Telemedicine versus face to face patient care: effects on professional practice and health care outcomes
Abstract
BACKGROUND: Telemedicine is the use of telecommunications technology for medical diagnosis and patient care. From its beginnings telemedicine has been used in a variety of health care fields, although widespread interest among healthcare providers has only now become apparent with the development of more sophisticated technology. OBJECTIVES: To assess the effects of telemedicine as an alternative to face-to-face patient care. SEARCH STRATEGY: We searched the Effective Practice and Organisation of Care Group's specialised register, The Cochrane Library, MEDLINE (1966-August 1999), EMBASE (to 1996), Cinahl (to August 1999), Inspec (to August 1996), Healthstar (1983-1996), OCLC, Sigle (to 1999), Assia, SCI (1981-1997), SSCI (1981-1997), DHSS-Data. We hand searched the Journal of Telemedicine and Telecare (1995-1999), Telemedicine Journal (1995-1999) and reference lists of articles. We also hand searched conference proceedings and contacted experts in countries identified as having an interest in telemedicine. SELECTION CRITERIA: Randomised trials, controlled before and after studies and interrupted time series comparing telemedicine with face-to-face patient care. The participants were qualified health professionals and patients receiving care through telemedicine. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Seven trials involving more than 800 people were included. One trial was concerned with telemedicine in the emergency department, one with video-consultations between primary health care and the hospital outpatients department, and the remainder were concerned with the provision of home care or patient self-monitoring of chronic disease. The studies appeared to be well conducted, although patient numbers were small in all but one. Although none of the studies showed any detrimental effects from the interventions, neither did they show unequivocal benefits and the findings did not constitute evidence of the safety of telemedicine. None of the studies included formal economic analysis. All the technological aspects of the interventions appear to have been reliable, and to have been well accepted by patients. REVIEWER'S CONCLUSIONS: Establishing systems for patient care using telecommunications technologies is feasible, but there is little evidence of clinical benefits. The studies provided variable and inconclusive results for other outcomes such as psychological measures, and no analysable data about the cost effectiveness of telemedicine systems. The review demonstrates the need for further research and the fact that it is feasible to carry out randomised trials of telemedicine applications. Policy makers should be cautious about recommending increased use and investment in unevaluated technologies.
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Five reviews focused on type 1 diabetes and one analyzed type 1 diabetes within a mixed review.
“A total of 5 reviews focused on type 1 diabetes [23,24,41,48,49] and 1 analyzed type 1 diabetes within a mixed review [19].”
Three 1-star narrative syntheses showed improvement in HbA1c limited to only a few RCTs, and all concluded that further evaluation was required.
“Three 1-star narrative syntheses showed improvement in HbA1c limited to only a few RCTs, and all concluded that further evaluation was required [19,23,48].”
Data were lacking to make many conclusions about telemedicine's clinical effectiveness compared with face-to-face care or about its cost savings.
“Data were lacking, however, to make many conclusions about its clinical effectiveness compared with faceto-face care or cost savings.24”
From Social Media and Clinical Care: Ethical, Professional, and Social Implications (2013) · cites this paper as [24]
Systematic reviews have found telemedicine to be feasible, well accepted by patients, and reliable.
“Systematic reviews of telemedicine have found telemedicine to be feasible, well accepted by patients, and reliable.24,25”
From Social Media and Clinical Care: Ethical, Professional, and Social Implications (2013) · cites this paper as [24]
Several studies confirmed the feasibility to perform cognitive assessment via telemedicine in elderly subjects with dementia and showed a good agreement with conventional face-to-face testing, and a high level of user satisfaction.
“Several studies confirmed the feasibility to perform cognitive assessment via telemedicine in elderly subjects with dementia and showed a good agreement with conventional face-to-face testing, and a high level of user satisfaction (359–362).”
From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [360]
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- Authors
- Currell, R., Urquhart, C., Wainwright, P., & Lewis, R.
- Affiliations
- Swansea University (GB)
- Aberystwyth University (GB)
- St George's, University of London (GB)
- Cardiff University (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2000-04-24
- Volume
- 97
- Issue
- 2
- Pages
- 35-35
- ISSN
- 1361-6137 (ISSN-L)
- OpenAlex
- W1955171727
- Cited by
- 463
- References
- 37
- Citations by year
- 2025: 5 · 2024: 14 · 2023: 14 · 2022: 25 · 2021: 28 · 2020: 20 · 2019: 20 · 2018: 22 · 2017: 37 · 2016: 17 · 2015: 42 · 2014: 32 · 2013: 21 · 2012: 26
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2015-09-07)
- Open access
- closed
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed (publishedVersion)
- PubMed
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- telemedicine, home care, video consultation, health care outcomes, professional practice, patient satisfaction, cost-effectiveness, feasibility, patient acceptance of technology, psychological outcomes, patient involvement in treatment decisions, patient-centered care
- MeSH terms
- Communication, Humans, Outcome and Process Assessment, Health Care, Physician-Patient Relations, Practice Patterns, Physicians', Telemedicine
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