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      Improving Access to Care: Telemedicine Across Medical Domains

      Author(s): 1 , 2 , 3 , 3 , 1 , 3
      Publication date Created:
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      Journal: Annual Review of Public Health
      Publisher: Annual Reviews

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          Abstract

          Over the past 20 years, the use of telemedicine has increased exponentially. Its fundamental aim is to improve access to care. In this review, we assess the extent to which telemedicine has fulfilled this promise across medical domains. Additionally, we assess whether telemedicine has improved related health outcomes. Finally, we determine who has benefited from this novel form of health care delivery. A review of the literature indicates that ( a) telemedicine has improved access to care for a wide range of clinical conditions ranging from stroke to pregnancy; ( b) telemedicine in select circumstances has demonstrated improved health outcomes; and ( c) telemedicine has addressed geographical, but less so social, barriers to care. For telemedicine to fulfill its promise, additional evidence needs to be gathered on health outcomes and cost savings, the digital divide needs to be bridged, and policy changes that support telemedicine reimbursement need to be enacted.

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          Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association

          Emelia Benjamin, Paul Muntner, Alvaro Alonso … (2019)
          Circulation, 139(10)
          Article 0 comments Cited 2374 times – based on 0 reviews     Review now
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            Evaluating barriers to adopting telemedicine worldwide: A systematic review

            Clemens Scott Kruse, Priyanka Karem, Kelli Shifflett … (2016)
            Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.
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              Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial.

              William T. Abraham, Philip B. Adamson, Robert Bourge … (2011)
              Results of previous studies support the hypothesis that implantable haemodynamic monitoring systems might reduce rates of hospitalisation in patients with heart failure. We undertook a single-blind trial to assess this approach. Patients with New York Heart Association (NYHA) class III heart failure, irrespective of the left ventricular ejection fraction, and a previous hospital admission for heart failure were enrolled in 64 centres in the USA. They were randomly assigned by use of a centralised electronic system to management with a wireless implantable haemodynamic monitoring (W-IHM) system (treatment group) or to a control group for at least 6 months. Only patients were masked to their assignment group. In the treatment group, clinicians used daily measurement of pulmonary artery pressures in addition to standard of care versus standard of care alone in the control group. The primary efficacy endpoint was the rate of heart-failure-related hospitalisations at 6 months. The safety endpoints assessed at 6 months were freedom from device-related or system-related complications (DSRC) and freedom from pressure-sensor failures. All analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00531661. In 6 months, 83 heart-failure-related hospitalisations were reported in the treatment group (n=270) compared with 120 in the control group (n=280; rate 0·31 vs 0·44, hazard ratio [HR] 0·70, 95% CI 0·60-0·84, p<0·0001). During the entire follow-up (mean 15 months [SD 7]), the treatment group had a 39% reduction in heart-failure-related hospitalisation compared with the control group (153 vs 253, HR 0·64, 95% CI 0·55-0·75; p<0·0001). Eight patients had DSRC and overall freedom from DSRC was 98·6% (97·3-99·4) compared with a prespecified performance criterion of 80% (p<0·0001); and overall freedom from pressure-sensor failures was 100% (99·3-100·0). Our results are consistent with, and extend, previous findings by definitively showing a significant and large reduction in hospitalisation for patients with NYHA class III heart failure who were managed with a wireless implantable haemodynamic monitoring system. The addition of information about pulmonary artery pressure to clinical signs and symptoms allows for improved heart failure management. CardioMEMS. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Title: Annual Review of Public Health
                Abbreviated Title: Annu. Rev. Public Health
                Publisher: Annual Reviews
                ISSN (Print): 0163-7525
                ISSN (Electronic): 1545-2093
                Publication date Created: April 01 2021
                Publication date (Print): April 01 2021
                Volume: 42
                Issue: 1
                Pages: 463-481
                Affiliations
                [1 ]Department of Neurology, University of Rochester Medical Center, Rochester, New York 14642, USA;
                [2 ]School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA
                [3 ]Center for Health + Technology, University of Rochester Medical Center, Rochester, New York 14642, USA
                Article
                DOI: 10.1146/annurev-publhealth-090519-093711
                PubMed ID: 33798406
                SO-VID: c275b74f-0a57-4cdb-98a7-dedb382b5ae2
                Copyright © © 2021
                License:

                http://creativecommons.org/licenses/by/4.0/

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