ELECTRONIC COMMUNICATION WITH PATIENTS - EVALUATION OF DISTANCE MEDICINE TECHNOLOGY

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.