Taking It to the People: Telemedicine promises increased access for rural patients. Even better, early data suggest patients are satisfied with this form of clinical care.

WelsbacherA 5-year study funded by the Department of Veterans Affairs (VA) is being conducted at the Milwaukee VA and its outpatient clinic in Appleton, Wis. The study, now finishing its second year, is looking at the effects of telemedicine technology on clinician-patient communication, an aspect in the growing field of telemedicine that has not yet received much attention.

The randomized trial study, working with 250 patients with illnesses in one or more of three areas, including pulmonary disease, is among the largest of its type in the country. Two types of outcomes are being measured: patient knowledge and compliance, and communication through videotaped visits.

Telemedicine, as defined in this study, uses videoconferencing and the VA’s electronic medical records, cameras, and electronic medical instruments to provide health care to people at a distant location.

Patients, however, are not alone at the other end, notes Zia Agha, MD, principal investigator and an assistant professor of medicine at the Medical College of Wisconsin in Milwaukee. A clinical nurse or RT is with the patient at the remote end, listening to the patient’s lungs and checking vital signs.

“From previous data, we know that patients are very satisfied with this form of care,” Agha says. “They can avoid travel, and they do not feel they get inferior care, although most people do look at it as supplemental care rather than a replacement” for traditional face-to-face care.

The Veterans Administration, Agha notes, is very active in telemedicine, partly because it faces fewer legislative hurdles. “It doesn’t have to deal with reimbursement issues or barriers due to state licensing requirements for physicians,” he says. Also, the veteran population in Wisconsin, as in most states, is spread out. Telemedicine is an ideal way to provide specialty care for veterans at satellite primary care clinics in smaller communities that the VA has set up. The VA has an advanced electronic medical records system that allows clinicians virtual access to patient records.

“The jury is still out,” Agha says, on whether telemedicine really saves any money. The research studies that have been performed are small demonstration projects, and concrete evidence from larger clinical trials is still not available. “The main impetus in this field,” he notes, “is not to save money, but to provide improved access to patients in remote areas or with disabilities or age-related illness. If done properly, it is a good thing.”

The study will be complete in 2006. In the meantime, you can learn more about this fascinating field from our cover article in this issue of RT.

—Anne Welsbacher
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