Infectious disease patients may benefit from telemedicine

Last Updated: 2015-01-01

By Kathryn Doyle

(Reuters Health) - Telemedicine can help connect isolated patients with infectious diseases to medical specialists, and patients appreciate it, according to a new review.

Many doctors who treat complicated infections practice near university medical centers, which many patients may not be able to get to easily, the authors say.

Telemedicine also connects local community doctors to specialists, the authors write.

"This is a very powerful tool to reach people marginalized by distance or socioeconomic status, and will become a more and more important tool for treating infectious disease," said senior author Dr. Curtis Cooper, an associate professor of Medicine at the University of Ottawa in Canada.

His team reviewed 29 recent studies in which patients with sudden or long-term infections went to a local clinic, where they had a secure and private telemedicine video link to specialists instead of having an in-person appointment.

Infections that are usually easily treatable but can have complications or require follow-up with a specialist, the authors write. Telemedicine can also make follow-up appointments easier, because patients don't have to travel long distances.

Telemedicine has also been used to manage chronic conditions like heart failure, diabetes, chronic obstructive pulmonary disease, hepatitis C infection and HIV, Cooper and his colleagues noted December 16 online in Clinical Infectious Diseases.

In three studies included in their review, HIV patients who "met" with specialists by telemedicine every six to 12 months were more likely to stick to their medications and to respond well to antiretroviral therapy.

Seven other studies found that chronic disease patients who used telemedicine felt more satisfied and involved in their care than those who did not use it.

Patients reported that attending remote appointments through telemedicine saved them time, diminished the distance traveled and reduced missed work days, the researchers reported.

"Telemedicine can increase access to high-quality care for many patient populations, including the incarcerated, persons living in chronic care facilities, those in rural areas and others with access or transportation issues," said Dr. Jeremy Young, medical director of Telehealth Services at the University of Illinois College of Medicine at Chicago. He was not part of the new review.

Particularly for prisoners, telemedicine eliminates the costs and escape risks of transporting a prisoner to an off-site doctor, the authors write.

But cost-effectiveness, another often-proposed advantage of telehealth, is still debatable.

"We've always sort of assumed that this is a cost-effective strategy, but there needs to be more analysis to prove what everybody believes to be true" Cooper told Reuters Health by phone.

Most studies have not included formal cost-effectiveness analysis, and those that do suggest telemedicine might not be more cost-effective than traditional clinic visits.

Another obvious drawback is that doctors can't perform physical exams via video chat, but new technology could help overcome that, the authors write.

"Several companies have developed remote monitoring technologies that can collect large amounts of patient data - vital signs, electrocardiography, glucometry - which is collated, analyzed and provided to the patient's physician to make better decisions in a person's care," Young said.

"While some of the benefits of telemedicine have been known for years - if not decades - the technologies have only recently become more widely available, less expensive and of better quality," he told Reuters Health by email.

Telemedicine is spreading, supported by laws in 21 states and the District of Columbia that provide equal billing for telemedicine and in-person services, he said. But it is still very difficult to design a sustainable telemedicine clinic in the other 29 states, he noted.

"Not being able to reliably bill insurance companies for services makes it difficult to pay physicians, clinical pharmacists, social workers, clinic schedulers, and the others who are vital to maintaining a high-quality clinical service," Young said.

Also, doctors are currently licensed to practice by the state, so treating patients further away is not an option, he said.

Licensed in Illinois, Young can provide care for anyone in the state, "but if a patient is 5 feet over the Indiana border, I cannot function as their provider," he said.

Despite these obstacles, Cooper said, "This review demonstrates that you can safely and effectively provide consultation services for patients with telemedicine. There is great potential with telemedicine to streamline healthcare."

SOURCE: http://bit.ly/1vGr6cR

Clin Infect Dis 2014.