For the 15 to 25 percent of Americans who live in nonurban or medically underserved communities, electronic communication may be a way to increase access to health care. Tele-medicine may take one of several forms, from relatively simple systems such as telephone or facsimile communication to high-tech computer systems that allow transmission of images (such as radiographs) and other data. Balas and associates studied the efficacy of “distance medicine” technology by reviewing data from 80 clinical trials of various methods of telecommunications.
Studies were included in the analysis if they were prospective controlled trials that randomly assigned patients to the intervention in question and if the consequence of the electronic intervention was evaluated. Information about the intervention, the clinician involved and the patient population was abstracted, as was information about the difference in outcome between the intervention and nonintervention groups. The interventions were classified into six categories: (1) computerized communications between physician and patient, (2) telephone follow-up care, (3) telephone reminders, (4) interactive telephone systems that used regular telephone lines to deliver messages, (5) patients' telephone access to the physician and (6) telephone screening. The authors summarized the data from studies that fit into one of the six categories.
Data from four studies of the use of telecommunications in the management of diabetes were evaluated. Three studies revealed significant decreases in glucose levels among patients who had their blood glucose levels transmitted to the physician by modem. The control group used traditional written records and did not show similar decreases in blood glucose levels. Members of the group using the modem also had better motivation for glucose management. In the fourth study, a computerized diet education program improved knowledge, habits and metabolic balance in patients with diabetes, compared with patients who did not have access to the computer-assisted diet education program.
Four studies of telephone follow-up after emergency department visits demonstrated greater compliance with treatment of urinary tract infection, pediatric emergencies and other acute and chronic illnesses. A greater degree of patient satisfaction and fewer missed appointments were also noted when telephone follow-up was used. There was also less inappropriate follow-up care.
Four studies of telephone programs for patients with myocardial infarction or cardiac surgery showed that telephone counseling was associated with improvement in rates of smoking cessation and in low-density lipoprotein cholesterol levels. The patients counseled by telephone also returned to normal activity more quickly than those who did not receive telephone follow-up.
Three studies of the impact of telephone follow-up on patients undergoing mammography showed that telephone counseling motivated women to obtain a mammogram. A study of the effect of telephone counseling in women who were recommended to undergo colposcopic examinations demonstrated significantly greater adherence to the recommendation in women who received telephone follow-up, compared with women who did not have this intervention. Compliance with colposcopy occurred in 67 percent of the women who were counseled by telephone, compared with 43 percent of the women who did not receive telephone counseling.
Other studies of telephone follow-up and counseling showed improvements in the areas of arthritis pain, adherence to antituberculosis drug therapy, tobacco use prevention and dental screening. Seventeen studies of telephone follow-up conducted in various clinical situations failed to show significant and beneficial differences between intervention and control groups.
Studies of the effects of telephone reminders showed increased compliance with influenza vaccination and childhood immunization in patients who received reminders. In one study, telephone reminders increased compliance with diabetic foot care instructions. Other successful applications of telephone reminders included reminders about medications and appointments.
Three trials of interactive telephone systems demonstrated beneficial effects among elderly patients with respect to drug compliance, influenza vaccination and knowledge of Alzheimer's disease. In another study, pre-recorded recall messages were associated with a higher number of visits to the health department in the month after the call. The volume of visits was not increased in the nonintervention group.
The authors conclude that distance medicine can have many benefits, especially in preventive care and in the management of chronic conditions such as diabetes mellitus. Vaccination rates among children and the elderly could be improved by use of various electronic forms of communication. Continuity of care between physician and patient may be enhanced by the use of such technologies.