SAN FRANCISCO — Using telemedicine to manage approximately one patient per week with acute infection at home instead of in the hospital netted $128,000 in savings in 1 year, Lawrence J. Eron, M.D., said at the annual meeting of the Infectious Diseases Society of America.
Telemedicine more commonly is used to help manage rural patients with chronic health problems.
In this study, Dr. Eron of the Kaiser Moanalua Medical Center, Honolulu, and his associates used telemedicine in a more urban/suburban setting for home-based monitoring of 34 patients with pneumonia, 8 with cellulitis, 3 with urinary tract infection, 2 with bacterial endocarditis, and 1 with cholecystitis.
Most patients were treated for 2–3 days in the hospital before being discharged home with telemedicine, but 15 required no hospitalization. The telemedical care lasted a median of 5 days per patient.
Figuring that each day avoided hospitalization costs of $1,000, telemedicine reduced costs by $240,000 for the 48 patients. Subtracting the costs of telemedicine—for equipment, personnel, and technical consultations—netted a savings of $128,000, he calculated.
The medical center plans to grow its telemedicine program to handle four patients with infections per week. “That's not a great number of patients, but that would save us $747,000 per year, we calculate. That's real money,” Dr. Eron said.
All but six patients were cured. Three of the six required rehospitalization. A subanalysis of 25 telemedicine patients matched to patients treated only in the hospital found much shorter convalescent periods with telemedicine. The telemedicine group returned to normal activities of daily living in 8 days, compared with 21 days for the hospitalized patients.
“Convalescence is more rapid at home,” but it can be hard to get anxious patients to leave what they consider the safety of the hospital to go home, he said.
Patients in the study were skeptical of the telemedicine arrangements initially. At the end of their time with the telemedicine unit, however, many were reluctant to give up the technology, Dr. Eron added.
The telemedicine unit connected the patient with health care providers over regular telephone lines that allowed them to see and speak with each other via video cameras and screens. The equipment included a stethoscope, blood pressure cuff, and pulse oximeter.
“The transmission of the heart sounds is as good, if not better, than if you're standing by the patient with your own stethoscope,” he said.
Dr. Eron has no relationship with the company that makes the telemedicine unit, American Telecare Inc., Eden Prairie, Minn.
Many issues still must be addressed before this becomes the standard of care, he added. During the study, there were problems with “freeze-ups” of the technology and disconnections of the phone lines.
Reimbursement will be a challenge for many physicians who already face difficulties being reimbursed for telephone consultations, he predicted.