Patients Give Positive Marks to Telemedicine Experience

April 14, 2000

New York (MedscapeWire) Apr 14 -- A small Mayo Clinic pilot study of patients using telemedicine from their homes in Florida found that patients were pleased with the system, but uncertain whether they would be willing to pay for a system in their homes.

Researchers at the Mayo Clinic in Jacksonville, Fla, consider the effort a strong first step in a field that is bound to expand as technology improvements help bring additional and faster computer technology into homes. The study, which aimed to measure patient acceptance of telemedicine, appears in the April 2000 issue of Mayo Clinic Proceedings.

"As telemedicine technology advances and more experience is gained with it, the expectations and realities of the patient-physician encounter will change," says Robert Bratton, MD, a family medicine physician at Mayo Clinic in Jacksonville and the chief author of the study.

In the study, 20 elderly patients were followed for 8 weeks in 1998 with a home-based telemedicine unit. The patients were members of a retirement community and were generally healthy with some underlying chronic medical conditions. Trained personnel assisted the volunteers at the site while the study participants were interviewed via the telemedicine unit by Mayo Clinic Jacksonville physicians 12 miles away. Various vital signs were recorded, and an electronic stethoscope was used to listen to the patients' heart and lungs. The average age of the participants was 77 years and 12 were female.

After the study was completed, 18 of the 20 participants completed a survey on the project. Eleven of the 18 were comfortable with the system and used it without assistance, and 72% said they thought the system correctly recorded their vital signs. Only 6% (1 participant) reported any discomfort while using the system. One of the most significant findings was that 17 (94%) of the 18 participants reported the computer system did not have a negative impact on their relationship with the physician and 11 participants (61%) actually thought the system had a positive effect. This is in contrast to many perceived beliefs that telehealthcare may harm the doctor-patient relationship.

Financial concerns remain one of the biggest hurdles both for the patient and the caregiver. In the Mayo study, 78% of the respondents said they would not be willing to pay a fee to have the system in their homes. The estimated costs for a home operation range from $5000 to $15,000 or more depending on the setup and equipment at the home. However, costs are decreasing. Leasing agreements also may help alleviate the high costs to consumers. Meanwhile, Medicare has begun paying for telemedicine consults, but only in areas where there is a geographic shortage of health professionals. Other restrictions on Medicare reimbursement included that a physician or limited-license provider recognized by Medicare is stationed at both ends of the consult.

A study by telecommunications companies in the 1990s estimated a healthcare cost reduction greater than $200 million annually through the use of telemedicine.

But there are also legal and ethical concerns to be worked out as the practice of telemedicine advances with technology, says Dr. Bratton. Quality of care and privacy are two of the main issues of concern. Another involves the guidelines that define where a physician is licensed to practice. Current guidelines don't address whether the physician is practicing where he is located or where the patient is located, oftentimes in another state. For this reason, many state boards of medicine have opposed the development of telemedicine, the study says.

Telemedicine use at Mayo Clinic began in the mid-1980s. The system links its Mayo Clinic in Rochester, Minn, with its sites in Jacksonville, Fla, and Scottsdale, Ariz, and smaller regional practices in Minnesota, Iowa, and Wisconsin. The Mayo Clinic in Rochester also has been involved in international telemedicine projects with Jordan and the United Arab Emirates.

Mayo Clin Proc. 2000;75(4):365-3

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