A randomized controlled trial assessing the health economics of realtime teledermatology compared with conventional care: an urban versus rural perspective

Abstract

A randomized controlled trial was carried out to measure the cost-effectiveness of realtime teledermatology compared with conventional outpatient dermatology care for patients from urban and rural areas. One urban and one rural health centre were linked to a regional hospital in Northern Ireland by ISDN at 128 kbit/s. Over two years, 274 patients required a hospital outpatient dermatology referral--126 patients (46%) were randomized to a telemedicine consultation and 148 (54%) to a conventional hospital outpatient consultation. Of those seen by telemedicine, 61% were registered with an urban practice, compared with 71% of those seen conventionally. The clinical outcomes of the two types of consultation were similar--almost half the patients were managed after a single consultation with the dermatologist. The observed marginal cost per patient of the initial realtime teledermatology consultation was 52.85 Pounds for those in urban areas and 59.93 Pounds per patient for those from rural areas. The observed marginal cost of the initial conventional consultation was 47.13 Pounds for urban patients and 48.77 Pounds for rural patients. The total observed costs of teledermatology were higher than the costs of conventional care in both urban and rural areas, mainly because of the fixed equipment costs. Sensitivity analysis using a real-world scenario showed that in urban areas the average costs of the telemedicine and conventional consultations were about equal, while in rural areas the average cost of the telemedicine consultation was less than that of the conventional consultation.

Reliability of telemedicine for diagnosing and managing eye problems in accident and emergency departments

“…[1][2][3][4] The accuracy of an ophthalmic diagnosis using telemedicine has been reported for the assessment of eyelid/orbital pathology, strabismus, glaucoma screening, and postoperative cataract assessment. [5][6][7][8] These studies have suggested telemedicine diagnosis using videoconferencing technology at 384 kbit/s to be reliable and safe for the provision of secondary advice in a majority of clinical studies.…”

Urban-rural difference in patients utilizing the service of telehealthcare

“…[14][15][16][17][18][19] Some studies applied telemedicine technology in dermatology and depression management in urban and rural areas. They found out that the clinical outcomes of the telemedicine are similar to the conventional care, [5] meanwhile with less travel and time cost for the patients. [5,20] However, the additional costs of equipments does make telemedicine technology expensive.…”

“…They found out that the clinical outcomes of the telemedicine are similar to the conventional care, [5] meanwhile with less travel and time cost for the patients. [5,20] However, the additional costs of equipments does make telemedicine technology expensive. [5,6] A number of diabetes telehealthcare programs include patient self-management information systems, commonly known as patient portals or web portals.…”

“…[1,2] In rural areas, patients are at higher risk than those in urban areas due to lessfrequent visits to the physician as well as less access to specialized care. [3][4][5] Longer travel distance to the hospital is related to lower odds of receiving guideline-concordant care. [6] Compared with urban patients, rural patients tend to have fewer visits, enter care later in the disease progression, have more serious symptoms at entry, receive lower-quality care, and need more expensive treatment.…”

“…[5,20] However, the additional costs of equipments does make telemedicine technology expensive. [5,6] A number of diabetes telehealthcare programs include patient self-management information systems, commonly known as patient portals or web portals. [21,22] These facilitate self-care for diabetic patients while they are away from medical institutes.…”