Medical care without leaving your home – has an attractive ring to it; but, one that has been a reality for many parts of the world where ease of access to healthcare has been an issue. For example, in Scotland, ‘Telestroke‘ was developed to allow acute stroke patients to be evaluated by a stroke specialist within the 4.5h thrombolysis window, remotely. Increasingly telemedicine is filtering into daily clinical practice, and is proving to be an attractive option not only for the patient, but the healthcare provider.
There are several ways by which telemedicine can applied, but commonly the one everyone favors is the ‘virtual house call’, where the clinic visit happens remotely via an audio-visual interface directly into your home. Not only is this an attractive option for those who are less mobile, it saves on time and money, and in the future may also be able to offer care from the world over.
In a study evaluating the feasibility, participant satisfaction and cost associated with web-based videoconferencing in multiple sclerosis, Robb et al. (see below for the abstract) report that the program is feasible, with 97% participating likely to recommend it. In addition, they report significant cost savings from parking, fuel costs, tolls etc., than face-to-face visits. The quality of the audio-visual connection in a majority was also not bad, with 94% reporting that connecting via telemedicine was easy. Although, not statistically different, 91% said that they were very likely or likely to return for a telemedicine visit compared with 100% for a face-to-face visit.
Some of the participant comments are listed below:
|a) Best Parts of Telemedicine Visit|
|“No drive time, parking fees or lost wages from my husband bringing me to the appointment”|
|“Not having to drive 6 h round trip to see a specialist”|
|“The convenience of meeting with my doctor from my home”|
|Equivalence to in-clinic visits|
|“How similar it actually is to an office visit”|
|“I believe it is a great alternative to an office visit.”|
|“I was happy with the virtual house call and hope it is something that will be used more in the future.”|
|“I can see this being a revolutionary step in medicine!”|
|b) Areas for Improvement of Virtual House Calls|
|“I need a better web cam.”|
|“The patient, if necessary, needs to have plenty of space to move with a camera that is adjustable.”|
|“I need to prop up my Notebook [and] made sure it’s 100% charged prior to the call.”|
|“We had a slight problem connecting, but I just called [the neurologist] directly and we connected within minutes.”|
|Non-Replacement of In-Clinic Visits|
|“While useful for “off-schedule” visits, I don’t think this type of interaction can replace the live, one on one visit with the doctor on an annual basis for a proper and thorough MS evaluation.”|
Although, this study was performed in the US, I doubt the findings would be very different from other parts of the developed world. I am, however, slightly concerned about the legislative issues with regard to the technology, but don’t foresee this as huge hurdle.
Mult Scler Relat Disord. 2019 May 6;36:101258. doi: 10.1016/j.msard.2019.05.001. [Epub ahead of print]
Comparison of telemedicine versus in-person visits for persons with multiple sclerosis: A randomized crossover study of feasibility, cost, and satisfaction.
Telemedicine, the remote delivery of health care services, increases access to care for patients with mobility or geographic limitations. Virtual house calls (VHCs) are one type of telemedicine in which clinical visits are conducted remotely using an audio-visual connection with the patient at home. Use of VHCs is more established in other neurologic disorders but is only recently being formally evaluated in multiple sclerosis (MS). This randomized crossover study systematically assessed VHCs compared with in-clinic visits in persons with MS.
Recruitment occurred in a university based MS clinic. Each subject completed one VHC and one in-clinic follow-up visit. A 1:1 randomization determined whether the VHC or in-clinic follow-up visit occurred first. Baseline surveys included demographics and MS history; post-visit surveys elicited subject responses regarding each visit type to assess feasibility, satisfaction, and cost differences. Outcomes were compared using t-tests for continuous variables and Fisher’s exact test for proportions.
Thirty-six participants completed both study visits and both post-visit surveys. VHC feasibility was demonstrated by a lack of statistically significant difference in the number of completed VHCs as compared with in-clinic visits. VHCs provided both cost and time savings to participants. The majority of participants reported that they would recommend telemedicine visits to others (97.1%) and rated it easy to connect via telemedicine (94.3%). In qualitative comments, participants expressed appreciation for VHCs due to convenience and similarity to in-clinic visits.
VHCs were found to be feasible, cost-effective, and appealing to persons with MS and physicians, supporting their utility as a care delivery method for MS.