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Telemedicine Helps Elderly Avoid Nursing Home : Rural elderly received 'virtual visits' from home health care nurses via two-way videoconferencing.


 

SAN FRANCISCO — Adding telemedicine to home health care halved the proportion of rural elderly patients who had to move from their homes to hospitals or nursing homes over a period of 2 1/2 years, in a randomized study of 53 patients.

Patients receiving skilled nursing care at home for heart failure, chronic obstructive pulmonary disease, or chronic wound care were randomized to one of three treatment groups. The researchers added simple videoconferencing equipment and Internet access to the homes of 14 patients in a video arm and 20 patients in a monitoring arm, who also received physiologic monitoring equipment—pulse oximeters, electronic spirometers, and/or blood pressure cuffs, depending on their medical problem. The two-way videoconferencing allowed virtual visits by the home health care nurse with the patient at home. In a control group, 19 patients did not get telemedicine equipment. All groups continued with actual home visits by the nurses.

During the study, six patients (18%) in the telemedicine groups (two in the video group and four in the monitoring group) transferred from their homes to a higher level of care. Eight patients (42%) in the control group did so, said Stuart M. Speedie, Ph.D., in a poster presentation at the triennial congress of the International Medical Informatics Association.

Death rates did not differ significantly between groups: Five control patients and seven patients in the two telemedicine groups died. Surveys showed that patients in the monitoring group were significantly more satisfied with their care, compared with control patients, because they believed they had greater choices about their care, felt safer, and reported greater flexibility in scheduling, said Dr. Speedie of the University of Minnesota, Minneapolis.

The mean number of nurse visits did not differ between groups—22 per patient in the control group and 19 per patient in the telemedicine groups. The telemedicine patients averaged 17 virtual visits each. Average patient age was 72 years in the control group and 76 years in the telemedicine groups.

Actual visits cost an average of $44.71, while video-only virtual visits cost $22.96 and video visits for physiologic monitoring cost $29.66. Nursing time during actual visits accounted for the higher average cost. In addition, the telemedicine equipment cost about $1,500 per patient, said Dr. Speedie, who conducted the study with lead investigator Stanley M. Finkelstein, Ph.D., and Sandra Potthoff, Ph.D., both of the university.

Home health nurses rated the technical quality of virtual visits as acceptable in 94% of visits and said that 92% of virtual visits would not have been better if done in person. The nurses said that questions were not asked in 5% of virtual visits that might have been asked in actual visits.

In a separate pilot study presented at the meeting, informal videoconferencing consultations offered once a week to residents of an assisted living facility led to formal clinic appointments for 6 of 31 patients (19%) over a 5-month period, Lawrence Afrin M.D., and his associates at the Medical University of South Carolina, Charleston, reported in a poster.

They provided the telemedicine service for free as a goodwill gesture. Third-party payers seldom pay for telemedicine services, but the results suggest that the service may be economically viable if it leads to normal clinic services that are billable, Dr. Afrin said. Assisted living facilities might be willing to pay a small fee for the service to gain a competitive advantage.

Five university physicians rotated duty on the sessions, discussing problems such as cardiovascular issues, allergies, pain, cancer, anemia, thalassemia, sleep disorders, and neurological disorders.

A man checks his wife's blood pressure during a videoconference with a nurse. Tri County Hospital

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