Telemedicine versus face to face patient care: effects on professional practice and health care outcomes

Currell R, Urquhart C, Wainwright P, Lewis R

Published Online:

January 20, 2010

Telemedicine is using telecommunications technology for medical diagnosis and health care. It includes transmitting test results down phone lines, using video technology for long distance consultations or education, and many other uses. The review found studies showing various forms of telemedicine are feasible, but there is not yet enough evidence to show the effects on health outcomes or costs of many expensive uses of technology. Overall, people self-monitoring at home or having video consultations were satisfied with their experience. More research is needed to assess the effects of the range of telemedicine techniques.

Abstract (click to read)

Background:

Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology.

Objectives:

To assess the effects of telemedicine as an alternative to face-to-face patient care.

Search strategy:

We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), CINAHL (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data.

We handsearched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also handsearched conference proceedings and contacted experts in countries identified as having an interest in telemedicine.

Selection criteria:

Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine.

Data collection and analysis:

Two reviewers independently assessed trial quality and extracted data.

Main results:

Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the technological aspects of the interventions appear to have been reliable, and to have been well accepted by patients.

Authors' conclusions:

Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies.

This record should be cited as:

Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098

Assessed as up to date:

January 24, 2000

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Primary Review Group:

Effective Practice and Organisation of Care Group

Health topics:

Effective practice/health systems > Reviews of specific types of interventions > Organizational interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Telemedicine versus face to face patient care: effects on professional practice and health care outcomes

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