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At least 667 records · Page 37Linked to original sources
PubMed2005

Targeted routine asthma care in general practice using telephone triage.

BACKGROUND: There is a high non-attendance rate for traditional clinic-based routine asthma care in general practice. Alternative methods of providing routine asthma care need to be examined. AIM: To examine the cost and effectiveness of targeted routine asthma care in general practice using telephone triage, compared to usual clinic care. DESIGN OF STUDY: An open randomised controlled trial. SETTING: A single semi-rural practice in the southwest of England. METHOD: Adult patients with asthma were randomised to receive either their routine asthma care in the surgery or care by telephone triage. Asthma control parameters, health status and NHS resource utilisation were measured over the 12-month study period. RESULTS: One hundred and ninety-four patients were randomised and 35% per cent more patients (n = 84 versus n = 62) received more than one consultation in the telephone group. Asthma control as measured by the asthma control questionnaire (ACQ) was similar in the clinic and telephone groups: mean change in ACQ = -0.11 (95% CI = -0.32 to 0.11) versus -0.18 (95% CI = -0.38 to 0.02). Mean NHS costs were 210 pounds sterling per patient per year in the telephone group compared to 334 pounds sterling in the clinic group (P-value of bootstrapped difference = 0.071). CONCLUSION: Targeted routine asthma care by telephone triage of adult asthmatics can lead to more asthma patients being reviewed, at less cost per patient and without loss of asthma control compared to usual routine care in the surgery.

Adolescent↗
PubMed2003

Telemedicine reduces discrepancies in rural trauma care.

Patients injured in rural areas die at roughly twice the rate of those patients with similar injuries in urban areas. A multitude of explanations have been suggested for higher mortality rates from trauma in the rural areas of the United States. Since rural emergency room (ER) staff see far fewer traumas than ER staff at large metropolitan trauma centers, their lack of exposure to this low-volume problem certainly contributes to the problem. To address discrepancies in trauma education and the delivery of care in our rural region, a telemedicine system was utilized to provide rapid consultation from surgeons at the level 1 trauma center and to provide enhanced educational opportunities for rural ambulance emergency first responders. Clinical outcome measures and evaluation questionnaires were designed in advance of implementation. Forty-one "tele-trauma consults" were performed over the first 30 months of the project, all for major, multi-system trauma. Though many clinical recommendations were made, the system was judged to be life saving in three instances, and both rural and trauma center providers felt the system enhanced clinical care. In addition, educational sessions for rural first responders were well attended and favorably reviewed. Early results of a telemedicine system provide encouragement as a means to address discrepancies in the outcomes after major trauma in rural areas, although more work needs to be completed and evaluated.

Ambulances↗
PubMed1998

Cost-minimization analysis: A follow-up study of a telemedicine program.

OBJECTIVE: To present the follow-up findings to a cost-benefit analysis of telemedicine subspecialty services provided between the Powhatan Correctional Center (PCC) of the Virginia Department of Corrections and the Medical College of Virginia Campus of Virginia Commonwealth University (MCV Campus). METHODS: Costs included those of operating the telemedicine system, transportation, litigation avoidance, and the medical care itself. RESULTS: Over a 12-month study period, the total number of consults completed through telemedicine was 290. The cost per visit of treating inmates at the MCV Campus clinics was $401. The cost per visit of treating inmates at PCC via telemedicine was $387, a net saving of $14 per visit with the use of telemedicine. CONCLUSION: As a result of implementing telemedicine, the Department of Corrections for the State of Virginia was able to achieve a cost saving of $14 per visit. Nonmonetary cost savings, such as greater security and increased access to care, should be considered a net benefit as well.

Cost Savings↗
PubMed2006

A survey of time management and particular tasks undertaken by consultant microbiologists in the UK.

BACKGROUND: Medical microbiology practice encompasses a diverse range of activities. Consultant medical microbiologists (CMMs) attribute widely differing priorities to, and spend differing proportions of time on various components of the job. AIM: To obtain a professional consensus on what are high-priority and low-priority activities, and to identify the time spent on low-priority activities. METHOD: National survey. RESULTS: Many respondents felt that time spent on report authorisation and telephoning of results was excessive, whereas time spent on ward-based work was inadequate. Timesaving could also be achieved through better prioritisation of infection-control activities. CONCLUSION: CMMs should apportion their time at work focusing on high-priority activities identified through professional consensus.

Adult↗
PubMed1997

Preliminary results from the Northern Ireland arms of the UK Multicentre Teledermatology Trial: effect of camera performance on diagnostic accuracy.

The diagnostic accuracy of realtime teledermatology was measured using two different video cameras. One camera was a relatively low-cost, single-chip device (camera 1), while the other was a more expensive three-chip camera (camera 2). The diagnosis obtained via the videolink was compared with the diagnosis made in person. Sixty-five new patients referred to a dermatology clinic were examined using camera 1 followed by a standard face-to-face consultation. A further 65 patients were examined using camera 2 and the same procedure applied. Seventy-six per cent of conditions were correctly diagnosed by telemedicine using camera 2 compared with 59% using camera 1. A working differential diagnosis was obtained in 12% of cases using camera 2 compared with 17% using camera 1. The percentage of 'no diagnosis', wrong and missed diagnoses was halved using camera 2 compared with camera 1. These results suggest that the performance of camera 2 was superior to that of camera 1 for realtime teledermatology.

Adolescent↗
PubMed2004

Diagnostic telepathology: long-term experience of a single institution.

OBJECTIVES: The paper reviews the development of the application of telepathology in a department of surgical pathology between 1991 and 2003. The goal of the efforts during this time was to give up the concept of programming a single application, available only between two fixed workstations with sophisticated devices and special software, and to find the virtual "largest common denominator" for implementing as many different applications as possible with the same basic system. METHODS: A new telepathology system was designed as a client-server system with a relational database at its centre. The clients interact together by transferring the questions (texts and images) to a record (case) in the database on the server and by transferring the answers to the same record on the database. RESULTS: The new "open" telepathology system iPath (http://telepath.patho.unibas.ch) has been very well accepted by many groups around the world. The main application fields are: consultations between pathologists and medical institutions without a pathologist (e.g. for frozen section diagnoses or for surgical diagnoses in hospitals in South Asia or Africa), tumour boards, field studies and distance education (http://teleteach.patho.unibas.ch). CONCLUSIONS: Having observed that with iPath we have succeeded in satisfying all our telepathology needs, we are inclined to put the emphasis on the nature of the tasks being performed, as opposed to the methods or technical means for performing a given task. The three organisation models proposed by Weinstein et al. (2001) can be reduced to only two models: the model of discussion groups and the model of expert groups (virtual institutes).

Global Health↗
PubMed2004

A comparative study on the utility of telehealth in the provision of rheumatology services to rural and northern communities.

INTRODUCTION: There is a critical shortage of specialty rheumatology services in Canada. The impact is felt more in rural and northern regions than on urban areas of the country. In response to the need, this study was conducted to compare the satisfaction of referring physicians with rheumatology services through conventional visiting specialty clinics; email consults and regularly scheduled videoconference. METHODS: Three rural communities of similar size and availability of physician services were assigned to one of the following means of providing outreach rheumatology services: visiting rheumatologist clinics, email access to rheumatologist and scheduled videoconference consults. A case based pre/post test, and post satisfaction questionnaire were administered to the primary care physicians in these communities. Patient outcomes, and physician ability and confidence in managing specific arthritis problems, were measured. RESULTS: Physicians responded positively to all methods of rheumatology service provision. The videoconference group were the most positive. The reasons were: immediate feedback to referring physician and patient, effective case based learning and transfer of knowledge, and improved accessibility. CONCLUSION: Videoconference is preferred to visiting clinics and email as a method for rheumatology services to rural/northern communities. It is cost effective and there is knowledge transfer between the rheumatologist and the referring physicians.

Arthritis, Rheumatoid↗
PubMed2003

Telepsychiatry in the Canary Islands: user acceptance and satisfaction.

A telepsychiatry service, using ISDN videoconferencing, was established to provide psychiatric consultations for the population of El Hierro, the most westerly of the Canary Islands. During the first year of routine operation, a total of 40 patients had 40 initial and 126 follow-up teleconsultations. The main reason for the consultation identified in the general practitioner's referral form was to establish a diagnosis (60% of patients); the second most common reason was the management of a patient previously diagnosed (20% of patients). According to the results of a questionnaire survey, patients' acceptance of and satisfaction with the technology were high. In their first teleconsultation, about a third of them said that they experienced some initial inconvenience, but this disappeared after a few minutes. Ninety per cent of the patients considered that they received the follow-up care they required. Telepsychiatry was considered by physicians and patients as an adequate vehicle for mental health-care.

Adolescent↗
PubMed2005

Adapting the Roter interaction analysis system for telemedicine: lessons from four specialty clinics.

Four specialists (a child psychiatrist, an oncologist, a cardiologist and a rheumatologist) conducted telemedicine clinics using videoconferencing at a bandwidth of 128-384 kbit/s. The consultations were videorecorded. The coded interactions from the first two patients recruited from each of the four telemedicine clinics were analysed. Tapes were coded by two raters. We adapted the Roter interaction analysis system (RIAS) for the telemedicine context. Utterances were coded into socio-emotional and task-focused categories. There were 1055 utterances in total. Providers generated significantly more utterances across categories than patients. In the patient-provider interactions, only 2% of the total utterances related to the technology. The predominance of socio-emotional utterances compared with task-focused utterances for providers was contrary to our expectations. Further studies are required to establish the reliability of the adapted RIAS measure and to increase understanding of telemedicine communication patterns.

Child↗
PubMed1998

Reasoning about tasks, activities and technology to support collaboration.

An aspect of collaboration described as 'semi-synchronized activity' is discussed as a particular challenge for the task analysis (TA) of collaborative work. TA typically involves the decomposition of work systems into essentially independent component processes between which commodities (information or materials) pass. In collaborative work, people routinely violate the condition of independence by moving seemlessly in and out of synchronization with one another, allowing for both independent and varying levels of conjoint activity. The shift between joint and independent projects is not fixed but managed through more or less explicit awareness of the other people over time. A number of case studies of the effect of communication technologies in telemedical consultation are drawn upon to illustrate the relationship between awareness and synchronization in collaborative work. They show that an analysis of collaborative activity requires a consideration of: (1) the activities constituting work; (2) the interactions between participants required to carry out the activities; (3) who else has access to these activities besides the primary participants in the ongoing work; (4) the contemporaneity of activities; (5) the locations/environments in which the activities are carried out; and (6) the constraints that apply to accessibility and participation within and between these environments. The Comms Usage Diagram is described as a framing notation incorporating these characteristics for a broad, communications-level analysis of collaborative activity. It shows how particular technologies relate to particular phases of work, indexing their effects to collaborative activities in those contexts.

Humans↗
PubMed2001

A cost study of teleconsultation for primary-care ophthalmology and dermatology.

Teleconsultations were performed between a health centre in a small Finnish town and a university hospital 55 km away. Telemedicine consultations were carried out with a total of 42 patients suffering from various eye and skin disorders. We evaluated the costs of the teleconsultations in the health centre and the conventional alternative of the patient travelling to the hospital. The cost of conventional consultations, which was not affected by the patient workload, was EU126 per patient for ophthalmology and EU143 per patient for dermatology. The cost of the teleconsultations per patient decreased as the number of patients increased. There were cost savings in relation to teleconsultations when the annual numbers of patients were more than 110 in ophthalmology and 92 in dermatology. Benefits and savings achieved through teleconsultations mainly consisted of reduced transportation costs and reduced paperwork both at the health centre and at the university hospital, as well as time savings for the patient. Another important benefit was improved medical education. The present study shows that teleconsultations can be performed in a cost-effective way in a relatively small health centre.

Cost-Benefit Analysis↗
PubMed2000

Review of teleconsultations for dermatologic diseases.

BACKGROUND: Telemedicine has been increasingly used in some areas to provide consultation for isolated populations that might otherwise have difficulty accessing specialty care. Little information exists on what types of patients or diseases are being seen in dermatology telemedicine consultation services. OBJECTIVE: To review our consultations done over a regional telemedicine network with an emphasis on looking at what type of patient, cutaneous diseases, and diagnostic or therapeutic recommendations were made. RESULTS: Between August 1992 and December 1997, 796 teleconsultations were done. The most common diagnoses made were eczemas, follicular based diseases, skin infections, and skin tumours. Steroids were the most commonly recommended therapy, along with antibiotics, antihistamines, and antifungal therapy. Diagnostic recommendations commonly made were a skin biopsy and potassium hydroxide preparation. CONCLUSIONS: Common skin problems were seen by our dermatology teleconsultation service. A significant number of diagnostic biopsies and potassium hydroxide preparations were recommended. The efficacy of telemedicine in the delivery of dermatologic care is reviewed.

Adolescent↗
PubMed1999

Digital still image recording during video endoscopy.

With the advances in telemedicine and virtual consultation services comes the need for state-of-the-art endoscopic imaging techniques and equipment. Concomitant with current day concerns of cost containment, the ability to utilize the aforementioned tools in a cost-effective fashion that lowers operating expenses, accurately depicts procedures, and expedites chart documentation is paramount. We report on a fast and efficient way to obtain and store images during endoscopic procedures, which can be stored on standard 3.5-inch floppy disks using an innovative digital image recorder. These images are stored as high-resolution (640x480x24) JPEG files, which can be placed in electronic medical records, imported into Internet Web pages, incorporated into slide presentations, and, most importantly, stored in easily accessed archives.

Computer Communication Networks↗
PubMed2002

The implementation of a call-back system reduces the doctor's workload, and improves accessibility by telephone in general practice.

BACKGROUND: In a general practice in The Netherlands, the demand for direct telephone consultation with the doctor became extreme, which resulted in poorly managed consultations, and poor telephone access due to busy lines. A call-back telephone appointment system was therefore introduced: all calls are answered and, when possible, managed by the practice assistant. If the assistant feels incapable, or if the patient prefers to speak to the doctor, a telephone appointment is scheduled, at which time the doctor returns the patient's call. OBJECTIVE: Our aim was to evaluate the effects of a call-back telephone appointment system on doctors' workload and patients' telephone access to doctors. METHODS: Telephone consultation data over 10 weeks were selected before and after the introduction of the call-back telephone appointment system. The outcomes measured were: number and duration of telephone calls to doctors, the reason for each call and how often telephone lines were engaged during the specified telephone hour. RESULTS: The number of calls requiring the doctor's attention was reduced by 59% and total time spent on the telephone by the GPs was reduced by 39%. This reduction is explained by a change in the reasons for calling. Telephone accessibility improved, as busy telephone lines were no longer an issue. CONCLUSION: The call-back telephone appointment system is superior to the previously used open access telephone hour.

Appointments and Schedules↗
PubMedDate not supplied

The clinical e-mail explosion.

The computer is transforming patient-physician communication. Physicians are already using electronic mail (e-mail) in physician-to-physician consultation, medical journal dissemination, and hospital-physician communication. This article addresses the value of e-mail for patient-physician communication. It explores the nature of this electronic medium, outlines published guidelines, delineates expected benefits and potential complications, and proposes how to incorporate e-mail into health information systems. This article is designed to help guide clinicians and health care delivery organizations in the use of e-mail with patients to enhance rather than complicate the provider-patient relationship. Unique advantages of e-mail in the clinical setting include: the ability to offer routine transactions and patient education; increased efficiency; the self-documenting nature of this medium; cost-effectiveness; and serving as a clinical extender.

Confidentiality↗
PubMedDate not supplied

Patient-physician e-mail: passion or fashion?

This article surveys the nature, prevalence, and risks and benefits of patient-physician e-mail as a prelude to critically evaluating what will be required for it to become a truly transformational technology. Diverse materials from both the popular press and various clinical domains are consulted in order to appraise patient-physician e-mail's efficacy in different contexts and among different patient and physician users. Early evidence that patient-physician e-mail has lasting power includes its use in niche clinical applications, appearance of unsolicited patient e-mail, historical patterns of medical technology adoption, and increasing use of the Internet in general. Patient-physician e-mail will become genuinely transformational if it affirmatively improves the patient-physician encounter, contributes to better clinical outcomes, makes patient-physician communication more convenient for both parties, demonstrably transcends existing reimbursement and medicolegal concerns, and promotes patient empowerment. Like all technologies, use and misuse of patient-physician e-mail will determine whether its possibilities will become realities.

Delivery of Health Care↗
PubMed2002

[Teleconsultation 2001--report of the Teleconsultation Study Circle of the Austrian Roentgen Society (ORG)].

In 1997, the working group "Teleconsultation" of the Austrian Roentgen Society (ORG) has performed a first survey about the status of teleradiological applications in Austria. Now, in 2001, a second survey was performed in order to adapt the ORG's approach in this field to the most actual needs. Most of the 38 teleradiological projects in Austria already working or shortly before inauguration are aiming at an improvement of the medical service in favour of our patients (expert consultation, image transfer to doctors requesting radiological examinations, clinical case discussion). However, a small but not unimportant fraction of teleradiology projects in Austria (11%) is performed for replacement of radiologists on duty, therefore for reasons mainly directed to minimising costs for the hospital administration. Other purposes of teleradiology projects, like quality assurance and medical education have even lost their small importance the 1997 survey already has shown. This paper discusses the professional implications from the results of the 2001 survey and the legal framework for the application of telecommunication in diagnostic radiology. The most important goal of all professional activities in radiology is the well-being of our patients, based on the immediacy of the medical profession in accordance with the "physician law".

Austria↗
PubMed2000

Application of telepsychiatry: a preliminary study.

Telemedicine is the provision of professional medical services from sites removed from the patient. This study was conducted in order to assess the reliability of psychiatric evaluations via video-consultation. The inter-rater reliability was determined for each interviewing condition by employing the reliability-testing paradigm in which the brief psychiatric rating scale (BPRS) and the interclass correlation coefficient (ICC) are used. The inter-rater reliability scores between face-to-face interviews and interviews conducted by video at two different levels of image qualities were compared by the authors. Reliability was found to be in perfect agreement in each of the interviewing conditions. This study verifies that telepsychiatry is a reliable method of assessing patient conditions. It may be used to provide much needed mental health-care services to patients whose access to them is restricted.

Adult↗