Summary:Purpose: This article compares a traditional ambulatory clinic in an academic medical center with a telemedicine clinic. The telemedicine clinic is a joint project of the UTMB Telehealth Center and the Epilepsy Foundation of Southeast Texas, with partial funding for clinical operations provided by the Texas Department of Health.Methods: Data were collected on all the patients (n = 155) in both clinics for 3 months in 2004. In addition to demographic information, outcome data (number of seizures, hospitalizations, and emergency room visits) were gathered. Medication compliance also was collected by using self-report and medication levels.Results: Outcome variables were subjected to t test and χ 2 analysis. No significant differences were found in any of the demographic data or outcome measures between the two groups. Conclusions:Telemedicine is an acceptable alternative to inperson clinics for the provision of care to adults with epilepsy. Because telemedicine programs are designed to bring medical care closer to where patients live, these clinics provide an excellent alternative to provide consistent care in rural and geographically isolated areas. Additional studies are needed to investigate the potential costs associated with telemedicine as well as the potential for cost savings over time as patients are more able to access care and therefore may be more likely to seek the needed routine care and follow-up.

Domestic violence is a significant public health problem and is correlated with serious mental and physical disorders. Victims' fear and isolation seriously limit access to psychiatric evaluation and treatment. Telemedicine provides a means to overcome these obstacles. This article describes a telemedicine program that provides psychiatric screening, evaluation, treatment, and referral for ongoing care to clients of a rural women's crisis center. Psychiatric evaluation and treatment were provided to a rural women's shelter program using telepsychiatry. The shelter program had difficulty accessing traditional mental health service. All new clients entering the program were screened for mental health problems. Those requiring further evaluation received a physical examination with medical history and initial psychological interview on site, followed by psychiatric evaluation by videoconference. Appropriate treatment was initiated, and referral for ongoing psychiatric care through the local community mental health clinic was arranged. Of the 38 women referred for mental health services by clinic staff, 35 completed a psychiatric evaluation using telepsychiatry and 31 entered treatment. The most commonly identified disorders were anxiety and major affective disorders, followed by substance use disorders. Telepsychiatry can provide rapid crisis intervention and effective mental health services to victims of domestic violence in a rural setting.

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