Effect of Telemedicine onEffect of Telemedicine on
Patients’ Diagnosis andPatients’ Diagnosis and
TreatmentTreatment
*Ann ...
The manuscript for this studyThe manuscript for this study
was published in thewas published in the JournalJournal
of Tele...
ObjectivesObjectives
Explain the study purpose, methods, andExplain the study purpose, methods, and
instrumentsinstruments...
IntroductionIntroduction
The quality of the diagnosis andThe quality of the diagnosis and
management of patients in remote...
IntroductionIntroduction
Telemedicine is a promising methodTelemedicine is a promising method
for managing the demand forf...
IntroductionIntroduction
Changes in the patient’sChanges in the patient’s
diagnosis and treatment plan, asdiagnosis and tr...
The Rural Hospital ProgramThe Rural Hospital Program
Interactive Video NetworkInteractive Video Network
University of Arka...
The UAMS Rural HospitalThe UAMS Rural Hospital
Telehealth ProjectTelehealth Project
• Developed in 1995Developed in 1995
•...
Telemedicine Technology: PolycomTelemedicine Technology: Polycom
View Stations, ELMO-400View Stations, ELMO-400
Document C...
Purpose of the StudyPurpose of the Study
Examined the effect of telemedicine onExamined the effect of telemedicine on
chan...
MethodsMethods
Post-use survey of consultants inPost-use survey of consultants in
the UAMS Rural Hospitalthe UAMS Rural Ho...
ProceduresProcedures
 Primary care providers from distant,Primary care providers from distant,
healthcare sites in the Ea...
InstrumentsInstruments
Consultant Demographics: 15 items,Consultant Demographics: 15 items,
characteristics of teleconsult...
Data AnalysisData Analysis
Statistical Package for the SocialStatistical Package for the Social
Sciences (SPSS), Version 1...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
N = 412 consultationsN =...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n_____n...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n_____n...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n_____n...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n_____n...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n__n__
...
Results: Characteristics of theResults: Characteristics of the
TeleconsultationsTeleconsultations
VariableVariable n__n__
...
Results: Changes in the Patient’sResults: Changes in the Patient’s
DiagnosisDiagnosis
The teleconsultants established aThe...
Results: Changes in the Patient’sResults: Changes in the Patient’s
DiagnosisDiagnosis
VariableVariable n__n__
Established ...
Results: Changes in the Patient’sResults: Changes in the Patient’s
Treatment PlanTreatment Plan
The consultants establishe...
Results: Changes in the Patient’sResults: Changes in the Patient’s
Treatment PlanTreatment Plan
VariableVariable n__n__
Es...
ConclusionsConclusions
These results show that telemedicineThese results show that telemedicine
had an effect on changing ...
ConclusionsConclusions
The majority of consultants had notThe majority of consultants had not
received training in telemed...
LimitationsLimitations
Limitations of the study designLimitations of the study design
restrict the generalizability of the...
Implications for Clinical PracticeImplications for Clinical Practice
The present study provided evidenceThe present study ...
Implications for Clinical PracticeImplications for Clinical Practice
The changes that occurred in theThe changes that occu...
Implications for Nursing PracticeImplications for Nursing Practice
Educate patients and healthcare providers:Educate patie...
Implications for FutureImplications for Future
ResearchResearch
Decrease non-responses for variablesDecrease non-responses...
Implications for FutureImplications for Future
ResearchResearch
Use an experimental design to compareUse an experimental d...
"Effect of Telemedicine on Patients' Diagnosis and Treatment,"
"Effect of Telemedicine on Patients' Diagnosis and Treatment,"
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  • Additional authors include:
    Dr. Ann Bynum, Director, UAMS Rural Hospital Program; Associate Director, Program Development, Arkansas AHEC Program
    Dr. Charles Cranford, Executive Director, UAMS Arkansas AHEC Program; Vice Chancellor, Regional Programs
    Dr. Joseph Banken, Assistant Professor; Evaluation Liaison for the Antenatal & Neonatal Guidelines Education and Learning System (ANGELS), UAMS, Department of Obstetrics and Gynecology
  • Reference for Bullet #2: Dept. of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), 1997, Federal Register.
  • For Reference or Discussion:
    More studies of evidence for the clinical effectiveness of telemedicine are needed to justify the widespread implementation of telemedicine and third-party reimbursement for these services.
    Twelve previous studies have been performed to assess the effect of telemedicine on changes in the patient’s diagnosis and treatment plan.
  • The data for this study were gathered from evaluations of a Telemedicine Project that was funded by the Office for the Advancement of Telehealth.
    The study was conducted by the UAMS Rural Hospital Program
    The mission of this program is to strengthen hospitals throughout the state by sharing resources available at the University Medical School.
    My Role as Research Associate at the UAMS Rural Hospital Program:
    Consultation, develop research design for study
    Identify variables for the study, based on review of program evaluation instruments and discussion with team of health professionals involved in planning of program/study
    Prepare study data set
    Perform the data analysis; consultation with statistician at Univ. of AR
    Interpret the data analysis
    Report the study findings
    Presentations—International, national, state
    Manuscripts for publication
  • This is a map of the interactive video sites in Arkansas. There are 53 sites in the medical network and compressed video technology in or within 30 miles of every hospital in the state.
    The target area for the UAMS Telehealth Project includes the East Arkansas Delta, with the following counties: Phillips, St. Francis, Monroe, Crittenden, Desha, Lee, and Chicot Counties.
    The rural population in this area includes more than 131,000 residents, of whom about 50% were from ethnic minorities; Some of the poorest counties in Arkansas; MUAs and HPSAs
    Barriers for access to healthcare: lack of providers, insurance, education, transportation, travel costs—need to travel long distances for medical care in other communities; lack of motor vehicles and phones
    Cultural barriers:Feelings of intimidation, distress and anxiety by idea of traveling to, and dealing with health professionals in large urban areas—prefer comfort of familiar surroundings for healthcare services and family support in their own community.
    These rural residents may not have the psychological, physical, or financial resources to travel to urban healthcare settings.
  • For Reference or Discussion:
    The grant funding provides payment for medical consultations for people without insurance.
    Patient billing for the consult session was made as for any other clinic billing.
    If the patient’s insurance was denied, the grant funds were used up to $60.00 for the consult.
    The hospitals pay for the telephone line charges.
    Plans for payment of telemedicine services when grant funding ends: Medicaid reimbursement
    Patient compliance with telemedicine appointments and follow-up appointments is very good.
    Follow-up time for treatment after the telemedicine consultations is adequate and acceptable—Treatment that is recommended by the consultant is readily implemented by the primary care physician.
    Home telemedicine programs (Not yet developed in UAMS Rural Hospital Telehealth Project):
    Patients lease the telemedicine equipment or rent the equipment for the telemedicine consultations.
  • The patients participated in the Telehealth Project at the distant, primary healthcare site (clinic exam room) that was equipped with the interactive compressed video technology.
    The distant sites included hospitals, Community Health Centers, rural health clinics, and AHEC clinics.
    With the telemedicine technology, patients and primary care providers at the distant healthcare sites could see and hear the consultant and interact with the consultant, who was mainly at the UAMS main campus (other consultant sites included Arkansas Children’s Hospital, Little Rock; Crittenden Hospital, and Helena Med. Center).
    The consultants included physicians, dieticians, pharmacists, allied health professionals, e.g. physical therapists and dieticians; RNs, nurse practitioners, and clinical nurse specialists.
    The consultant can perform the patient assessment with inspection and examination over interactive video using an electronic stethoscope and a camera that can be attached to an otoscope, ophthalmoscope, and dermascope.
  • This slide shows a health educator in the Telehealth Project during a telehealth education session, using the interactive video equipment.
    Photos of patients’ telemedicine consults cannot be used due to confidentiality issues.
  • Significance: The results can be used to improve the telemedicine procedures used in the Telehealth Project.
  • For Reference or Discussion:
    Sample:
    Only grant-funded sites
    Provider-to-provider consults (n = 99) and telepharmacy education study consults (n = 49) were excluded--represented a different type of service.
    5 Consultant sites, frequencies ranged from 1-374 (UAMS)
    11 Distant primary care sites, frequencies ranged from 3-132 (Clarendon)
    (See SPSS Frequencies enclosed)
    Primary care provider’s initial diagnosis and treatment plan were assessed in a pre-use telemedicine survey.
  • For Reference/Discussion:
    Patients were referred to the Project when physicians in the target counties were unable to provide services that were needed.
    Coordinator forwarded the pt. hx. , phys. assessm. to consultant prior to the consult
    Compressed video technology delivers video images that have been processed to remove redundant information, thereby reducing the amount of bandwidth required to transmit them.
    Typically, the patient would arrive at the distant, primary care site about 30 minutes prior to the consult.
    Pt. assessment: inspection and phys. examination over interactive video using electronic stethoscope, camera with otoscope, ophthalmoscope, dermascope.
    The project site facilitator would coordinate the session at the distant site.
    Telemed. Protocols, Guidelines for consult: Equipment use, referrals, scheduling, appointments, required information and evaluation forms
    Consultants completed the post-session evaluation and session information form prior to leaving the consult session.
    After the session, the consultant reviewed the patient data with the referring provider and made recommendations regarding diagnosis and treatment.
  • For Reference or Discussion:
    The post-session evaluation instrument was developed using items from previous telehealth evaluation instruments.[Reid, A Telemedicine Primer. Understanding the Issues, 1996.]
    The response scale for the two items regarding the established diagnosis included a yes-no and not applicable response; and the established treatment plan item consisted of a yes-no response.
    The two items for change in the patient’s diagnosis and treatment plan had a response scale with a yes-no and not applicable response, not aware of a prior diagnosis or treatment plan, and no prior diagnosis or treatment plan.
     
     
  • For Reference or Discussion:
    The 63 respondents for cases where there was a prior diagnosis and a change was applicable included:
    n = 17, Yes, change in diagnosis (17/63 = 27%)
    n = 46, No, change in diagnosis
    See following table for these results
  • For Reference or Discussion:
    The 123 respondents for cases where there was a prior treatment plan and a change was applicable included:
    n = 82, Yes, change in treatment plan (82/123 = 67%).
    n = 41, No, change in treatment plan
    See following table for these results
  • Implications for future research include studies that…
    Additional future research is recommended to…
    Thank you for your attention.
    I can now address any Questions or Discussion.
  • "Effect of Telemedicine on Patients' Diagnosis and Treatment,"

    1. 1. Effect of Telemedicine onEffect of Telemedicine on Patients’ Diagnosis andPatients’ Diagnosis and TreatmentTreatment *Ann B. Bynum, EdD, Rural Hospital Program,*Ann B. Bynum, EdD, Rural Hospital Program, Arkansas Area Health Education Center (AHEC)Arkansas Area Health Education Center (AHEC) Program; *Charles O. Cranford, DDS, MPA,Program; *Charles O. Cranford, DDS, MPA, Regional Programs, Arkansas AHEC Program;Regional Programs, Arkansas AHEC Program; *Cathy A. Irwin, PhD, RN, Rural Hospital Program;*Cathy A. Irwin, PhD, RN, Rural Hospital Program; *Joseph A. Banken, MA, PhD, HSPP, Antenatal &*Joseph A. Banken, MA, PhD, HSPP, Antenatal & Neonatal Guidelines Education and LearningNeonatal Guidelines Education and Learning System (ANGELS), Department of Obstetrics andSystem (ANGELS), Department of Obstetrics and GynecologyGynecology *University of Arkansas for Medical Sciences*University of Arkansas for Medical Sciences (UAMS), Little Rock, AR(UAMS), Little Rock, AR
    2. 2. The manuscript for this studyThe manuscript for this study was published in thewas published in the JournalJournal of Telemedicine and Telecareof Telemedicine and Telecare 2006;2006; 1212: 39-43.: 39-43.
    3. 3. ObjectivesObjectives Explain the study purpose, methods, andExplain the study purpose, methods, and instrumentsinstruments Describe results for characteristics of theDescribe results for characteristics of the teleconsultations and for changes in theteleconsultations and for changes in the patient’s diagnosis and treatment planpatient’s diagnosis and treatment plan Identify the study conclusions andIdentify the study conclusions and limitationslimitations Describe the implications for clinicalDescribe the implications for clinical practice and future researchpractice and future research
    4. 4. IntroductionIntroduction The quality of the diagnosis andThe quality of the diagnosis and management of patients in remotemanagement of patients in remote areas may be improved by usingareas may be improved by using telemedicine.telemedicine. Telemedicine: Use ofTelemedicine: Use of telecommunications and informationtelecommunications and information technologies for the clinical care oftechnologies for the clinical care of patients and patient counselingpatients and patient counseling
    5. 5. IntroductionIntroduction Telemedicine is a promising methodTelemedicine is a promising method for managing the demand forfor managing the demand for secondary and tertiary health caresecondary and tertiary health care and disease management within theand disease management within the primary-care delivery system in theprimary-care delivery system in the patient’s local community.patient’s local community. Delays in the diagnosis andDelays in the diagnosis and management of patients in remotemanagement of patients in remote and rural areas may increase theirand rural areas may increase their morbidity and mortality.morbidity and mortality.
    6. 6. IntroductionIntroduction Changes in the patient’sChanges in the patient’s diagnosis and treatment plan, asdiagnosis and treatment plan, as a result of the teleconsultation,a result of the teleconsultation, can avoid:can avoid: morbidity, costly treatmentmorbidity, costly treatment inappropriate treatmentinappropriate treatment patient transferspatient transfers traveling costs to see a specialist.traveling costs to see a specialist.
    7. 7. The Rural Hospital ProgramThe Rural Hospital Program Interactive Video NetworkInteractive Video Network University of Arkansas forUniversity of Arkansas for Medical SciencesMedical Sciences
    8. 8. The UAMS Rural HospitalThe UAMS Rural Hospital Telehealth ProjectTelehealth Project • Developed in 1995Developed in 1995 • Delivers specialty telemedicineDelivers specialty telemedicine consultations to patients at distant sitesconsultations to patients at distant sites • Serves a poor, underserved, ruralServes a poor, underserved, rural population in the East Arkansas Deltapopulation in the East Arkansas Delta • Project Objective: Increase rural residents’Project Objective: Increase rural residents’ access to specialty medical servicesaccess to specialty medical services across the life-span using telemedicineacross the life-span using telemedicine technologytechnology • Funded by the Office for the AdvancementFunded by the Office for the Advancement of Telehealth, HRSA, DHHSof Telehealth, HRSA, DHHS
    9. 9. Telemedicine Technology: PolycomTelemedicine Technology: Polycom View Stations, ELMO-400View Stations, ELMO-400 Document Cameras, T-1Document Cameras, T-1 Telephone LinesTelephone Lines
    10. 10. Purpose of the StudyPurpose of the Study Examined the effect of telemedicine onExamined the effect of telemedicine on changes in the patient’s diagnosis andchanges in the patient’s diagnosis and treatment plan in the UAMS Rural Hospitaltreatment plan in the UAMS Rural Hospital Telehealth Project.Telehealth Project. Changes in the patient’s diagnosis andChanges in the patient’s diagnosis and treatment plan were based on the initialtreatment plan were based on the initial diagnosis and treatment plan, which werediagnosis and treatment plan, which were established by the primary care providerestablished by the primary care provider before the telemedicine session took place.before the telemedicine session took place.
    11. 11. MethodsMethods Post-use survey of consultants inPost-use survey of consultants in the UAMS Rural Hospitalthe UAMS Rural Hospital Telehealth ProjectTelehealth Project N = 412 consultationsN = 412 consultations Data collection: March, 1998-Data collection: March, 1998- June, 2002June, 2002
    12. 12. ProceduresProcedures  Primary care providers from distant,Primary care providers from distant, healthcare sites in the East Arkansas Deltahealthcare sites in the East Arkansas Delta requested the telemedicine consultsrequested the telemedicine consults through the project coordinator.through the project coordinator.  Consult sessions, 30 min: PatientConsult sessions, 30 min: Patient interviews, physical examinationsinterviews, physical examinations  The primary care provider or site facilitatorThe primary care provider or site facilitator presented the patient to the consultant.presented the patient to the consultant.  Follow-up care and instructions for theFollow-up care and instructions for the patientpatient  Patient privacy in clinic roomPatient privacy in clinic room  Telemedicine protocols for each specialtyTelemedicine protocols for each specialty  Interactive compressed video technologyInteractive compressed video technology
    13. 13. InstrumentsInstruments Consultant Demographics: 15 items,Consultant Demographics: 15 items, characteristics of teleconsultants—practice,characteristics of teleconsultants—practice, training, patient referrals, use of telemed.training, patient referrals, use of telemed. Session Information Evaluation: 21 items,Session Information Evaluation: 21 items, characteristics of teleconsultations—cliniccharacteristics of teleconsultations—clinic site, patient status, staffing, equipmentsite, patient status, staffing, equipment Post-Session Evaluation: 9 items,Post-Session Evaluation: 9 items, established diagnosis, change in diagnosis,established diagnosis, change in diagnosis, established treatment plan, change inestablished treatment plan, change in treatment as a result of the teleconsultationtreatment as a result of the teleconsultation
    14. 14. Data AnalysisData Analysis Statistical Package for the SocialStatistical Package for the Social Sciences (SPSS), Version 11Sciences (SPSS), Version 11 Statistical Procedures:Statistical Procedures: Frequency percentages for studyFrequency percentages for study variablesvariables
    15. 15. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations N = 412 consultationsN = 412 consultations 47 consultants who conducted 2-8247 consultants who conducted 2-82 consultations eachconsultations each 62% of consultants had not received62% of consultants had not received training in telemedicinetraining in telemedicine Reason for consultants using theReason for consultants using the telemedicine system: Desire to improvetelemedicine system: Desire to improve patient access to care (95%)patient access to care (95%) Teleconsultations mainly for new patientsTeleconsultations mainly for new patients (45%)(45%) 75% Outpatients75% Outpatients
    16. 16. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n_____n_____ Primary practice settingPrimary practice setting Academic medical centerAcademic medical center 326326 HospitalHospital 6868 Outpatient clinicOutpatient clinic 102102 Private officePrivate office 1717 Date telemedicine practiceDate telemedicine practice began within this systembegan within this system 1995-19981995-1998 260260 1999-20011999-2001 140140
    17. 17. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n_____n_____ Consultant specialtyConsultant specialty Nutrition and dieteticsNutrition and dietetics 112112 Psychiatry/psychologyPsychiatry/psychology 9494 DermatologyDermatology 7272 PharmacyPharmacy 4848 NeurologyNeurology 1313 PulmonaryPulmonary 1111 Other 18 specialtiesOther 18 specialties 6262
    18. 18. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n_____n_____ Consultant disciplineConsultant discipline MDMD 151151 PhDPhD 8888 PhD, registered dieticianPhD, registered dietician 8383 PharmDPharmD 4848 Health-related professionsHealth-related professions 3333 RN, nurse practitioner, clinicalRN, nurse practitioner, clinical nurse specialistnurse specialist 77
    19. 19. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n_____n_____ Number of patients seenNumber of patients seen using telemedicineusing telemedicine > 30 patients> 30 patients 104104 << 30 patients30 patients 184184 First consultationFirst consultation 112112 Patient referred for further carePatient referred for further care YesYes 171171 NoNo 107107
    20. 20. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n__n__ Patient referred toPatient referred to Hospital ERHospital ER 1313 Participating primary providerParticipating primary provider 2424 Another consulting specialistAnother consulting specialist 1111 Consulting specialist inConsulting specialist in telemedicine sessiontelemedicine session 105105 Referral careReferral care In-person in another communityIn-person in another community 3131 In-person in patient’s communityIn-person in patient’s community 2929 Via telemedicineVia telemedicine 112112
    21. 21. Results: Characteristics of theResults: Characteristics of the TeleconsultationsTeleconsultations VariableVariable n__n__ Problems with equipment orProblems with equipment or transmissiontransmission Problems with audioProblems with audio 66 Problems with videoProblems with video 99 Problems with peripheralsProblems with peripherals 66 No problemsNo problems 298298
    22. 22. Results: Changes in the Patient’sResults: Changes in the Patient’s DiagnosisDiagnosis The teleconsultants established aThe teleconsultants established a diagnosis in 74 consultations.diagnosis in 74 consultations. This was 26% of the 286 respondents.This was 26% of the 286 respondents. Of the 63 respondents for casesOf the 63 respondents for cases where there was a prior diagnosiswhere there was a prior diagnosis and a change was applicable, 17and a change was applicable, 17 (27%) consultants reported that there(27%) consultants reported that there was a change in the patient'swas a change in the patient's diagnosis.diagnosis.
    23. 23. Results: Changes in the Patient’sResults: Changes in the Patient’s DiagnosisDiagnosis VariableVariable n__n__ Established diagnosisEstablished diagnosis YesYes 7474 NoNo 212212 Change in diagnosisChange in diagnosis YesYes 1717 NoNo 4646 Not aware of a prior diagnosisNot aware of a prior diagnosis 1010 No prior diagnosisNo prior diagnosis 99 Not applicableNot applicable 7373
    24. 24. Results: Changes in the Patient’sResults: Changes in the Patient’s Treatment PlanTreatment Plan The consultants established a patientThe consultants established a patient treatment plan in 139 consultations.treatment plan in 139 consultations. This was 52% of the 268 respondents.This was 52% of the 268 respondents. Of the 123 respondents for casesOf the 123 respondents for cases where there was a prior treatmentwhere there was a prior treatment plan and a change was applicable,plan and a change was applicable, 82 (67%) consultants reported a82 (67%) consultants reported a change in the treatment plan.change in the treatment plan.
    25. 25. Results: Changes in the Patient’sResults: Changes in the Patient’s Treatment PlanTreatment Plan VariableVariable n__n__ Established treatment planEstablished treatment plan YesYes 139139 NoNo 129129 Change in treatment planChange in treatment plan YesYes 8282 NoNo 4141 Not aware of prior treatmentNot aware of prior treatment planplan 1919 No prior treatment planNo prior treatment plan 1919 Not applicableNot applicable 5151
    26. 26. ConclusionsConclusions These results show that telemedicineThese results show that telemedicine had an effect on changing thehad an effect on changing the patient’s diagnosis and treatmentpatient’s diagnosis and treatment plan.plan. Although changes in the patient’sAlthough changes in the patient’s diagnosis and treatment plan are notdiagnosis and treatment plan are not direct measures of quality, thesedirect measures of quality, these results imply that the patient’sresults imply that the patient’s diagnosis and treatment plan werediagnosis and treatment plan were improved.improved.
    27. 27. ConclusionsConclusions The majority of consultants had notThe majority of consultants had not received training in telemedicine,received training in telemedicine, which could reduce the consultant’swhich could reduce the consultant’s confidence in establishing a diagnosisconfidence in establishing a diagnosis and treatment plan by telemedicine.and treatment plan by telemedicine. These factors might have reduced theThese factors might have reduced the likelihood of making a change.likelihood of making a change.
    28. 28. LimitationsLimitations Limitations of the study designLimitations of the study design restrict the generalizability of therestrict the generalizability of the findings.findings. Non-respondents for variablesNon-respondents for variables regarding the teleconsultationsregarding the teleconsultations and the patient’s diagnosis andand the patient’s diagnosis and treatment plantreatment plan
    29. 29. Implications for Clinical PracticeImplications for Clinical Practice The present study provided evidenceThe present study provided evidence for the benefits of telemedicine infor the benefits of telemedicine in changing the patient’s diagnosis andchanging the patient’s diagnosis and treatment plan for a poor,treatment plan for a poor, underserved, rural population in theunderserved, rural population in the East Arkansas Delta.East Arkansas Delta. Telemedicine promoted access toTelemedicine promoted access to medical specialists for these patientsmedical specialists for these patients in their local community.in their local community.
    30. 30. Implications for Clinical PracticeImplications for Clinical Practice The changes that occurred in theThe changes that occurred in the patient’s diagnosis and treatmentpatient’s diagnosis and treatment plan as a result of the telemedicineplan as a result of the telemedicine session may have avoided delays insession may have avoided delays in the proper diagnosis and treatment ofthe proper diagnosis and treatment of these patients in rural Arkansas.these patients in rural Arkansas. The results can be used to improveThe results can be used to improve the telemedicine procedures used inthe telemedicine procedures used in the Telehealth Project.the Telehealth Project.
    31. 31. Implications for Nursing PracticeImplications for Nursing Practice Educate patients and healthcare providers:Educate patients and healthcare providers: Benefits of telemedicine in improving theBenefits of telemedicine in improving the patient’s diagnosis and treatment plan forpatient’s diagnosis and treatment plan for poor, underserved, rural populations inpoor, underserved, rural populations in ArkansasArkansas Promote patient referrals for telemedicinePromote patient referrals for telemedicine Use telemedicine to provide nursingUse telemedicine to provide nursing consultations and to address the nursingconsultations and to address the nursing shortagesshortages Promote nursing education regarding thePromote nursing education regarding the use of telemedicine technology for theuse of telemedicine technology for the clinical care of patients and patientclinical care of patients and patient counselingcounseling
    32. 32. Implications for FutureImplications for Future ResearchResearch Decrease non-responses for variablesDecrease non-responses for variables regarding the teleconsultations and theregarding the teleconsultations and the patient’s diagnosis and treatment planpatient’s diagnosis and treatment plan Instructions for consultants regardingInstructions for consultants regarding completion of all instrument items for thecompletion of all instrument items for the teleconsultation variables, patientteleconsultation variables, patient diagnosis and treatment plan variablesdiagnosis and treatment plan variables Training for site facilitators on theseTraining for site facilitators on these methods of instrument distributionmethods of instrument distribution
    33. 33. Implications for FutureImplications for Future ResearchResearch Use an experimental design to compareUse an experimental design to compare teleconsultations and face-to-face primaryteleconsultations and face-to-face primary medical care on the patient’s diagnosis andmedical care on the patient’s diagnosis and treatment plantreatment plan Assess the effect of telemedicine on theAssess the effect of telemedicine on the number of patients’ hospitalizations, patientnumber of patients’ hospitalizations, patient transfers to tertiary healthcare facilities,transfers to tertiary healthcare facilities, delays in patients’ treatment, and patientdelays in patients’ treatment, and patient referral patterns, especially in ruralreferral patterns, especially in rural communities and among different ethniccommunities and among different ethnic groupsgroups

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