Telemedicine Service May Expand Access To Acute Medical Care, Study Finds

Patients who used the service suffered from a broad assortment of acute medical problems such as respiratory illnesses and pores and skin problems, and research workers found little evidence of misdiagnosis or treatment failure among those who used the ongoing service. The findings, published in the February edition of the journal Health Affairs, are from the first assessment of the telemedicine program offered to a large, diverse band of patients over the USA. Lori Uscher-Pines, lead author of the analysis and a policy researcher at RAND, a nonprofit research company. Interest is continuing to grow in telemedicine programs because of the lack of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the Affordable Care Act.

Telemedicine is one of the alternatives touted as a way to better provide major healthcare without greatly expanding the number of doctors. Uscher-Pines and co-author Dr. Ateev Mehrotra studied 3,701 patient “visits” provided from April 2012 to February 2013 by Teladoc, one of the country’s largest providers of telemedicine services.

Teladoc differs from almost every other telemedicine initiatives that connect patients to providers for area of expertise trips or connect providers to other providers for consults for in-hospital care. The patients analyzed all were covered through a health plan offered by the California Public Employees’ Retirement System, which gives medical health insurance to the state’s open public workers.

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Patients who used Teladoc were in comparison to peers who have seen hospital emergency departments or a doctor’s office for an identical problem. To use the Teladoc service, patients establish an online account filled with information about their medical history. If they need treatment, they ask for a consult with a Teladoc doctor. The patient doesn’t have a relationship using their consulting doctor, but callbacks take place within 20 to 25 minutes usually. Among patients studied, the most common problems for a Teladoc visit were acute respiratory conditions, urinary tract skin, and infections problems, which accounted for over fifty percent of the full situations. Other frequent-known reasons for Teladoc visits were stomach pain, and joint problems back, viral illnesses, eye problems, and ear infections.

Though telemedicine has promise, Teladoc visits accounted for only a very small proportion of the health care used by the group studied. In addition, more than a third of Teladoc visits happened on vacations or weekends. Mehrotra, a RAND researcher and a co-employee professor at the Harvard Medical School. Across the leading conditions, trips to Teladoc were less likely than visits to the crisis department or your physician office to lead to a follow-up visit for an identical condition. RAND analysts say the finding suggests that health problems were most likely adequately addressed during the Teladoc trips. However, researchers caution that more research is necessary to further evaluate the quality and safety of telemedicine services such as Teladoc.

There are concerns that expanded use of the kind of telemedicine can lead to fragmentation of care. Teladoc physicians do not have access to information that can be gathered during a patient exam or diagnostic testing. Some providers dread these and other limitations can result in misdiagnosis and higher rates of follow-up visits.

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