alternative, 11(31%) found greater costs and 3 (9%) gave the same or mixed results. 23 of the studies took the perspective of the health services, 12 were societal, and one was from the patient perspective. In three studies of telehealth to rural areas, the health services paid more for telehealth, but due to savings in patient travel, the societal perspective demonstrated cost savings. In regard to health outcomes, 12 (33%) of studies found improved health outcomes, 21 (58%) found outcomes were not significantly different, 2(6%) found that telehealth was less effective, and 1 (3%) found outcomes differed according to patient group. The organisational model of care was more important in determining the value of the service than the clinical discipline, the type of technology, or the date of the study.ConclusionDelivery of health services by real time video communication was cost-effective for home care and access to on-call hospital specialists, showed mixed results for rural service delivery, and was not cost-effective for local delivery of services between hospitals and primary care.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A systematic review of economic analyses of telehealth services using real time video communication

Wade

Karnon

Elshaug

et al. 2010

BMC Health Serv Res

276

227

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show abstract

“…A study of a small-scale program in Ontario by Pronovost and colleagues has shown that the use of telemedicine in the management of chronic pain is cost-effective. 6 Living a long distance from a tertiary care pain centre should not preclude access to expert advice.…”

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confidence: 99%

Better management of chronic pain care for all

MacDonald¹,

Flegel²,

Hébert³

et al. 2011

Canadian Medical Association Journal

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“…They found an average consultation cost of $228 per patient based on a sample of 4,317 consultations, and fewer than 10% of the encounters were considered a failure (ie, patient no‐showed the encounter or failed to connect with the provider). Pronovost et al 23 . examined the direct and indirect costs associated with a telehealth chronic pain treatment program using a randomized crossover trial.…”

Section: Telehealth Costsmentioning

confidence: 99%

A Comprehensive Review of Telehealth for Pain Management: Where We Are and The Way Ahead

McGeary

Gatchel

2012

Pain Practice

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Pain is generally undertreated in the United States, owing to a number of barriers including geographic distance from specialty treatment providers; functional disability that limits mobility; treatment-related stigma; economic limitations; and educational barriers. Pain undertreatment exacerbates pain chronicity and emotional disruption that can significantly erode a pain patient's quality of life, and there is widespread agreement that pain care must evolve to address this significant problem. The growing field of telehealth (defined for the purposes of this paper as technology that allows for distance interaction between providers and/or patients) offers a novel opportunity to expand pain assessment, consultation, and treatment services beyond the walls of the specialty pain clinic, but there is limited availability of resources describing how to best use this technology to improve access to care. A recent literature review (September 2011) using universally endorsed MeSH search criteria revealed only 32 MEDLINE references focusing on telehealth for pain. This is surprising in light of the very large number of references covering telehealth (14,164 references) and pain (104,564 references), respectively. Of the studies available, there are very few randomized trials of telehealth pain care and only one general overview of e-health and chronic pain, which dedicates just a few paragraphs to telehealth. This manuscript represents one of the first comprehensive reviews of the current state of telehealth and pain management research and practice. The goals are to provide a rationale for the potential benefit of telehealth-based pain management services; describe the various applications of telehealth technology for pain management; orient the reader to cost models for telehealth; present examples of services in place; and offer recommendations for future research based on the current state of knowledge.

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Telemedicine in the management of chronic pain: a cost analysis study

Cited by 38 publications

References 12 publications

A systematic review of economic analyses of telehealth services using real time video communication

A systematic review of economic analyses of telehealth services using real time video communication

Better management of chronic pain care for all

A Comprehensive Review of Telehealth for Pain Management: Where We Are and The Way Ahead

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