Effect of Telemedicine on Diagnosis and Treatment by Teleconsultants Characteristics

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Effect of Telemedicine on Diagnosis and Treatment
by Teleconsultants Characteristics

• Ann B. Bynum, EdD, Director, UAMS, Regional
  Programs Rural Hospital Program Co-Director,
  Center for Distance Health
• Cathy A. Irwin, PhD, RN, Research Associate,
  Rural Hospital Program
• University of Arkansas for Medical Sciences
  (UAMS), Little Rock, Arkansas

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The Rural Hospital Program Interactive Video
Network
University of Arkansas for Medical Sciences

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(No Transcript)
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The UAMS Rural Hospital Telehealth Project

• Developed in 1995
• Delivers specialty telemedicine consultations to
  patients at distant sites
• Serves a poor, underserved, rural population in
  the East Arkansas Delta
• Project Objective Increase rural residents
  access to specialty medical services across the
  life-span using telemedicine technology
• Funded by the Office for the Advancement of
  Telehealth, HRSA, DHHS

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Purpose of the Study

• Examined the effect of telemedicine on diagnosis
  and treatment by the teleconsultants
• specialty
• practice setting
• type of employment
• years and training in telemedicine
• reason for using telemedicine

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Methods

• Post-consultation survey of consultants in the
  UAMS Rural Hospital Telehealth Project
• N 1,449 consultations
• 61 consultants, conducted 1-464 consultations
  each
• Data collection March 6, 1998- June 19, 2006

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Methods

• Changes in the patients diagnosis and treatment
  plan were based on the initial diagnosis and
  treatment plan, which were established by the
  primary-care provider before the telemedicine
  session took place.

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Instruments

• Consultant Demographics 15 items,
  characteristics of teleconsultantspractice,
  training, patient referrals, use of telemed.
• Session Information Evaluation 21 items,
  characteristics of teleconsultationsclinic
  site, patient status, staffing, equipment
• Post-Session Evaluation 9 items, established
  diagnosis, change in diagnosis, established
  treatment plan, change in treatment as a result
  of the teleconsultation

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Data Analysis

• Statistical Package for the Social Sciences
  (SPSS), Version 14
• Statistical Procedures
• Logistic regression and chi-square test of
  independenceused to assess significant
  differences in patients diagnosis and treatment
  by the teleconsultants characteristics

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Results Characteristics of the Teleconsultants

• Variable n
• N 1,449 consultations
• Training in telemedicine
• Yes 712 68
• No 330 32
• Reason for using telemedicine
• Improve access to care 974 93
• Expand client base 754 87
• Terms of employment 46 6
• Increased Income 22 3

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Results Characteristics of the Teleconsultants

• Variable n
• Primary practice setting
• Academic medical center 992 89
• Hospital 406 36
• Outpatient clinic 423 38
• Private office 374 34
• Community health clinic 364 33 Nursing
  home 5 0.4
• Outpatient mental health 4 0.4
• Inpatient mental health 4 0.4
• Other 3 0.3
•  

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Results Characteristics of the Teleconsultants

• Variable n
• Consultant specialty
• Obstetrics/Gynecology 455 31
• Genetic Counseling 349 24
• Psychiatry/Psychology 210 15
• Nutrition and Dietetics 113 8
• Dermatology 109 8
• Primary Care 59 4
• Pharmacy 56 4
• Other 17 specialties 98 7

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Results Characteristics of the Teleconsultants

• Variable n
• Type of employment
• Healthcare facility 991 95
• Provider organization 24 2
• Self-employed, other 33 3
• Began practicing telemedicine
• within this system ( years)
• 1/1/95 through 6/1/99 (7-11 yrs.) 357 52
• 7/1/99 to 1/1/03 (3-7 yrs.) 336 49

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Results Changes in the Patients Diagnosis

• The teleconsultants established a diagnosis in
  121 (27) consultations.
• Of the 103 respondents for cases where there was
  a prior diagnosis and a change was applicable, 29
  (28) consultants reported a change in the
  patient's diagnosis.
•  

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Results Changes in the Patients Diagnosis

• Variable n
• Established diagnosis
• Yes 121
• No 320
• Change in diagnosis
• Yes 29
• No 74
• Not aware of a prior diagnosis 25
• No prior diagnosis 17
• Not applicable 139

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Results Changes in the Patients Treatment Plan

• The consultants established a patient treatment
  plan in 219 (52)
• consultations.
• Of the 166 respondents for cases where there was
  a prior treatment plan and a change was
  applicable, 100 (60) consultants reported a
  change in the treatment plan.

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Results Changes in the Patients Treatment Plan

• Variable n
• Established treatment plan
• Yes 219
• No 203
• Change in treatment plan
• Yes 100
• No 66
• Not aware of prior treatment 40
• plan
• No prior treatment plan 27
• Not applicable 114

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Results Patients Diagnosis by Teleconsultants
Characteristics

• Dermatologists (p lt .001) teleconsultants who
  practiced in an academic medical center
  (p lt .001),outpatient clinic (p .001),
  and private office (p .029) were significantly
  more likely to establish a diagnosis.
• Dermatologists were significantly more likely to
  change the diagnosis (p .005).

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Results Patients Treatment by Teleconsultants
Characteristics

• Dermatologists (p .03),
• teleconsultants who practiced in an outpatient
  clinic (p .02), and those who used this
  telemedicine system to increase their income (p
  .005) were significantly more likely to establish
  a treatment plan.
• Teleconsultants who were self-employed (p .012)
  were significantly more likely to change the
  treatment plan.

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Conclusions

• The results show that telemedicine had an effect
  on changing the patients diagnosis and treatment
  plan.
• Although changes in the patients diagnosis and
  treatment plan are not direct measures of
  quality, these results imply that the patients
  diagnosis and treatment plan were improved.
• The findings suggest that teleconsultants
  characteristics can affect diagnosis and
  treatment in telemedicine.

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Implications for Clinical Practice and Future
Research

• Results provide evidence for the benefits of
  telemedicine in diagnosis and treatment for a
  poor, rural population in East Arkansas.
• Decrease non-responses for variables
• Use an experimental design to compare
  teleconsultations and face-to-face medical care
  on patients diagnosis and treatment
• Assess the effect of telemedicine on clinical
  improvement, hospitalizations, transfers, delays
  in treatment, and referral patterns in rural
  communities and among ethnic groups