Showing papers on "Telemedicine published in 2001"

Assessing telemedicine: a systematic review of the literature

Abstract: Background: To clarify the current status of telemedicine, we carried out a systematic review of the literature. We identified controlled assessment studies of telemedicine that reported patient outcomes, administrative changes or economic assessments and assessed the quality of that literature. Methods: We carried out a systematic electronic search for articles published from 1966 to early 2000 using the MEDLINE (1966–April 2000), HEALTHSTAR (1975–January 2000), EMBASE (1988–February 2000) and CINALH (1982–January 2000) databases. In addition, the HSTAT database (Health Services/Technology Assessment Text, US National Library of Medicine), the Database of Abstracts of Reviews of Effectiveness (DARE, NHS Centre for Reviews and Dissemination, United Kingdom), the NHS Economic Evaluation Database and the Cochrane Controlled Trials Register were searched. We consulted experts in the field and did a manual search of the reference lists of review articles. Results: A total of 1124 studies were identified. Based on a review of the abstracts, 133 full-text articles were obtained for closer inspection. Of these, 50 were deemed to represent assessment studies fulfilling the inclusion criteria of the review. Thirty-four of the articles assessed at least some clinical outcomes; the remaining 16 were mainly economic analyses. Most of the available literature referred only to pilot projects and short-term outcomes, and most of the studies were of low quality. Relatively convincing evidence of effectiveness was found only for teleradiology, teleneurosurgery, telepsychiatry, transmission of echocardiographic images, and the use of electronic referrals enabling email consultations and video conferencing between primary and secondary health care providers. Economic analyses suggested that teleradiology, especially transmission of CT images, can be cost-saving. Interpretation: Evidence regarding the effectiveness or cost-effectiveness of telemedicine is still limited. Based on current scientific evidence, only a few telemedicine applications can be recommended for broader use.

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes.

Abstract: Background Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology. Objectives To assess the effects of telemedicine as an alternative to face-to-face patient care. Search methods We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), CINAHL (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data. We handsearched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also handsearched conference proceedings and contacted experts in countries identified as having an interest in telemedicine. Selection criteria Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine. Data collection and analysis Two reviewers independently assessed trial quality and extracted data. Main results Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the technological aspects of the interventions appear to have been reliable, and to have been well accepted by patients. Authors' conclusions Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies.

Clinical outcomes resulting from telemedicine interventions: a systematic review

Abstract: The use of telemedicine is growing, but its efficacy for achieving comparable or improved clinical outcomes has not been established in many medical specialties. The objective of this systematic review was to evaluate the efficacy of telemedicine interventions for health outcomes in two classes of application: home-based and office/hospital-based. Data sources for the study included deports of studies from the MEDLINE, EMBASE, CINAHL, and HealthSTAR databases; searching of bibliographies of review and other articles; and consultation of printed resources as well as investigators in the field. We included studies that were relevant to at least one of the two classes of telemedicine and addressed the assessment of efficacy for clinical outcomes with data of reported results. We excluded studies where the service did not historically require face-to-face encounters (e.g., radiology or pathology diagnosis). All included articles were abstracted and graded for quality and direction of the evidence. A total of 25 articles met inclusion criteria and were assessed. The strongest evidence for the efficacy of telemedicine in clinical outcomes comes from home-based telemedicine in the areas of chronic disease management, hypertension, and AIDS. The value of home glucose monitoring in diabetes mellitus is conflicting. There is also reasonable evidence that telemedicine is comparable to face-to-face care in emergency medicine and is beneficial in surgical and neonatal intensive care units as well as patient transfer in neurosurgery. Despite the widespread use of telemedicine in virtually all major areas of health care, evidence concerning the benefits of its use exists in only a small number of them. Further randomized controlled trials must be done to determine where its use is most effective.

Teledermatology: a review

Abstract: Teledermatology holds great potential for revolutionizing the delivery of dermatology services, providing equitable service to remote areas and allowing primary care physicians to refer patients to dermatology centres of excellence at a distance. However, before its routine application as a service tool, its reliability, accuracy and cost-effectiveness need to be verified by rigorous evaluation. Teledermatology can be applied in one of two ways: it may be conducted in real-time, utilizing videoconferencing equipment, or by store-and-forward methods, when transmitted digital images or photographs are submitted with a clinical history. While there is a considerable range of reported accuracy and reliability, evidence suggests that teledermatology will become increasingly utilized and incorporated into more conventional dermatology service delivery systems. Studies to date have generally found that real-time dermatology is likely to allow greater clinical information to be obtained from the patient. This may result in fewer patients requiring conventional consultations, but it is generally more time-consuming and costly to the health service provider. It is often favoured by the patient because of the instantaneous nature of the diagnosis and management regimen for the condition, and it has educational value to the primary care physician. Store-and-forward systems of teledermatology often give high levels of diagnostic accuracy, and are cheaper and more convenient for the health care provider, but lack the immediacy of patient contact with the dermatologist, and involve a delay in obtaining the diagnosis and advice on management. It is increasingly likely that teledermatology will prove to be a significant tool in the provision of dermatology services in the future. These services will probably be provided by store-and-forward digital image systems, with real-time videoconferencing being used for case conferences and education. However, much more research is needed into the outcomes and limitations of such a service and its effect on waiting lists, as well as possible cost benefits for patients, primary health care professionals and dermatology departments.

Limitations of Patient Satisfaction Studies in Telehealthcare: A Systematic Review of the Literature

Abstract: The objective of this study is to provide a systematic review of studies on patient satisfaction with telemedicine. The review included empirical studies that investigated patient satisfaction with that telemedicine service. The search strategy involved matching at least one of 11 'telemedicine' terms with one of 5 'satisfaction' terms. The following databases were searched: Telemedicine Information Exchange (TIE) database, MEDLINE, Science Citation Index (SCI), Social Science Citation Index (SSCI), Psycinfo, and Citation Index of Nursing and Allied Health (CINAHL). A highly structured instrument was used for data extraction. The review included 93 studies. Telepsychiatry represents the largest portion of these studies (25%), followed by multispecialty care (14%), nursing (11%), and dermatology (8%). Real-time videoconferencing was used in 88% of these studies. Only 19 (20%) included an independent control group, including 9 (10%) randomized control trial (RCT) studies. One third of studies were based on samples of less than 20 patients, and only 21% had samples of over 100 patients. Aspects of patient satisfaction most commonly assessed were: professional-patient interaction, the patient's feeling about the consultation, and technical aspects of the consultation. Only 33% of the studies included a measure of preference between telemedicine and face-to-face consultation. Almost half the studies measured only 1 or 2 dimensions of satisfaction. Reported levels of satisfaction with telemedicine are consistently greater than 80%, and frequently reported at 100%. Progression of telemedicine services from "trial" status to routine health service must be supported by improved research into patients' satisfaction with telemedicine. Further investigation of factors that influence patient acceptance of telemedicine is indicated.

Essentials of Telemedicine and Telecare

Abstract: Preface Origins and Development Introduction Definitions of Telemedicine, Telehealth and Telecare Origins and Development of Telemedicine Drivers of Telemedicine and Telecare Telemedicine in Developed and Underdeveloped Countries The Future of Telemedicine Summary Scope, Benefits and Limitations of Telemedicine Introduction Types of Telemedicine Patients and Carers Benefits and Limitations of Telemedicine Barriers to Progress Summary Technology of Telemedicine Systems Introduction Information Types and Transmissions Teleconsultation System Components Telecommunications Options Integration and Operational Issues Summary Telemedicine Service Providers and Applications Introduction Mainstream Health Sector Services Commercial Services and Other Agencies Summary Development and Delivery of Telemedicine Services Introduction The Strategic Context of Service Development The Evaluation of Pilot Studies Developing and Delivering a Telemedicine Service Summary Ethical and Legal Aspects of Telemedicine Introduction Confidentiality, Patient Rights and Consent Data Protection and Security Ethical and Legal Aspects of the Internet Telemedical Malpractice Jurisdictional Issues Intellectual Property Rights Summary Telemedicine Books and Web Sites References Index

E-Health, telehealth, and telemedicine : a guide to start-up and success

Abstract: Foreword: Evan Melrose, M.D Preface The Authors History, Definitions, and Current Applications From Telemedicine and Telehealth to E-Health Telecommunication Technologies in Health Care Clinical Applications Special Settings Computerization of Medical Records and E-Health Services Privacy, Confidentiality, Security, and Data Integrity Legal and Ethical Issues Malpractice and Risk Management A Beginner's Blueprint: How to Get Started Research: Issues, Methods, and Outcomes Visions into the Future of Health Care Appendix A: Tips from the Experts Appendix B: Vendor Agreements: A Primer Appendix C: Videoconferencing Room Requirements and Etiquette Glossary Resources References Index.

Design of a telemedicine system using a mobile telephone

Abstract: This paper describes the design of a prototype integrated mobile telemedicine system that is compatible with existing mobile telecommunications networks and upgradable for use with third-generation networks. The system, when fully developed, will enable a doctor to monitor remotely a patient who is free to move around for sports medicine and for emergency situations.

The eICU: it's not just telemedicine.

Abstract: Intensive care units (ICUs) are major sites for medical errors and adverse events. Suboptimal outcomes reflect a widespread failure to implement care delivery systems that successfully address the complexity of modern ICUs. Whereas other industries have used information technologies to fundamentally improve operating efficiency and enhance safety, medicine has been slow to implement such strategies. Most ICUs do not even track performance; fewer still have the capability to examine clinical data and use this information to guide quality improvement initiatives. This article describes a technology-enabled care model (electronic ICU, or eICU) that represents a new paradigm for delivery of critical care services. A major component of the model is the use of telemedicine to leverage clinical expertise and facilitate a round-the-clock proactive care by intensivist-led teams of ICU caregivers. Novel data presentation formats, computerized decision support, and smart alarms are used to enhance efficiency, increase effectiveness, and standardize clinical and operating processes. In addition, the technology infrastructure facilitates performance improvement by providing an automated means to measure outcomes, track performance, and monitor resource utilization. The program is designed to support the multidisciplinary intensivist-led team model and incorporates comprehensive ICU re-engineering efforts to change practice behavior. Although this model can transform ICUs into centers of excellence, success will hinge on hospitals accepting the underlying value proposition and physicians being willing to change established practices.

Telemedicine and doctor-patient communication: an analytical survey of the literature.

Abstract: The literature about the effect of telemedicine on doctor-patient communication was reviewed. A total of 38 studies were identified: six were surveys of provider and community attitudes; 21 were post-encounter surveys of participants in a medical consultation; and 11 were qualitative analyses of behaviour in a medical encounter. Twenty-one of the 38 investigations originated in the USA, six in the UK, four in Australia, three in Norway, two in Canada, one in Finland and one in Sweden. All were relatively recent. The findings from each study were coded according to 23 categories developed from the literature and a positive or negative rating was assigned to each of the 213 communication results. Approximately 80% of abstracted findings favoured telemedicine, with all but two of the 23 categories analysed (non-verbal behaviour and lack of touch) reporting more positive than negative results. Verbal content analysis is important for the development of interventions aimed at facilitating doctor-patient telecommunication. However, further research is necessary if the nature and content of the communication process are to be fully understood.

The use of Telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: Preliminary results

Abstract: Background: By geographic necessity, rural trauma patients must be initially stabilized at local community hospitals before transfer for definitive care. In this study, it was hypothesized that telemedicine consults with trauma surgeons from a Level I trauma center online while the patient was still in the community hospital ED could positively affect care. Methods: Four community hospital emergency departments in upstate New York and Vermont were equipped with dual cameras with remote control capability. Three trauma surgeons' homes were wired and equipped with telemedicine systems. Protocols were developed for the initiation of a telemedicine consult. Results: There were 26 telemedicine consults over an 8-month period. The telemedicine population was significantly more severely injured and had a higher mortality than the general trauma population admitted to the Level I trauma center. In two cases, it was felt that the telemedicine consultation was potentially lifesaving. On follow-up, more than 80% of the referring providers felt that the telemedicine consult improved care. Conclusion: Telemedicine provides a virtual online trauma surgeon to assist with the resuscitation and stabilization of the major trauma patient in a small community hospital. These preliminary results show a positive impact on rural trauma patient care at the local community hospital.

Real-time ECG transmission via Internet for nonclinical applications

Abstract: Telemedicine is having a great impact on the monitoring of patients located in remote non-clinical environments, such as homes, elderly communities, gymnasiums, schools, remote military bases, ships, and the like. A number of applications, ranging from data collection to chronic patient surveillance, and even to the control of therapeutic procedures, are being implemented in many parts of the world. As part of this growing trend, this paper discusses the problems in electrocardiogram (ECG) real-time data acquisition, transmission and visualization over the Internet. ECG signals are transmitted in real time from a patient in a remote non-clinical environment to a specialist in a hospital or clinic using the current capabilities and availability of the Internet. A prototype system is described that is composed of (1) a portable data acquisition and pre-processing module connected to the computer at the remote site via its RS-232 port, (2) a Java-based client-server platform, and (3) software modules to handle communication protocols between the data acquisition module and the patient's personal computer, and to handle client-server communication. The purpose of the system is the provision of extended monitoring for patients under drug therapy after infarction, data collection in some particular cases, remote consultation and low-cost ECG monitoring for the elderly.

Empowering Children and Families With Information Technology

Abstract: Patient empowerment is the enhanced ability of patients to actively understand and influence their health status. Information is the key to patient empowerment. Without information, children and families cannot engage in meaningful discussions or make thoughtful decisions regarding medical care. Information sharing is a model for patient interaction with the health care system that may significantly improve the care of children and families. This article focuses on information technologies that utilize user-centered design principles and interactive capabilities to facilitate information sharing and to empower children and families. Examples include electronic pediatric personal medical records, customized health information systems, and interactive physician offices with electronic mail (e-mail) and telemedicine capabilities. Ideally, these systems would all be integrated. Successful implementation of new technologies will require thoughtful attention and balanced solutions to tensions between information sharing vs security, and curatorship vs censorship. Issues related to access and the digital divide must also be addressed. Acceptance and usability of new technologies is predicated on close collaboration among physicians, researchers in informatics, librarians, educators, and other professionals with expertise in the human-computer interface. Child and family empowerment will be both the driving force and ultimate outcome of information-sharing technologies.

An evaluation of the first year's experience with a low-cost telemedicine link in Bangladesh

Abstract: In July 1999, the Swinfen Charitable Trust in the UK established a telemedicine link in Bangladesh, between the Centre for the Rehabilitation of the Paralysed (CRP) in Dhaka and medical consultants abroad. This low-cost telemedicine system used a digital camera to capture still images, which were then transmitted by email. During the first 12 months, 27 telemedicine referrals were made. The following specialties were consulted: neurology (44%), orthopaedics (40%), rheumatology (8%), nephrology (4%) and paediatrics (4%). Initial email replies were received at the CRP within a day of referral in 70% of cases and within thee days in 100%, which shows that store-and-forward telemedicine can be both fast and reliable. Telemedicine consultation was complete within three days in 14 cases (52%) and within three weeks in 24 cases (89%). Referral was judged to be beneficial in 24 cases (89%), the benefits including establishment of the diagnosis, the provision of reassurance to the patient and referring doctor, and a change of management. Four patients (15% of the total) and their families were spared the considerable expense and unnecessary stress of travelling abroad for a second opinion, and the savings from this alone outweighed the set-up and running costs in Bangladesh. The latter are limited to an email account with an Internet service provider and the local-rate telephone call charges from the CRP. This successful telemedicine system is a model for further telemedicine projects in the developing world.

Telemedicine in developing countries : May have more impact than in developed countries

Abstract: Clinical review p 557 The advent of modern communication technology has unleashed a new wave of opportunities and threats to the delivery of health services.1 Telemedicine, a broad umbrella term for delivery of medical care at a distance, has reached around the world, and now health professionals can communicate faster, more widely, and more directly with clients and colleagues, no matter where they are.2 Telemedicine may in fact have a more profound impact on developing countries than on developed ones. Satellite stations in Uzbekistan, wireless connections in Cambodia, and microwave transmission in Kosova have shown that the low bandwidth internet can reach into remote areas, some of them with troubled political situations and uncertain economic environments. It has been more difficult and costly to implement broad bandwidth applications in these locations. Nevertheless, with the internet come email, websites, chatlines, multimedia presentations, and occasional opportunities for synchronous communication via internet phones and videoconferencing. Each of these communication vehicles provides an opportunity for medical education and medical care, not to mention collegial support.3 Of course, they …

Verifying quality and safety in health informatics services.

Abstract: Information and its handling and transmission form an essential part of health care and are reflected in professional standards. Automated information systems in health care—health informatics services—will improve these functions and bring new opportunities through the harnessing of modern information and communications technologies. Thus, computer support is now essential in many parts of medicine, the US Institute of Medicine has long espoused the value of computerised patient records,1 and many countries have developed strategies on this topic, and there are countless health related internet sites. However, as new information and communication technologies in health bring new opportunities, they also bring new risks. Emphasis has rightly been placed on ensuring appropriate levels of confidentiality in electronic information systems—to the point that the highly exacting requirements being demanded by independent commentators and professional bodies2 are difficult to satisfy without jeopardising the functioning of core services 3 4 or the interests of the most vulnerable groups.5 In contrast, much less thought has been given so far to ensuring the appropriateness of the design and integrity of functioning of health informatics services. #### Summary points Like drugs 40 years ago, products in health informatics are unregulated with regard to safety and efficacy A European project has now recommended ways of accrediting healthcare related software, telemedicine, and internet sites A scheme like CE marking of electrical goods is recommended for software, national regulatory bodies should be identified for telemedicine, and a European certification of integrity scheme developed for websites If informatics systems are increasingly essential in the delivery of health care then their integrity and quality must be of equal importance, but this has been scarcely recognised to date. In 1963 the then UK secretary of state for health stated to the House of Commons: “The House and the public suddenly …

Evaluating a telemedicine system to assist in the management of dermatology referrals.

Abstract: Background Teledermatology systems fall into two categories: live video or store-and-forward. In the former, video-conferencing equipment is used to connect a patient with a remote consultant. This method has been evaluated as an aid to dermatology, but it is expensive both in terms of capital and running costs. Video consultations are generally longer than conventional ones and harder to schedule. Some authors have considered store-and-forward as an alternative to live video: instead of a consultation, specialists could make a rapid inspection of a transmitted still image. Objectives A study was conducted to evaluate the role of telemedicine in the dermatology outpatients department of a district general hospital (Whittington Hospital NHS Trust, London, U.K.). Methods One hundred and ninety-four patients were seen by one of two consultant dermatologists. A nurse used a video camera to store digital images of each patient's problem and compiled a history from the GP's referral letter. The images were reviewed 13 months later by both dermatologists; they recorded a provisional diagnosis and an assessment of how urgent an appointment would have been made given the information provided by the system. A third consultant graded the level of agreement between the telemedicine diagnoses and the face-to-face consultations. Results High levels of agreement were found between the diagnoses of the dermatologists using the system to inspect images and those of the dermatologist who saw the patients (77%). Consultants using the system recommended fewer urgent appointments (32% compared with 64%) and felt that in 31% of cases the patient did not need to be seen. In 15% of these cases (5% of the total), however, their diagnosis differed significantly from that of the consultant who saw the patient. Had the system been in use, 14% of patients conventionally assigned a non-urgent appointment would have been seen urgently. Conclusions The images allowed a reasonably accurate diagnosis. The software was not reliable (six cases could not be viewed), or easy to use (it took approximately an hour to view 20 cases) but an improved version could be used in triaging outpatient appointments.

Clinical effectiveness and cost analysis of patient referral by videoconferencing in orthopaedics

Abstract: The clinical effectiveness and costs of videoconferencing in orthopaedics between primary and secondary care were examined in an eight-month prospective, comparative study. The general surgery outpatient clinics of two Finnish district hospitals were compared: Peijas Hospital, with telemedicine, and Hyvinkaa Hospital, without it. The three study primary-care centres referred a total of 419 adult patients to the outpatient clinics. The population-based number of referrals to Peijas Hospital was similar to that to Hyvinkaa Hospital after adjusting for the proportion of older people living in the Hyvinkaa Hospital municipalities. Of the 225 patients referred to Peijas Hospital, 168 (75%) were given appointments at the outpatient clinic of surgery and the rest of the referred patients received a teleconsultation. All patients referred to Hyvinkaa Hospital were given appointments at the outpatient clinic. The direct costs of an outpatient visit were 45% greater per patient than for a teleconsultation, with a marginal cost decrease of EU48 for every new teleconsultation. A cost-minimization analysis of the alternative interventions showed a net benefit of EU2500 in favour of teleconsultations. The use of videoconferencing between primary and secondary care was modest in orthopaedics, although the use of this telemedicine method was shown to reduce direct costs and be cost-effective.

Low-bandwidth, Internet-based videoconferencing for physical rehabilitation consultations.

Abstract: Low-bandwidth, Internet-based videoconferencing was used to provide physical rehabilitation consultation services for eight community hospitals Videoconferencing and file transmission used a PC and modem A separate telephone line was used for voice Over 21 months, 47 physical rehabilitation consultations were completed for communication disorders, foot care, gait problems, orthotics, prosthetics, arm weakness and wheelchair prescription Consultations were approximately 40 min long Clinician questionnaires were completed by 47 individuals While more than 80% of the questionnaire responses supported the telemedicine approach, remote clinicians rated their satisfaction higher than did the specialists Client questionnaires were completed by 24 individuals (a response rate of 51%) All clients were comfortable with and had confidence in the teleconsultations

A qualitative study of the organizational consequences of telemedicine.

Abstract: The organizational consequences of telemedicine have frequently been mentioned in the telemedicine community, but there are few empirical studies. A study was therefore carried out of what happens in organizations when telemedicine is implemented. Qualitative interviews were undertaken with 30 persons working in teledermatology, telepsychiatry, a telepathology frozen-section service and tele-otolaryngology. Almost all respondents reported numerous organizational changes, some important. Changes in work processes were the most common. Examples of the organizational consequences of telemedicine were organizational restructuring, new organizational units, changed mechanisms for internal coordination, different flows of patients through the health-care system, improved coordination of care, new job descriptions, relocation of the place of work, employment of personnel living far away from the workplace, effects on employees not directly involved in telemedicine, sharing of experiences, minor staffing changes, clinical teamwork independent of co-location, administrative meetings arranged by telemedicine, merger of organizations independent of location, less travel by staff (and patients), a possible beneficial effect on the quality of care, and limited opposition to the adoption of the technology. Telemedicine may be important in the future organization of the disciplines studied and in health-care generally. The infrastructure of electronic networks may play an important role for organizations as the volume of telemedicine activity increases and economies of scale are realized.

Patient satisfaction with teledermatology is related to perceived quality of life.

Abstract: Background: There is a lack of good data about patient satisfaction with teledermatology and about its potential interaction with quality-of-life factors. Objectives: To assess the association between perceived skin-related quality of life and patient satisfaction with a nurse-led teledermatology service. Methods: In a mobile nurse-led teledermatology clinic located in four inner city general practices in Manchester, the teledermatology service used digital cameras to capture and store images of skin conditions for remote diagnosis by dermatologists. One hundred and twenty-three adult patients, non-urgent dermatology referrals from primary care, completed the Dermatology Life Quality Index (DLQI) and a 15-item patient satisfaction questionnaire. Results: In common with other studies of patient satisfaction, subjects reported highly favourable views of ‘hotel’ aspects of the service (93%) and found it ‘convenient’ (86%). However, 40% of patients would have preferred to have had a conventional face-to-face consultation with a dermatologist, and 17% felt unable to speak freely about their condition. Patient satisfaction with the service was related to quality of life. Patients reporting lower quality of life as measured by the DLQI were more likely to prefer a face-to-face encounter with a dermatologist (r = 0·216, P Conclusions:Patient acceptance and satisfaction with telemedicine services is complicated by patients' subjective health status. Telehealthcare providers need to recognize that patients with poor quality of life may want and benefit from face-to-face interaction with expert clinicians.

Introducing telemedicine technology to rural physicians and settings.

Abstract: Objective The researchers investigated rural health providers' perceptions of telemedicine, developed a framework for assessing their readiness to adopt this type of technology, and offered a guide for its implementation. Study design Qualitative data were collected from semistructured interviews with thematic analysis. Population The study population included physicians, nurses, and administrative personnel located in 10 health care practices in 4 communities in 3 rural Missouri counties. Outcomes measured The researchers measured how often health providers used telemedicine technology and their perceptions of the advantages, disadvantages, barriers, and facilitators involved in adopting it. Results Participants varied widely in their perceptions of telemedicine. Providers in practices affiliated with the university's tertiary center were more likely to use it than were those in private practice. Interviews and other data yielded 6 themes related to a provider's receptivity to technological change: These themes were turf, efficacy, practice context, apprehension, time to learn, and ownership. Each theme applies to the computer and videoconferencing components of telemedicine, and each may operate as a perceived barrier or facilitator of change. Conclusions Care providers and administrators consider a range of factors, including economic ramifications, efficacy, social pressure, and apprehension, when deciding whether and how fast to adopt telemedicine. Since adopting this technology can be a major change, agencies trying to introduce it into rural areas should take all these factors into account in their approach to health care providers, staff, and communities.

Telemedicine: a pilot study in nursing home residents.

Abstract: Background: Telemedicine has been applied successfully in various fields of medicine. This mode of health care delivery may potentially be useful in supporting frail nursing home re