Veterans Health Administration Telemedicine Projects

For a decade or more the Veterans Health Administration has used telemedicine as a method to improve care at a reasonable price.  The VHA has one of the longest continuous records of telemedicine use and numerous research reports have been conducted on its efforts.  A systematic review article published in the American Journal of Managed Care examined the results of those studies and the VHA’s telemedicine program.   (AJMC Article) The review covered 19 studies from 2000 to 2009, all of which were good quality trials or studies.

The studies all involved either mental health services or chronic disease management and utilized regular monitoring and contact through a telemedicine device, usually with a care coordinator.  For the psychiatric patients, the interventions in some cases also included remote individual or group therapy sessions.  Most of the studies had as endpoint measures various health outcomes, such as biological measures like glycosylated hemoglobin, or mortality, or patient self-reports on stress or depression or quality of life.  Some also looked at health care utilization and costs.

Of the nineteen studies, twelve showed unequivocal benefits for the telemedicine intervention.  Some of the primary benefits included enhanced patient access to health care professionals, quick access to electronically stored health information to help in assessing and managing the patient’s care and facilitation of collaborative and coordinated care.  Particularly for the mental health patients, the constant monitoring and interaction capability seemed to strengthen the therapeutic bond.  Some of the studies showed reductions in overall utilization and costs.  Two primary barriers identified in the studies were maintaining patient adherence to using the technology and keeping the technology up-to-date and personnel trained on it.