The provision of health care when the patient and clinician are not face-to-face can aid the system by expanding access, especially to scarcer specialty resources, and potentially lowering costs, while maintaining or even improving outcomes. But like all trends, telemedicine should be judged by its actual results in high-quality research. A Health Affairs article provides a quick summary of research findings on telehealth. (HA Article) The article covers systematic reviews and meta-analyses of telemedicine that were published from 2004 to 2018 for patient/provider interactions, so not including clinician to clinician tele-consultations. Altogether, 20 studies were included for the article. There were eight on tele-mental health services. Overall, the underlying studies and the systematic reviews of those studies found general equivalence in in-person and telehealth for behavioral issues. This specialty is one where telemedicine has rapidly expanded, given the shortage of professionals, and has been well-accepted by patients. There were five reviews for tele-rehabilitation. Again, the findings were generally supportive of telehealth services, with many studies finding somewhat better outcomes using that modality. For tele-dermatology, there were two systematic reviews, and while in-person services had slightly better outcomes, those for tele-dermatology were viewed as acceptable. There were other reviews for specific therapeutic categories or types of services, and they all were similar–telemedicine generally has similar outcomes to in-person care. While not a specific focus of this article, the authors did note that there is variation in studies looking at the effect of telehealth on utilization. Some research has found that the convenience of telemedicine may actually add to overall utilization. Since it is usually cheaper, it is less clear that overall costs go up. Hopefully, policymakers continue to support telemedicine and researchers keep trying to do rigorous evaluations.
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The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected]keptic.com.
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