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telemedicine

Technology-based delivery of health care to patients located remotely from the health-care provider. For example, a physician (or other health care provider) in his/her office can interact with a patient at home via videophone &/or two-way interactive computer networks. A model for delivery of telehealth services is the hub-&-spoke system, wherein a center with expertise in a diagnosis & management of a disease (the hub) provides telehealth services to underserved centers (the spokes). [9,19] Indications: - diagnosis & management of patients with diabetic retinopathy [15] - roadblocks in providing care can be removed by telemedicine [21] - may reduce unnecessary ambulance transports [25] - integration as part of usual primary care [26] - a telehealth visit offers an opportunities to: - review chronic conditions - authorize refill of medications - check patient well-being - review advance care planning [29] - depression; therapy from lay counselor or licensed clinician of benefit [27] Clinical trials: - telephone-based system for frequent, remote data collection after hospitalization for heart failure [10] a) did not reduce hospitalizations or improve outcomes b) patient compliance was poor c) of benefit [14] d) telemedicine program many diminish mortality if patients with major depression excluded [22]* - telemonitoring of patients multiple serious morbidities consisting of daily assessments of weight, blood pressure, blood glucose, oxygen saturation, & peak expiratory flow with at least some real-time video conferencing reviewed by a nurse case-manager resulted in: a) increased hospitalization (52% vs 44%) vs usual care b) increased emergency department visits ((35% vs 28%) c) increased mortality (14.7% vs 3.9%) [11] - postdischarge telephone calls to patients after hospital discharge resulted in fewer hospital readmissions 9.3% vs 11.5%, fewer emergency room visits 8.1% vs 9.4%, but more physician office visits 76.5% vs. 72.3% [12] - the closer the intervention to the date of hospital discharge, the greater the reduction in number of hospital readmissions - telemonitroing improves blood pressure control in patients with uncontrolled hypertension [13] - telemedicine approach to management of Parkinson's disease non-inferior to traditional office-based approach [20] - telemedicine approach saved a median of 88 minutes & 38 miles of travel time per visit [20] * telemedicine program for heart failure (preserved or reduced LVEF) - daily transmissions of body weight, blood pressure, cardiac rhythm, oxygen saturation, health status - patient education - algorithm-guided physician management - 4 full-time physicians & 5 nurses during working hours & 2 on-call physicians at night (~800 patients) [22] Notes: - visits for respiratory infections are slightly shorter when antibiotics are prescribed than when not (7.5 vs 8.0 minutes) & patient satisfaction are better with any prescription than nothing, & best with an antibiotic [23] - patients generally are satisfied with video visits integrated with usual primary care [26]

Specific

telemedicine for detection of diabetic retinopathy telemedicine for management of diabetic retinopathy virtual home care

General

medicine

References

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  9. Schwamm LH et al. and on behalf of the American Heart Association Stroke Council and the Interdisciplinary Council on Peripheral Vascular Disease. A review of the evidence for the use of telemedicine within stroke systems of care: A scientific statement from the American Heart Association/American Stroke Association. Stroke 2009 Jul; 40:2616. PMID: 19423852 - Schwamm LH et al. and on behalf of the American Heart Association Stroke Council; Council on Epidemiology and Prevention; Interdisciplinary Council on Peripheral Vascular Disease; and the Council on Cardiovascular Radiology and Intervention. Recommendations for the implementation of telemedicine within stroke systems of care: A policy statement from the American Heart Association. Stroke 2009 Jul; 40:2635. PMID: 19423851
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  17. Kumar G, Falk DM, Bonello RS et al The costs of critical care telemedicine programs: a systematic review and analysis. Chest. 2013 Jan;143(1):19-29. Review. PMID: 22797291 Free PMC Article
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  21. Halpren-Ruder D Why Give It Up? My Late-Career Fellowship NEJM Catalyst. Jan 16, 2018 https://catalyst.nejm.org/late-career-fellowship/
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  29. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - Batsis JA, DiMilia PR, Seo LM, et al. Effectiveness of ambulatory telemedicine care in older adults: a systematic review. J Am Geriatr Soc. 2019;67(8):1737-1749 PMID: 31066916 PMCID: PMC6684409 Free PMC article https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.15959 - Block BL, Smith AK, Sudore RL. During COVID-19, outpatient advance care planning is imperative: we need all hands on deck. J Am Geriatr Soc. 2020;68(7):1395-1397 PMID: 32359075 PMCID: PMC7267338 Free PMC article https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.16532