Telehealth and Underserved, Vulnerable Populations: Prisons, Schools, Military, Seniors
Learn the tremendous impact telemedicine is having on access to healthcare in correctional facilities, in schools...June 12, 2019
Get familiar with four important telemedicine studies from the past few years, highlighting a diverse array of telemedicine applications, healthcare cost savings, and positive patient outcomes.
Numerous studies have been conducted on telehealth programs attempting to identify the value to the healthcare system at large, value to patients, and most importantly, effect on patient outcomes.
In a broad review of telehealth studies through 2016, researchers from the Agency for Healthcare Research and Quality found substantial evidence for positive telehealth outcomes in remote patient monitoring for chronic conditions and for psychotherapy in behavioral healthcare. In these two domains, the applications of telemedicine programs are becoming better established and more well known. And with 90% of the nation’s 3.3 trillion in annual healthcare expenditures arising from chronic and mental health conditions, cost savings from telemedicine programs are a welcome and needed boon in these areas.
Beyond chronic conditions and mental health, there is also compelling research to support telemedicine use in clinical fields like asthma management, digestive diseases, stroke and seizures, and even cancer care.
In an effort to catalog the most compelling telemedicine research to date, we consulted our medical director, Dr. Rafid Fadul, to help identify recent critical research and empirical evidence supporting telehealth program implementation and outcomes. Commit these studies to memory and leverage this data to highlight the importance of telemedicine programs in future-forward healthcare delivery.
Schools are known to be promising domains for telehealth program implementation due to cost savings, convenience, and quick provider accessibility to foster faster treatment. In this asthma management study, researchers found positive preventive medicine outcomes that could serve as a model for sustainable asthma care for school children.
This Rochester, New York study, published in JAMA, was a randomized control trial with a sample size of 400 children looking at the effects of a school-based, telemedicine-enhanced, asthma management program on asthma morbidity. The researchers attempted to answer whether school-based asthma therapy with telemedicine would improve outcomes for urban children with asthma. The program aimed to increase adherence to preventive asthma care by providing supervised administration of preventive corticosteroids as well as three telemedicine visits for assessment, prescriptions, and follow up.
Children in the trial group had more symptom-free days compared with children in the control group and were less likely to have a visit to the ED or be hospitalized for asthma.
Diabetes is one of the most prevalent chronic health conditions in the US and a leading cause of death. However, access to endocrinology care, particularly in rural areas, is a common barrier to preventive treatment, and mismanagement adds to already burdensome costs and strain on the healthcare system. Telemedicine is a prime tool to deliver preventive diabetes care to in-need populations, improve long-term patient outcomes, and reduce costs for both patients and the healthcare system.
In a retrospective study of veterans with type 1 diabetes in rural Alabama and Georgia, researchers found evidence that telemedicine is an effective alternative method of healthcare delivery for endocrinology care. Researchers conducted chart reviews of patients enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from 2014 to 2016.
Positive outcome trends: Hemoglobin A1c levels and glucose variability trended towards a mean decrease
Time savings: Patients saved 78 minutes of travel (one way)
Cost savings: The VA saved $72.94 in travel reimbursements per patient visit
Appointment adherence: Patients adhered to 88% of appointments
Patient satisfaction: 100% of patients said they would recommend telehealth to other veterans
A similar study conducted with Denver VA diabetes patients found that endocrinology telehealth consultations improved short-term glycemic control just as effectively as face-to-face visits.
While telemedicine applications for chronic conditions like diabetes are more well-known, remote care for chronic digestive diseases has been less prevalent. This systematic review of telemedicine for digestive diseases cataloged prior research on the remote treatment of IBD, IBS, ulcerative colitis, Chron’s Disease, and colorectal cancer to draw collective outcomes in patient compliance and satisfaction, disease activity, and quality of life.
In general, patient compliance was widely variable between 25 and 100% while patient satisfaction was always ranked high between 74 and 100%. Several studies showed disease activity improvements, and general and disease-specific quality of life showed improvements in as little as three months following telemedicine interventions.
More research is needed in this area, but initial outcomes for telemedicine in digestive health seem promising.
With the economic impact of cancer estimated at 80.2 billion in the US alone, and as the second leading cause of death, effective, cost-saving alternative treatment delivery options like telemedicine are a necessary addition to sustainable cancer care programs.
Two high-volume cancer care centers have implemented tele-oncology programs with promising success in patient/provider satisfaction, care coordination, and clinical outcomes while simultaneously decreasing costs.
With the help of the Ontario Telemedicine Network, Cancer Care Ontario enabled 268 sites across the 14 Ontario Regional cancer centers with telemedicine services. The program has the highest utilization among prostate, lung, breast, and colorectal cancers and is leveraged by 20% of radiation and medical oncologists. So far, telemedicine has saved patients 6.4 million km of driving, 64K hours of travel time, and over $4.7 million in travel and accommodation costs.
Similarly, Memorial Sloan Kettering Cancer Center has demonstrated success in patient portal use, virtual visits, and video monitoring programs. The center has wide adoption of its patient portal for delivering appointment information, reviewing lab information, securely communicating with providers, and facilitating patient assessments to track post-surgical recovery. Patients have completed thousands of virtual visits in telegenetics and telepsychiatry. And a fall prevention program using video monitoring has decreased falls by 42% in GI and 34% in neurology cancer inpatients while also decreasing patient attendant costs by $393,000.
From wearable technologies to home-based programs, virtual visits, and communication portals, telemedicine initiatives are improving healthcare accessibility, fostering patient-provider communication, delivering positive patient satisfaction, and delivering healthcare outcomes on par, or better than, face-to-face treatment. And research results are showcasing the applications of telehealth across a variety of telemedicine domains.
Its clear telehealth is an effective method of alternative healthcare delivery in many clinical areas and a critical element of forward-thinking healthcare programs.
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