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At least 505 records · Page 28Linked to original sources
PubMed2001

A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective.

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral--126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar--almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 Pounds for those in urban areas and 59.93 Pounds per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was 47.13 Pounds for urban patients and 48.77 Pounds for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Adolescent↗
PubMed1995

Integration of medical imaging into a multi-institutional hospital information system structure.

The Department of Veterans Affairs (VA) is providing integrated text and image data to its clinical users at its Washington and Baltimore medical centers and, soon, at nine other medical centers. The DHCP Imaging System records clinically significant diagnostic images selected by medical specialists in a variety of departments, including cardiology, gastroenterology, pathology, dermatology, surgery, radiology, podiatry, dentistry, and emergency medicine. These images, which include color and gray scale images, and electrocardiogram waveforms, are displayed on workstations located throughout the medical centers. Integration of clinical images with the VA's electronic mail system allows transfer of data from one medical center to another. The ability to incorporate transmitted text and image data into on-line patient records at the collaborating sites is an important aspect of professional consultation. In order to achieve the maximum benefits from an integrated patient record system, a critical mass of information must be available for clinicians. When there is also seamless support for administration, it becomes possible to re-engineer the processes involved in providing medical care.

Baltimore↗
PubMed1997

High-performance clinical patient data review and consultation system.

Primary care physicians rely on specialists. Specialists are too expensive to be located at every clinical site requiring a practical means for specialists to help without requiring patients or specialists to travel for consultation. To address the challenge of providing primary care physician access to specialists, we are developing a clinical prototype system for the high-speed access and transfer of patient data and images within Radiology Departments, Medical Centers and Health Care Networks. The key components of the system are: a high-bandwidth network (100 Mbit/s upgradeable to ATM); an image server system with a 30-60 day patient image on-line archive ( < 10 sec. recall) coupled with a long term archive; viewing consoles matching existing film display paradigms located within the medical center and clinics providing rapid access to patient data and diagnostic images for house staff (OR/ER/ICU); clinician access to the image archive on a consultation basis in office computers; and image review applications which closely follow the established paradigms used by clinicians. Using our system primary care physicians can rapidly review patient data locally obtaining additional consultation from tertiary sites while the patient is present. Clinics and outlying medical centers gain rapid access to specialists with physicians in different cities discussing patient diagnostic and management issues in a shared environment leading to instantaneous data analysis and diagnosis further reducing health care costs and enhancing patient care.

Computer Communication Networks↗
PubMed2002

The internet--friend or foe? A questionnaire study of orthopaedic out-patients.

OBJECTIVE: To examine patients' use of the Internet to obtain medical information, their opinions on the quality of medical Web sites, and their attitudes towards Internet-based consultations. DESIGN: Questionnaire study. PARTICIPANTS AND SETTING: 398 patients, aged 10-95 years, visiting the orthopaedic outpatient clinics of a London district general hospital over a 2-week period. MAIN OUTCOME MEASURES: (i) The rate of Internet use by patients; (ii) the perception of the quality of medical web sites; (iii) future intentions and attitudes towards Internet-based consultations; and (iv) concurrence between information obtained from Web sites and advice given by the orthopaedic surgeon in the clinic. RESULTS: From 369 respondents (response rate 93%), 55.3% of patients had accessed the Internet. Of these, 52.0% had obtained medical information from this source. Access was linearly correlated with age (r2 = 0.975, P < 0.01) and was also related to social status. Of the 12.3% of patients who had researched their particular orthopaedic condition, 20% reported that the advice received from the surgeon in the clinic contradicted that obtained from the Internet. A total of 35.7% of patients would undergo an Internet-based consultation, whilst a further 25.5% would consider this, depending on the medical condition in question. CONCLUSIONS: Over half of the patients studied were willing to access the Internet for medical information, with younger patients more likely to undertake this activity. Moreover, a significant proportion of respondents were willing to undergo an Internet-based consultation. The increased use of medical Web sites by patients raises important issues regarding the need for quality control, and impacts significantly upon the surgeon-patient relationship.

Adolescent↗
PubMed2005

The effects of telephone consultation and triage on healthcare use and patient satisfaction: a systematic review.

BACKGROUND: In recent years there has been a growth in the use of the telephone consultation for healthcare problems. This has developed, in part, as a response to increased demand for GP and accident and emergency department care. AIM: To assess the effects of telephone consultation and triage on safety, service use, and patient satisfaction. DESIGN OF STUDY: We looked at randomised controlled trials, controlled studies, controlled before/after studies, and interrupted time series of telephone consultation or triage in a general healthcare setting. SETTING: All healthcare settings were included but the majority of studies were in primary care. METHOD: We searched the Cochrane Central Register of Controlled Trials, EPOC specialised register, PubMed, EMBASE, CINAHL, SIGLE, and the National Research Register and checked reference lists of identified studies and review articles. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. RESULTS: Nine studies met our inclusion criteria: five randomised controlled trials; one controlled trial; and three interrupted time series. Six studies compared telephone consultation with normal care; four by a doctor, one by a nurse, and one by a clinic clerk. Three of five studies found a significant decrease in visits to GPs but two found an increase in return consultations. In general at least 50% (range = 25.5-72.2%) of calls were handled by telephone consultation alone. Of seven studies reporting accident and emergency department visits, six showed no difference between the groups and one--of nurse telephone consultation--found an increase. Two studies reported deaths and found no difference between nurse telephone consultation and normal care. CONCLUSIONS: Although telephone consultation appears to have the potential to reduce GP workload, questions remain about its effect on service use. Further rigorous evaluation is needed with emphasis on service use, safety, cost, and patient satisfaction.

Controlled Clinical Trials as Topic↗
PubMed2006

Teledermatology reduces the number of patient referrals to a dermatologist.

During a two-year study, 505 teledermatology consultations were carried out on 503 patients of 29 participating general practitioners (GPs) in the province of Friesland. One overview and two detail digital photographs of the skin problems were taken on a digital camera and attached to an email message containing standard clinical information. These email messages were sent to a dermatologist, who replied by email after evaluation. After a median follow-up time of 548 days, the GPs were interviewed about the dermatological referrals. The reduction in referrals was 51% (0.95 confidence interval = 47-58%) when the GP had the intention to refer. When the GPs had no intention to refer, there turned out to be a secondary traditional consultation in 17% of cases. The reduction of 51% of referrals after store-and-forward teledermatology consultation was similar to that seen in other studies of videoconferencing. Consultation using digital store-and-forward teledermatology by the GP can halve the number of referrals to a dermatologist for selected patients.

Adolescent↗
PubMed1997

Clinical applications of renal telemedicine.

In 1994, a telemedicine network was established linking the renal unit at The Queen Elizabeth Hospital to three satellite dialysis centres in South Australia. In the first two and a half years of operation, the telemedicine equipment was used on over 6000 occasions. Interviews were conducted with 18 medical, nursing and allied health staff and dialysis patients. The main finding was that the full range of staff, from surgeons and nephrologists to allied health staff and nurses, were able use the technology successfully for clinical purposes. A second finding was that the technology enabled staff to perform a wide range of clinical procedures, from routine outpatient consultations and monitoring infections to making decisions about retrieval or confirming decisions to operate. A third finding was that telemedicine enabled the renal unit to provide improved services in which teams of staff at the different sites cooperated in ways that were not possible before the telemedicine links became available.

Attitude of Health Personnel↗
PubMed2001

[Telemedicine in sparsely populated areas yields satisfied patients and better competence].

A telemedical pilot-project involving two rural primary health care centers in Tärnaby/Storuman in Southern Lappland and the University Hospital of Umeå was carried out during the period Sept. 1, 1996-Dec. 31, 1998. Out of 169 consultations in all, 40 pertained to dermatology, 50 to ENT, 40 to orthopedics, and a further 27 to other specialties (surgery, medicine and gynecology). Among the 169, 47 cases were successfully managed via telemedicine. 30% of consultations were made in order to secure a second opinion. The remaining 70% were made in order to seek advice concerning a possible referral. At the telemedical visit, patients indicated a satisfaction score of 5.5 on a scale up to 6.0. The GP's rated the educational value at 4.4. After completion of the pilot-project, a survey of acceptance and ratings of the future potential of telemedicine for the health care system was carried out among 191 doctors and other health care workers in Västerbotten county. Using a similar graded scale up to 6.0, physicians rated telemedicine as regards utility for patients and quality of care at 4.6 and 4.5 respectively, somewhat higher than they rated the consequences of telemedical consulting for their working conditions and health care organizations, at 3.8 and 4.1 respectively. Despite a low volume of patients in the pilot project, we can conclude that telemedical consultations seem to reduce the number of referrals and raise the level of competency of the GP's. It's important to find further fields of application, as well as further ways of working and organizing the communication network in order to increase volume.

Clinical Competence↗
PubMed2004

[Teledermatological consultation].

Teledermatological consultation can be effected in two ways. One is 'store-and-forward' which involves storing photographic digital images and sending them to a consultant dermatologist who then replies by e-mail, and the other is by videoconferencing using a real time interactive audiovisual link. In daily general practice the first method is the easiest to implement. In 76-90% of cases, a diagnosis or differential diagnosis made in this way corresponds with the diagnosis made at the more usual face-to-face examination. The advantage of teledermatological consultation is that diagnosis and therapy take place faster than after regular referral and it is better than no referral at all. The referring physician should deliver data on the patient's history and physical examination in a standardized format. The same is true for the encoded personal data, the working diagnosis, and referral request. One overview and 2 detailed photos from two angles are normally taken. The overview shows the extent and localization of the skin abnormality. The patient has to consent to a teledermatological consultation. The responsibility for the treatment lies with the doctor who sees the patient face-to-face. The data that is transmitted must be encrypted or coded in such a way that it cannot be traced back to one particular person.

Adult↗
PubMedDate not supplied

Experiments on the quick-relief medical communications via the Japan's domestic communication satellite CS-2 for the case of disasters and emergencies.

Experiments on the quick-relief medical communications via the CS-2 satellite were carried out by using two types of 30/20 GHz small transportable earth stations whose antenna diameters are 1 and 2 m. As the terminal equipments, FM-SCPC systems with a one-telephone-equivalent channel were prepared for the transmission of voice, color freezed picture (9.6 kbps), supersonic echo signal and heart sound from a electrocardiograph. Signals from various medical equipments were transmitted by an FM-SCPC system from Simizu harbour (1 m station) to Tokyo transportable station (2 m), assuming that a person was injured in the ship and the ship came alongside the pier. Transmitted materials are mainly various kinds of pictures of affected parts, X-ray films and electrocardiograph with breathing sounds. It was found possible to send various medical information mentioned above via CS-2 by the 30/20 GHz simple communication systems with one-telephone-equivalent channel. Doctors suggested it would be possible to judge very well about the patients' emergency conditions and to give quick consult with inevitable treatment procedures for them. However, a few problems were found in the Hi-Fi reproduction of original colors and in the transmission of heart sounds in the very low frequency band less than 300 Hz.

Emergency Medical Services↗
PubMed1998

Telemedicine diagnosis of eye disorders by direct ophthalmoscopy. A pilot study.

OBJECTIVE: To report a pilot study of telemedical direct ophthalmoscopy in the diagnosis of acquired immune deficiency syndrome (AIDS)-related retinopathy in a human immunodeficiency virus (HIV)-positive population and in the diagnosis of glaucoma, cataract, and retinopathy in a diabetic population. DESIGN: Prospective comparative case series. PARTICIPANTS: Seventeen HIV-positive and 20 diabetic patients. METHODS: A direct ophthalmoscope custom-fitted with a digital microcamera capable of transmitting images from any of 61 sites within the Georgia Statewide Telemedicine Program was used by a nonophthalmologist to examine 34 eyes of 17 HIV-positive patients and 39 eyes of 20 patients with diabetes. Fundus images were transmitted in real-time to a reviewing ophthalmologist. An in-person, comprehensive examination including indirect ophthalmoscopy, was performed by a second ophthalmologist. Telemedical examination was compared to the in-person comprehensive examination. RESULTS: For the HIV study, 21 eyes did not show HIV retinopathy (noninfectious retinopathy with cotton-wool spots) by in-person examination. Telemedical examination correctly identified 20 of these eyes as disease-free (specificity = 95%). HIV retinopathy was present in 12 of the 34 eyes by in-person evaluation with telemedical examination correctly diagnosing 10 of these eyes (sensitivity = 83%). One eye with dense cataract and retinal detachment was unable to be evaluated ophthalmoscopically by either in-person or telemedical examination. Telemedical and in-person assessments for HIV retinopathy were identical in 100% of eyes without cataract. Disagreement in diagnosis between telemedical and in-person examination was associated with cataract (P < 0.0007). For the diabetes study, because of an inadequate image, telemedical examination was unable to classify 46% and 36% of eyes for glaucoma and diabetic retinopathy, respectively. Inability to make a telemedical determination for glaucoma (P < 0.011), nonproliferative (P < 0.064) and proliferative (P < 0.064) diabetic retinopathy was associated with cataract. Of the eyes that were able to be assessed by telemedical examination for diabetic retinopathy (n = 25), glaucoma (n = 21), and cataract (n = 39), the accuracy was poor (sensitivity = 29%, 50%, and 41%, respectively). Telemedical examination for diabetic retinopathy and glaucoma was more likely to agree with in-person examination in eyes without cataract as compared to eyes with cataract (not statistically significant). CONCLUSION: Telemedical direct ophthalmoscopic, real-time fundus imaging may provide a valuable means for providing ophthalmic consultation to the primary care physician in younger patients without lens or media opacity, but is inadequate for eyes with any degree of lens or media opacity.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Systematic review of recent innovations in service provision to improve access to primary care.

BACKGROUND: In England, there are particularly pressing problems concerning access to adequate primary care services. Consequently, innovative ways of delivering primary care have been introduced to facilitate and broaden access. AIMS: The aim of this study was to review the evidence of seven recent innovations in service provision to improve access or equity in access to primary care, by performing a systematic review of the literature. DESIGN OF STUDY: Systematic review. SETTING: Primary care in the United Kingdom (UK). METHOD: Seven electronic databases were searched and key journals were hand-searched. Unpublished and 'grey' literature were sought via the Internet and through professional contacts. Intervention studies addressing one of seven recent innovations and conducted in the UK during the last 20 years were included. Two researchers independently assessed the quality of papers. RESULTS: Thirty studies (32 papers and two reports) were identified overall. Variation in study design and outcome measures made comparisons difficult. However, there was some evidence to suggest that access is improved by changing the ways in which primary care is delivered. First-wave personal medical services pilots facilitated improvements in access to primary care in previously under-served areas and/or populations. Walk-in centres and NHS Direct have provided additional access to primary care for white middle-class patients; there is some evidence suggesting that these innovations have increased access inequalities. There is some evidence that telephone consultations with GPs or nurses can safely substitute face-to-face consultations, although it is not clear that this reduces the number of face-to-face consultations over time. Nurse practitioners and community pharmacists can manage common conditions without the patient consulting a general practitioner. CONCLUSION: The evidence is insufficient to make clear recommendations regarding ways to improve access to primary care. In the future, it is important that, as new initiatives are planned, well-designed evaluations are commissioned simultaneously.

Ambulatory Care Facilities↗
PubMed2005

Teledermatology: just cool or a real tool?

Telemedicine is the practice of healthcare using interactive audio, visual and data communication. This includes healthcare delivery, diagnoses, consultation and treatment as well as education and transfer of medical data. The transmission of multimedia streams has remained a major challenge. Although the Internet remains basically insecure, technology allows today to define and implement complete security profiles for specific (medical) communities. Data security is a must as in all other areas of applied medicine. Teledermatology offers possibilities in consulting, continuous medical education or teleteaching. In the future, consulting and asking for a second opinion will be the gold standard of medical care. The quality of healthcare will be improved without saving direct costs. However, indirect costs such as time and effort for the patient and the citizen will be reduced.

Dermatology↗
PubMed2003

Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service.

BACKGROUND: In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters. OBJECTIVE: To study why individuals choose to consult previously-unknown doctors on the Internet. METHODS: Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?" RESULTS: 1223 surveys were completed (response rate 36 %). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care. CONCLUSIONS: We found that that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.

Access to Information↗
PubMed2004

Review on the state of telemedicine and eHealth in Iceland.

This article provides an overview of telemedicine and other eHealth activities in Iceland. Several telemedicine projects, which have been running since 1996, are described. The projects include teleradiology, teleobstetrics, telepsychiatry, maritime telemedicine, telemedicine in surgery, telepathology and a project for the use of telemedicine in various consultations. The role of the Icelandic Health-net for telemedicine, including projects for teleobstetrics and telemedicine for emergency medicine, is described with the projects included:. A few other eHealth activities, including electronic patient record and information systems, are also described.

Health Status↗
PubMedDate not supplied

Internet visits: a new approach to chronic disease management.

First Health has become the first national managed care company to establish reimbursement for Web-based Internet consultations between patients and their physicians. Initially limited to chronic conditions such as diabetes, asthma, and congestive heart failure, the program will reimburse up to 24 consultations per year at a rate of $25 each. Privacy issues have been addressed by utilizing secure network procedures. First Health believes that this initiative will enhance subscribers' well-being and potentially reduce the rates of hospitalization and even lengths of stay.

Chronic Disease↗
PubMed2002

An integrated nursing and telemedicine approach to vascular care.

We have developed a telemedicine approach to vascular care for patients being managed in primary care. District nurses visit patients in their homes. Clinical information and digital photographs can be sent by email to the vascular surgeon for assessment. Where appropriate a preliminary teleconsultation between the patient and a vascular surgeon, with the nurse in attendance, is held at the primary care centre and the management of the patient is agreed. This may include referral to surgery. Over eight months six patients with diabetes and peripheral ulcers participated in the vascular telemedicine clinic. The average consultation time was 12 min (SD 4), which included discussion of the case and negotiation of its management. Important outcomes of the new system were the ability to schedule patients for rapid referral and to have completed the management of the case during the teleconsultation.

Diabetic Foot↗
PubMed1995

Video-based teleradiology for intraosseous lesions. A receiver operating characteristic analysis.

Immediate access to off-site expert diagnostic consultants regarding unusual radiographic findings or radiographic quality assurance issues could be a current problem for private dental practitioners. Teleradiology, a system for transmitting radiographic images, offers a potential solution to this problem. Although much research has been done to evaluate feasibility and utilization of teleradiology systems in medical imaging, little research on dental applications has been performed. In this investigation 47 panoramic films with an equal distribution of images with intraosseous jaw lesions and no disease were viewed by a panel of observers with teleradiology and conventional viewing methods. The teleradiology system consisted of an analog video-based system simulating remote radiographic consultation between a general dentist and a dental imaging specialist. Conventional viewing consisted of traditional viewbox methods. Observers were asked to identify the presence or absence of 24 intraosseous lesions and to determine their locations. No statistically significant differences in modalities or observers were identified between methods at the 0.05 level. The results indicate that viewing intraosseous lesions of video-based panoramic images is equal to conventional light box viewing.

Analysis of Variance↗