Michael P. Caputo

Benefits of a Telepsychiatry Consultation Service for Rural Nursing Home Residents

Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than

Improved rural provider access to continuing medical education through interactive videoconferencing.

3,700 would be spent on gasoline for 278 separate encounters; decreased to

APPLIED RESEARCH: Effectiveness of Lectures Attended via Interactive Video Conferencing Versus In-Person in Preparing Third-Year Internal Medicine Clerkship Students for Clinical Practice Examinations (CPX)

925 for four visits per roundtrip. Personnel cost savings estimates ranged from

Telemedicine to a moving ambulance improves outcome after trauma in simulated patients.

33,739 to

Technical communication and clinical health care: Improving rural emergency trauma care through synchronous videoconferencing

67,477. Physician costs associated with additional travel time ranged from

The use of telemedicine for real-time video consultation between trauma center and community hospital in a rural setting improves early trauma care: preliminary results.

84,347 to

Telemedicine reduces discrepancies in rural trauma care

253,040 for 278 encounters, or from

Medical Student Evaluations of Lectures Attended in Person or From Rural Sites via Interactive Videoconferencing

21,087 to

The feasibility of using ultrasound and video laryngoscopy in a mobile telemedicine consult.

63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.

The Use of Telemedicine for Delivering Continuing Medical Education in Rural Communities

We sought to describe use patterns and user evaluation of remotely-attended continuing medical education (CME) programs in Vermont and upstate New York. Remote attendees were required to return an evaluation form to receive CME credit. The form included name and date of the program; name, location, and specialty of the respondent; and questions regarding program quality, value, effectiveness, and attendee plans if the program had not been available via telemedicine. From April, 1996, through December, 1998, health care providers from 14 remote sites used the network 927 times to attend 394 CME programs at Fletcher Allen Health Care in Burlington, Vermont. After the start-up period, an average of over three programs per week was attended, with an average of 2.4 remote attendees per program. Seventy-seven percent of remote attendees stated that they would not have attended the program if it had not been available over telemedicine, while the remaining 23% said that they avoided traveling due to videoconferencing. When asked the effectiveness of telemedicine technology for attending, 73% said it was as effective as having the presenter in the room, 23% said it was less effective, and 4% said it was more effective. Major technical problems, such as having the call disconnect during the presentation, decreased over time. There were continuing minor logistical problems common to large group videoconferencing. The telemedicine system has increased availability of CME programs for rural providers in Vermont and upstate New York. Most attendees have found the programs to be worthwhile, and technological advancements have improved the quality of the system.