Telemedicine: is it really worth it? A perspective from evidence and experience

Freed, John B.; Lowe, Charles; Flodgren, Gerd; Binks, Rachel M.; Doughty, K.; Kolsi, Jyrki

doi:10.14236/jhi.v25i1.957

Cited by 45 publications

(38 citation statements)

References 5 publications

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“…In total, 19 articles looked at health care provider cost, patient cost, or costs incurred by both. This comprised 5 RCTs [25,26,41,60,71], 3 systematic reviews [73,75,104], 2 nonsystematic reviews [54,91], 1 retrospective study [27], 1 case-control study [78], 1 service report [96], 3 pilots [12,43,55], and 3 protocols [38,68,106]. Nearly all of the studies reported higher costs for health care providers, including all RCTs.…”

Section: Costmentioning

confidence: 99%

The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review

O’Cathail¹,

Sivanandan²,

Diver³

et al. 2020

JMIR Med Inform

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Background The National Health Service (NHS) Long-Term Plan has set out a vision of enabling patients to access digital interactions with health care professionals within 5 years, including by video link. Objective This review aimed to examine the extent and nature of the use of patient-facing teleconsultations within a health care setting in the United Kingdom and what outcome measures have been assessed. Methods We conducted a systematic scoping review of teleconsultation studies following the Joanna Briggs Institute methodology. PubMed, Scopus, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature were searched up to the end of December 2018 for publications that reported on the use of patient-facing teleconsultations in a UK health care setting. Results The search retrieved 3132 publications, of which 101 were included for a full review. Overall, the studies were heterogeneous in design, in the specialty assessed, and reported outcome measures. The technology used for teleconsultations changed over time with earlier studies employing bespoke, often expensive, solutions. Two-thirds of the studies, conducted between 1995 and 2005, used this method. Later studies transitioned to Web-based commercial solutions such as Skype. There were five outcome measures that were assessed: (1) technical feasibility, (2) user satisfaction, (3) clinical effectiveness, (4) cost, (5) logistical and operational considerations. Due to the changing nature of technology over time, there were differing technical issues across the studies. Generally, teleconsultations were acceptable to patients, but this was less consistent among health care professionals. However, among both groups, face-to-face consultations were still seen as the gold standard. A wide range of clinical scenarios found teleconsultations to be clinically useful but potentially limited to more straightforward clinical interactions. Due to the wide array of study types and changes in technology over time, it is difficult to draw definitive conclusions on the cost involved. However, cost savings for health care providers have been demonstrated by the goal-directed implementation of teleconsultations. The integration of technology into routine practice represents a complex problem with barriers identified in funding and hospital reimbursement, information technologies infrastructure, and integration into clinicians’ workflow. Conclusions Teleconsultations appear to be safe and effective in the correct clinical situations. Where offered, it is likely that patients will be keen to engage, although teleconsultations should only be offered as an option to support traditional care models rather than replace them outright. Health care staff should be encouraged and supported in using teleconsultations to diversify their practice. Health care organizations need to consider developing a digital technology strategy and implementation groups to assist health care staff to integrate digitally enabled care into routine practice. The introduction of new technologies should be assessed after a set period with service evaluations, including feedback from key stakeholders.

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Section: Costmentioning

confidence: 99%

The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review

O’Cathail¹,

Sivanandan²,

Diver³

et al. 2020

JMIR Med Inform

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“…No conceptual or theoretical frameworks concerning the relationships between telemedicine barriers and adoption were found. Robust prior studies in telemedicine, e-Health, telehealth, and m-Health (Alaboudi et al, 2016;Bigna, Noubiap, Plottel, Kouanfack, & Koulla-Shiro, 2014;Boonstra & Broekhuis, 2010;Bullock et al, 2017;Cajita, Hodgson, Lam, Yoo, & Han, 2018;De Bustos, Moulin, & Audebert, 2009;Faber, van Geenhuizen, & de Reuver, 2017;Freed et al, 2018;Gravel, Légaré, & Graham, 2006;Jang-Jaccard et al, 2014;Johnson, 2001;Leaming, 2007;LeRouge & Garfield, 2013;Lin, Lin, & Roan, 2012;Lohmann, Muula, Houlfort, & De Allegri, 2018;Modi, Portney, Hollenbeck, & Ellimoottil, 2018;Moffatt & Eley, 2011;Ramtohul, 2015;Rogove, McArthur, Demaerschalk, & Vespa, 2012;Scott Kruse et al, 2018;Scott & Mars, 2013;Van Dyk, 2014;Whitten, Holtz, Meyer, & Nazione, 2009) were used to develop and test the hypotheses regarded as mutually exclusive and exhaustive when considered from a model parsimony perspective. These seven broad categories of barriers are encapsulated in the study's conceptual model (see Figure 1).…”

Section: Review Of the Literature (Hypotheses And Conceptual Model)mentioning

confidence: 99%

“…Interestingly, to bolster patient satisfaction, current telemedicine does not offer an emergency telemedicine service facility, a specialised diagnosis facility in a rural centre or assurance of prescribed medicine availability in a local pharmacy. Patients should have continual access to a telemedicine clinical team, promoting their health and wellbeing (Freed et al, 2018). A study identified a positive relationship between service quality and patient satisfaction in healthcare interventions (Lee & Yom, 2007), suggesting that satisfaction is critical in healthcare quality assessment and organisational loyalty, reflecting the core issues affecting the longevity of current healthcare industries (Elbeck, 1987).…”

Section: Patient Satisfaction Barriersmentioning

confidence: 99%

Telemedicine Healthcare Service Adoption Barriers in Rural Bangladesh

Zobair

Sanzogni

Sandhu

2020

AJIS

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This article investigates potential barriers to telemedicine adoption in centres hosted by rural public hospitals in Bangladesh. Little is known of the barriers related to telemedicine adoption in this context. Analysis of data collected from rural telemedicine patients identified seven broad categories of barriers: lack of organisational effectiveness, information and communication technology infrastructure, quality of care, allocation of resources, health staff motivation, patient satisfaction and trustworthiness. Their significance is explored. This research is based on the quantitative analysis of a data set of 500 telemedicine patients, from rural areas in Bangladesh. A conceptual model showing the interaction of pre-determined classes of barriers was established and hypotheses set up and tested using partial least squares structural equation modelling. Exemplary barriers to telemedicine adoption were identified and confirmed (p<.01) namely, lack of organisational effectiveness, health staff motivation, patient satisfaction, and trustworthiness collectively explaining 62% of the variance in barriers to adoption and providing for the first-time empirical support of their existence. These barriers offer considerable resistance to the adoption and maintenance of current telemedicine projects in rural Bangladesh. Further, lack of information and communication technology infrastructure, allocation of resources and quality of care are indirect barriers affecting successful deployment of telemedicine in rural settings. These findings illuminate adoption impediments faced by existing telemedicine projects and institutionalise favourable policy guidelines to improve Bangladesh’s and similar emerging economies’ healthcare industries. Policy interventions and recommendations are provided, including current research limitations leading to opportunities for future research.

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“…Honest!5 , 6 Even when the technology was offered to the NHS free – there was no interest from our local commissioners! The paper by Reed et al 7. reminds us that corporate culture and the skills to implement technology are as much needed now as they were 20 years ago!…”

Section: Implementation and Integration Into Clinical Workflowmentioning

confidence: 99%

In this issue – patient risks are ignored at organisation level

Lusignan

2018

BMJ Health Care Inform

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Telemedicine: is it really worth it? A perspective from evidence and experience

Cited by 45 publications

References 5 publications

The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review

The Use of Patient-Facing Teleconsultations in the National Health Service: Scoping Review

Telemedicine Healthcare Service Adoption Barriers in Rural Bangladesh

In this issue – patient risks are ignored at organisation level

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