Real-World Clinical Evaluation and Costs of Telemedicine for Chronic Wound Management

Abstract

Background:Chronic wounds are frequent, affect quality of life, and increase care costs. Telemedicine provides potential for effective wound care management, especially for the monitoring of complex wounds at home.Objectives:The objective of the present study was to determine the clinical effects and costs of telemedicine for the follow-up of complex chronic wounds from the perspective of the public health insurance. The study ran over a period of 9 months.Methods:We conducted a prospective, pragmatic, open-label, observational study and carried out a cost-effectiveness analysis. A total of 116 patients with chronic wounds were assigned to their choice of two groups: telemedicine (N = 77) and traditional follow-up (control; N = 39). The primary outcome was the time to healing. Secondary outcomes included percentage of wounds reaching target objective, percentage of wounds healed completely, outpatient care costs, travel costs, and hospitalizations.Results:Time to healing was shorter in the telemedicine group than in the control group (137 versus 174 days; p < .05). The percentage of wounds completely healed was not statistically different between the telemedicine and control group (66 percent versus 61 percent; p > .05). Outpatient care and hospitalization costs were not significantly different. The main results in terms of economic savings were medical transport costs reimbursed by the French public health insurance, which were significantly lower in the telemedicine group. Telemedicine costs were found to be €4,583 less per patient compared with standard practice over 9 months.Conclusions:This trial suggests that telemedicine saves travel costs and results in a shorter healing time than traditional follow-up.

Telemedicine and the COVID-19 Pandemic: Are We Ready to Go Live?

“…16,19 There is also some evidence that telemedicine can provide an equal, or even shorter, time to healing than is seen with in-person clinical examinations. 19,27,28,33 Combined, these studies support the expansion of telemedicine.…”

“…Even before the onset of this pandemic, the benefits of telemedicine had been continuously publicized: from cost 7,19,[24][25][26] and time savings 12,17,18,27 to equal or even better health outcomes. 19,27,28,33 Limitations in the form of technological glitches 7,8 and uncertainty in future legal 11,12 and insurance [12][13][14] regulation of telemedicine do exist. New regulations have temporarily lifted some of these barriers, however.…”

“…Decreased healthcare costs 7,19,[24][25][26] Inconsistent clarity and quality of transmitted images 7,9,10 Avoidance of patient travel 7,19,26 Technological difficulties 7,8 Timesaving for patients 12,27 Data protection and Health Insurance Portability and Accountability Act compliance concerns 11 Timesaving for providers 17,18,27 Malpractice and liability concerns remain unclear 12 The limitations of telemedicine specific to wound care are primarily related to the loss of some of the senses needed for clinical examination. Touch and odor are lost in telecommunication, although patients can be asked a set of clinical questions to circumvent this challenge.…”

“…These virtual visits lead to a time-savings for both providers (eg, decrease downtime and inefficiencies) and patients (eg, decrease travel and wait times). 12,17,18,27 These appointments also provide for those disadvantaged populations who can only take time during a scheduled break or are confined to their home during regular clinic hours because of a lack of adequate childcare. Overall, telemedicine has comparable patient 8,19,22,26,28,29 and provider satisfaction 8,12,29 in relation to face-to-face healthcare delivery.…”

“…Comparable accuracy and outcomes of telemedicine videoconferencing to in-person visits 16,19 Loss of sensation and odor in clinical assessment Comparable or even shorter time to healing 19,27,28,33 Need for assistance from patients' family members or caregivers to aid in photographing, videoconferencing, or dressing wound conditions, a population that may not be the most comfortable with smartphone and computer use. That said, Wiseman and colleagues found that this population not only has access to smartphones, but also is willing to use them for at-home wound monitoring.…”