Implementing AHRQ Effective Health Care Reviews

Helping Clinicians Make Better Treatment Choices

The Effectiveness of Outpatient Telehealth Consultations

 

Am Fam Physician. 2019 Nov 1;100(9):575-577.

Author disclosure: No relevant financial affiliations.

Key Clinical Issue

Does the use of telehealth for outpatients requiring subspecialty consultations improve clinical outcomes, reduce costs, or increase patient satisfaction?

Evidence-Based Answer

Telehealth consultations improve clinical outcomes in the areas of wound care, psychiatry, and certain chronic conditions. (Strength of recommendation [SOR]: B, based on inconsistent or limited-quality patient-oriented evidence.) Telehealth may increase patient satisfaction and may reduce cost and health care utilization. (SOR: B, based on inconsistent or limited-quality patient-oriented evidence.) There is insufficient evidence regarding potential harms of telehealth.1

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CLINICAL BOTTOM LINE

Outpatient Care Telehealth Consultations: Strength of Evidence

OutcomeNumber of studiesMain findingsStrength of evidence

Primary outcomes

Dermatology

3

No significant difference in clinical course

● ○ ○

Wound care

5

Better healing and fewer amputations

● ● ○

Ophthalmology

0

No studies reported data on clinical outcomes

○ ○ ○

Orthopedics

0

No studies reported data on clinical outcomes

○ ○ ○

Dental

0

No studies reported data on clinical outcomes

○ ○ ○

Cancer

1

Rate of serious adverse effects from chemotherapy reported in one study

○ ○ ○

Psychiatry

3 (in five articles)

Decrease in symptoms and high remission rates

● ● ○

Infectious disease

3

Inconsistent results for virologic suppression across studies

○ ○ ○

Single conditions with diagnostic technology

0

No studies reported data on clinical outcomes

○ ○ ○

Single subspecialties

6

Positive effects on clinical outcomes such as response to treatment

● ● ○

Multiple subspecialties

4

Inconsistent results across studies for unanticipated or avoidable health services utilization

○ ○ ○

Cost

32

Most studies reported cost savings with telehealth, but calculations varied and most were dependent on patients avoiding travel and loss of time

● ○ ○

Intermediate outcomes

Access

35

Access in terms of time to or comprehensiveness of service was improved with telehealth

● ● ○

Management and utilization

31

Mixed results with most finding some benefit in terms of avoiding visits and similar diagnosis or management between telehealth and standard care, but a subset of studies reported differences in diagnosis and management between the two

● ○ ○

Satisfaction

22

Patient satisfaction was generally the same, with higher satisfaction with telehealth if time/travel was avoided; clinicians had the same or slightly worse satisfaction for telehealth

● ○ ○

Harms

2

Rates of complications and serious adverse events reported in two studies

○ ○ ○


Strength of evidence scale

● ● ● High: High confidence that the evidence reflects the true effect. Further research is very unlikely to change the confidence in the estimate of effect.

● ● ○ Moderate: Moderate confidence that the evidence reflects the true effect. Further research may change the confidence in the estimate of effect and may change the estimate.

● ○ ○ Low: Low confidence that the evidence reflects the true effect. Further research is likely to change the confidence in the estimate of effect and is likely to change the estimate.

○ ○ ○Insufficient: Evidence either is unavailable or does not permit a conclusion.

Adapted from the Agency for Healthcare Research and Quality, Effective Health Care Program. Telehealth for acute and chronic care consultations. April 2019. Accessed May 4, 2019. https://effectivehealthcare.ahrq.gov/topics/telehealth-acute-chronic/research

CLINICAL BOTTOM LINE

Outpatient Care Telehealth Consultations: Strength of Evidence

OutcomeNumber of studiesMain findingsStrength of evidence

Primary outcomes

Dermatology

3

No significant difference in clinical course

● ○ ○

Wound care

5

Better healing and fewer amputations

● ● ○

Ophthalmology

0

No studies reported data on clinical outcomes

○ ○ ○

Orthopedics

0

No studies reported data on clinical outcomes

○ ○ ○

Dental

0

No studies reported data on clinical outcomes

○ ○ ○

Cancer

1

Rate of serious adverse effects from chemotherapy reported in one study

○ ○ ○

Psychiatry

3 (in five articles)

Decrease in symptoms and high remission rates

● ● ○

Infectious disease

3

Inconsistent results for virologic suppression across studies

○ ○ ○

Single conditions with diagnostic technology

0

No studies reported data on clinical outcomes

○ ○ ○

Single subspecialties

6

Positive effects on clinical outcomes such as response to treatment

● ● ○

Multiple subspecialties

4

Inconsistent results across studies for unanticipated or avoidable health services utilization

○ ○ ○

Cost

32

Most studies reported cost savings with telehealth, but calculations varied and most were dependent on patients avoiding travel and loss of time

● ○ ○

Intermediate outcomes

Access

35

Access in terms of time

Address correspondence to Dean A. Seehusen, MD, MPH, at dseehusen@msn.com. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Agency for Healthcare Research and Quality, Effective Health Care Program. Telehealth for acute and chronic care consultations. April 2019. Accessed May 4, 2019. https://effectivehealthcare.ahrq.gov/topics/telehealth-acute-chronic/research...

2. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585–1592.

3. Chaet D, Clearfield R, Sabin JE, et al.; Council on Ethical and Judicial Affairs American Medical Association. Ethical practice in telehealth and telemedicine. J Gen Intern Med. 2017;32(10):1136–1140.

4. Moore MA, Coffman M, Jetty A, et al. Only 15% of FPs report using telehealth; training and lack of reimbursement are top barriers. Am Fam Physician. 2016;93(2):101. Accessed August 19, 2019. https://www.aafp.org/afp/2016/0115/p101.html

5. American Academy of Family Physicians. Telehealth and telemedicine. Accessed May 17, 2019. https://www.aafp.org/about/policies/all/telemedicine.html

The Agency for Healthcare Research and Quality (AHRQ) conducts the Effective Health Care Program as part of its mission to produce evidence to improve health care and to make sure the evidence is understood and used. A key clinical question based on the AHRQ Effective Health Care Program systematic review of the literature is presented, followed by an evidence-based answer based upon the review. AHRQ's summary is accompanied by an interpretation by an AFP author that will help guide clinicians in making treatment decisions. For the full review, go to https://effectivehealthcare.ahrq.gov/topics/telehealth-acute-chronic/research.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Implementing AHRQ Effective Health Care Reviews published in AFP is available at https://www.aafp.org/afp/ahrq.

 

 

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