Author Interviews, Telemedicine, University of Michigan / 15.09.2014
Telemedicine Supported For Chronic Disease Management Except For In Frail, Elderly Patients
MedicalResearch.com Interview with:
Rashid Bashshur, PhD
Senior Advisor for eHealth
Professor Emeritus, Department of Health Management and Policy
Executive Director, UMHS eHealth Center
University of Michigan Health System
Medical Research: What are the Main findings of the study?
Dr. Bashshur: The main findings can be summarized as follows:
- The prevalence of chronic disease is increasing due to the changing demographic composition of the population and unhealthy life styles. Chronic diseases are expensive, accounting for about 70% of health care expenditures; but they are amenable to telemedicine interventions. These interventions consist of ongoing monitoring of patients living in their own home environments, engaging them in managing their health, providing them with educational materials and the necessary tools to manage their life style mostly by avoiding risky behaviors and adopting healthy ones.
- Telemedicine interventions consist of various configurations of technology (telephone, video, wired or wireless, automated or manual) , human resources (physicians, nurses, combinations, and patient populations at various levels risk levels or severity of illness, The interventions investigated to date also vary in terms of study design, duration of application (during the study period), and frequency of administration of the intervention. Hence, the findings must be viewed from the perspective of the specific methodological attributes of the studies that were performed.
- Using only robust studies from 2000 to the near present, and limited to congestive heart failure, stroke and COPD. With notable exceptions, overall there is substantial and fairly consistent evidence of:
- A decrease in use of service, including hospitalization, rehospitalization, and emergency depart visits as a result of the telemedicine intervention.
- Improved health outcomes.
- Improved event timing for stroke patients.
- Reduced exacerbations of symptoms for COPD patients
- Some interesting trends to be considered:
- Frail and elderly patients, those with co-morbid conditions, and those in advanced stages of illness are not likely to benefit from telemedicine interventions, as compared to their counterparts.
- Visual information as in videoconferencing proved superior to telephone only connection for the diagnosis and treatment of stroke patients.
- There could be a tradeoff between extra nursing time versus reduced physician time in some settings, but the net effect is cost savings.
- There seems to be a paradoxical telemedicine effect in terms of increasing longevity but no reduction in hospitalization, reported in few studies.