profession of telemedicine finds itself being pursued with vigor given the widely believed perception that one of the main advantages it offers is that of cost savings in the field of healthcare. These economical considerations may appear in both forms- tangible as well as intangible. Telemedicine, however, is also an outcome of the lesser number of healthcare professionals in proportion to the rise in number of patients. The other factor that has contributed in actualization of telemedicine is the rise of ICT sector and ease of communication over the distance (McLean et al., 2013).
One aspect of Telemedicine that appears immediately is whether it is safe, given the general feeling of trust one encounters when meeting one’s physician and his reassuring tone. In this regard, one well-researched article in Sweden notes that after decades of resorting to Telemedicine, one realizes that the parameter of safety revolves around the ambient social environment, the management ethos of the telenursing organization, the patient himself and the nurse/doctor attending to the call. As such much needs to be done in this sector (Marta Roing, 2013).
All these developments have converged to make telemedicine practice an acceptable solution to the general Evidence Based therapies and diagnoses. We aim to evaluate the article in the light of these parameters. This paper focuses on analyzing the article ‘The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview’ (McLean et al., 2013). We have chosen this article for analysis as it professes to scrutinize the facts of claims laid by those adapting it in the light of economic considerations, the benefits and the risks involved in telemedicine.
Analysis
The Study
In its introduction itself, the authors have declared that it is high time we analyzed critically the costs, benefits and risks involved in practicing Telemedicine. Towards this effort they have reviewed articles in various acclaimed journals and periodicals like the PakMed, IndMed, MEDLINE, The Cochrane Library, LILACS and EMBASE. The authors have done a comprehensive job in analyzing as many as 1,782 articles published in the period January1997 through November 2011.
The article follows the directions of the CASP (Critical Appraisal Skills Programme) in its pursuit and can hence be depended upon for academic authenticity. The article incorporates review of articles of both methods of use of ICT in medicine: synchronous and asynchronous. The synchronous one is in which the telemedicine Healthcare professional interacts with the patient in a one-on-one mode to offer solutions for relief. The asynchronous interactions are the ones that use ICT to store medical data and forward them on request or need to help medical assistance.
Inferences and Limitations
One of the conclusions drawn in the study is that most studies agree that there is no qualitative difference in the services and consequential outcomes between real time bed-side healthcare services and those given by long-distance telemedicine professionals. That seems to imply that Telemedicine can replace to a large degree the conventional real time nursing and medical services. However, in the conclusion the article itself refutes the claim partially in cautioning the policy makers that investment in Telemedicine does not necessarily transform into monetary or clinical advantages. Such a posit needs to be revisited because the article has considered certain articles with as few as twenty (20) respondents (McLean et al., 2013).
Another important parameter is that of reduced hospitalization instantiations or revisits to the hospital for follow-up advices. This factor is amongst the main aims of Telemedicine gaining importance as an alternative to patients who find it difficult to travel to hospitals repeatedly. The article observes that many of the studies it reviewed supported this claim. This claim is open to questions of economic costs involved and constraints like mobility, time, occupational hazards, availability of assigned doctors and quality of services. An important point of safety of patients arises from the same concerns. In fact, these two points – that of accessibility and the reliability of telemedicine do converge to invite attention from researchers.
The outcomes in clinical domain have not been established even though in some cases that the article reviewed, the systolic and diastolic measures of Blood Pressure improved and stabilized significantly. The patients were however monitored for short durations (less than 12 months).
In the field of coronary diseases where most emergency attention is required, combination of tele-monitoring and store-and-forward methodologies has been realized to be quite effective, though not conclusively in favor of Telemedicine, though some changes in the way the services are practiced may need alterations and improvements. CVT (Clinical Video Teleconferencing) is one the most regularly adopted methods for providing treatment to patients and has been found to be more cost-effective as well as clinically qualitative when compared to in-person services (Morland et al., 2013).
One of the fields in which Telemedicine can be most effective is psychotherapy- rehabilitation of mentally afflicted patients (PTSD in Veterans of war) (Morland et al., 2013), drug and alcohol addiction cases, and to some extent in social phobia cases. Controlled studies were carried out in some articles studied in this research overview. Hence, the general inference of positive effect of telemedicine in such cases might not be misplaced.
On the cost-effectiveness of Telemedicine, the article considered only one review for its study, and this makes the overall article impact weak. Economics is one f the main considerations of telemedicine. The Treatment of PTSD is one of costliest in medical sciences and requires close attention as the sufferer has a low quality of life too along with bouts of depression, as about 50% of those Veterans thus affected do not access expert care (Morland et al., 2013).
Discussion
This research work is a good initial effort academically as it studies many types of target groups and diverse interventions. Thus, it gives a wholesome picture of effects of Telemedicine, even though the quantity and quality of articles is found wanting in some cases. The review has followed the authentic guidelines of analysis and incorporated the established principles of rigors of academic study.
One glaring omission is that of economic impact of Telemedicine. The lack of effectual economic impact of Telemedicine is also noted in another article ‘Can Economic Evaluation in Telemedicine be Trusted? A Systematic Review of Literature’. This also results in difficulties for reimbursement and recording by employers and insurance entities (Bergmo, 2009).
Ironically, studies that found financial advantages to patients made no mention of commensurate clinical benefits (Bergmo, 2009). Secondly, the process followed in this article can be followed up by studying articles that study effects and patients over longer periods. Many other patient fields like VA (especially for PTSD), ICU the aged and disabled and the like need to included in further research studies to make further studies all-encompassing and relevant for practical use. In a study it has been affirmed that CVT based interventions are an useful clinical method to provide effective service to Veterans that suffer from PTSD as comparable to in-person therapy and can be an cost-effective, too (Morland et al., 2013).
Conclusion
This article could have included articles where the reasons for failures in telemedicine had also been evaluated. It has been recognized that there is a need for the nurses and doctors providing CVT, telemedicine or the like to understand their criticality in comprehension of the dialogue and the sensitiveness when in interaction with the patient. Interpersonal communication skill is another vital skill that the nurses need to develop and keep learning if the best services are to be expected of this new alternative (Johnson, Wilhelmsson, Borjeson, & Lindberg, 2014).
The article, however, has accepted as much in its conclusion. The article also suggests that both the patients as well as the service providers need more education for telemedicine to be effective as an alternative to conventional bedside healthcare. Indeed, as mentioned in one of the papers, Telemedicine can be more effective alternative for ‘distanced’ or remote patients (Bergmo, 2009).
References:
Bergmo, T. (2009). Can economic evaluation in telemedicine be trusted? A systematic review of the literature. BioMed Central, 2009; 7: 18.(PMC2770451). http://doi.org/10.1186/1478-7547-7-18
Johnson, C., Wilhelmsson, S., Borjeson, S., & Lindberg, M. (2014). Improvement of communication and interpersonal competence in telenursing — development of a self-assessment tool. Journal of Clinical Nursing, n/a — n/a. http://doi.org/10.1111/jocn.12705
Marta Roing, U.R. (2013). Threats to patient safety in telenursing as revealed in Swedish telenurses' reflections on their dialogues. Scandinavian Journal of Caring Sciences. http://doi.org/10.1111/scs.12016
McLean, S., Sheikh, A., Cresswell, K., Nurmatov, U., Mukherjee, M., Hemmi, A., & Pagliari, C. (2013). The Impact of Telehealthcare on the Quality and Safety of Care: A Systematic Overview. PLoS ONE, 8(8), e71238. http://doi.org/10.1371/journal.pone.0071238
Morland, L.A., Raab, M., Mackintosh, M.-A., Rosen, C.S., Dismuke, C.E., Greene, C.J., & Frueh, B.C. (2013). Telemedicine: A Cost-Reducing Means of Delivering Psychotherapy to Rural Combat Veterans with PTSD. Telemedicine Journal and E-Health, 19(10), 754 — 759. http://doi.org/10.1089/tmj.2012.0298
