An analysis of unsuccessful teleconsultations

Abstract

Over six years, 4317 teleconsultations were scheduled in the Arizona Telemedicine Program. A total of 402 scheduled teleconsultations (9.3%) did not take place. A review showed that 254 were cancelled but eventually took place (5.9%), while 148 never took place (3.4%). The cost of a teleconsultation to the service provider was, at minimum, 228 US dollars. Telepsychiatry accounted for all the missed consultations that eventually took place, and 92% of these were from three of the six sites referring telepsychiatry patients. Pain management (23%) and psychiatry (21%) accounted for the largest proportions of teleconsultations that never took place. Telepsychiatry cases accounted for 71% of all unsuccessful consultations and accounted for only 34% of successful teleconsultations during the same period. Most missed teleconsultations had been scheduled as realtime sessions (84%). The most common reason for unsuccessful teleconsultations was that the patient did not attend (26%), followed by the patient having to be seen in person (17%). Although all referring sites had unsuccessful cases, certain sites accounted for more than others. These were sites that scheduled more telepsychiatry consultations than the others. The proportion of unsuccessful cases per site ranged from 4% to 17% of the total number of scheduled teleconsultations.

Current directions in videoconferencing tele-mental health research.

“…Most tele‐mental health research includes indices of clinical processes such as satisfaction, therapeutic alliance, therapeutic environment, clinical context, and clinician skills (e.g., Bischoff et al., 2004; Foster & Whitworth, 2005; Frueh, Monnier, Yim, et al, 2007; Miller, 2003; Modai et al, 2006; Rees & Stone, 2005; Shores et al., 2004; Singh, Arya, & Peters, 2007). The most consistently reported outcomes for tele‐mental health research are satisfaction and acceptance, which are virtually always high (Browne et al., 2006; Cluver et al., 2005; De Las Cuevas, Artiles, De La Fuente, & Serrano, 2003; Dobscha, Corson, Solodky, & Gerrity, 2005; Ekblad et al., 2004; Frueh et al., 2005; Greenberg, Boydell, & Volpe, 2006; Greenwood, Chamberlain, & Parker, 2004; Keilman, 2005; Krupinski, Barker, Lopez, & Weinstein, 2004; Meyer et al., 2005; Modai et al., 2006; Morgan, Patrick, & Magaletta, 2008; Morland, Frueh, Pierce, & Miyahara, 2003; Urness, Wass, Gordon, Tian, & Bulger, 2006). Patients participating in tele‐mental health have specifically cited the benefits of reduced travel time, decreased lost work time, shorter wait times for services, and a greater sense of personal control over sessions (Hilty, Nesbitt, Kuenneth, Cruz, & Hales, 2007; Simpson, Bell, Knox, & Britton, 2005).…”

A Comprehensive Review of Telehealth for Pain Management: Where We Are and The Way Ahead

“…There are very few cost‐effectiveness studies focused on pain management, although the extant preliminary data are encouraging. Krupinski et al 5 . examined the cost of telehealth‐based consultations for a variety of conditions (including chronic pain) that presented as part of the Arizona Telemedicine Program.…”

“…There are very few cost-effectiveness studies focused on pain management, although the extant preliminary data are encouraging. Krupinski et al 5 examined the cost of telehealth-based consultations for a variety of conditions (including chronic pain) that presented as part of the Arizona Telemedicine Program. They found an average consultation cost of $228 per patient based on a sample of 4,317 consultations, and fewer than 10% of the encounters were considered a failure (ie, patient no-showed the encounter or failed to connect with the provider).…”

Assessment of Research Quality of Telehealth Trials in Pain Management: A Meta‐Analysis

“…Their findings confirm the cost‐effectiveness of telehealth‐based pain intervention found elsewhere. For example, an examination of the Arizona Telemedicine Program revealed relatively low telehealth consultation costs with surprisingly low failure rates . Although these findings are encouraging, there is still insufficient data to make a solid determination of cost‐benefit and cost‐effectiveness for telehealth compared with in‐person care.…”

“…For example, an examination of the Arizona Telemedicine Program revealed relatively low telehealth consultation costs with surprisingly low failure rates. 37 Although these findings are encouraging, there is still insufficient data to make a solid determination of cost-benefit and cost-effectiveness for telehealth compared with in-person care. Future studies should include detailed information about costs and cost savings associated with telehealth pain programs.…”