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RAND study cites telemedicine benefits: lowers costs, expands access

By Steven Ross Johnson

The first assessment of a wide-scale deployment of telemedicine suggests the technology shows promise as a means of addressing an expected shortage of physicians in some areas as millions of Americans gain health coverage.

The study, conducted by the RAND Corp. and published Monday in the journal Health Affairs, found that using telecommunication services to provide clinical care from a distance were used mostly by younger, more affluent patients who were more tech savvy. Researchers found no increase in clinical misdiagnosis or errors in treatment among those using the service.

“Telemedicine services such as the one we studied that directly links physicians and patient via telephone or Internet have the potential to expand access to care and lower costs,” Lori Uscher-Pines, study lead author and a policy researcher at RAND, said in a written statement. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing healthcare trend.” The study assessed the utilization of telemedicine services in a commercial insurance plan that offered access 24 hours a day to Teladoc, a Texas-based firm that is one of the largest telehealth providers in the country. The service offers consultation for minor illnesses over the phone or via the Internet. The patients who used the service were compared to other plan holders who visited an emergency room or went to see a primary-care physician for similar health conditions. At $38 a visit, Teladoc had the potential to save on healthcosts by reducing the number of visits to a primary-care physician or the emergency room. Most users sought treatment for conditions such as respiratory illness, urinary tract infection and skin problems, though patients called for as many as 395 different diagnoses. Compared to doctor and emergency room visits, Teladoc represented a small portion of services. During the 11-month study, 291 patients received a Teladoc consultation compared with 39,431 primary-care physician visits and 883 trips to the emergency department. Also, Teladoc users were less likely to follow up with another consultation, with only 6% doing so compared with 13% of those who went to a doctor's office, and 20% of ER visits. Despite its potential, the authors said further study is necessary to assess the capacity of services like Teladoc to accurately treat and manage certain conditions. Viewed by many as a viable alternative to traditional healthcare delivery, use of telemedicine has increased significantly in recent years. The global telemedicine market grew from $4.2 billion in 2007 to more than $10 billion in 2012, according to a report released last June by medical market research firm Kalorama Information. Follow Steven Ross Johnson on Twitter: @MHSjohnson