Ea. Balas et al., ELECTRONIC COMMUNICATION WITH PATIENTS - EVALUATION OF DISTANCE MEDICINE TECHNOLOGY, JAMA, the journal of the American Medical Association, 278(2), 1997, pp. 152-159
Objective.-To evaluate controlled evidence on the efficacy of distance
medicine technologies in clinical practice and health care outcome. D
ata Sources.-Systematic electronic database and manual searches (1966-
1996) were conducted to identify clinical trial reports on distance me
dicine applications. Study Selection.-Three eligibility criteria were
applied: prospective, contemporaneously controlled clinical trial with
random assignment of the intervention; electronic distance technology
application in the intervention group and no similar intervention in
the control group; and measurement of the intervention effect on proce
ss or outcome of care. Data Extraction.-Data were abstracted by indepe
ndent reviewers using a standardized abstraction form and the quality
of methodology was scored. Distance technology applications were descr
ibed in 6 categories. computerized communication, telephone follow-up
and counseling, telephone reminders, interactive telephone systems, af
ter-hours telephone access, and telephone screening. Data Synthesis.-O
f 80 eligible clinical trials, 61 (76%) analyzed provider-initiated co
mmunication with patients and 50 (63%) reported positive outcome, impr
oved performance, or significant benefits, including studies of comput
erized communication (7 of 7), telephone follow-up and counseling (20
of 37), telephone reminders (14 of 23), interactive telephone systems
(5 of 6), telephone access (3 of 4), and telephone screening (1 of 3).
Significantly improved outcomes were demonstrated in studies of preve
ntive care, management of osteoarthritis, cardiac rehabilitation, and
diabetes care. Conclusions.-Distance medicine technology enables great
er continuity of care by improving access and supporting the coordinat
ion of activities by a clinician, The benefits of distance technologie
s in facilitating communication between clinicians and patients indica
te that application of telemedicine should not be limited to physician
-to-physician communication.