Ryan Spaulding

Evidence-Based Practice for Telemental Health

Telemental Health Standards and Guidelines Working Group Co-Chairs: Brian Grady, MD Kathleen Myers, MD, MPH Eve-Lynn Nelson, PhD Writing Committees: Evidence-Based Practice for Telemental Health Norbert Belz, MHSA RHIA, Leslie Bennett, LCSW, Lisa Carnahan, PhD, Veronica Decker, APRN, BC, MBA, Brian Grady, MD, Dwight Holden, MD, Kathleen Myers, MD, MPH, Eve-Lynn Nelson, PhD, Gregg Perry, MD, Lynne S. Rosenthal, PhD, Nancy Rowe, Ryan Spaulding, PhD, Carolyn Turvey, PhD, Debbie Voyles, Robert White, MA, LCPC Practice Guidelines for Videoconferencing-Based Telemental Health Peter Yellowlees, MD, Jay Shore, MD, Lisa Roberts, PhD Contributors: Working Group Members [WG], Consultants [C], Reviewers [R], Telemental Health Special Interest Group Chairs [MH], ATA Standards and Guidelines Committee Member [SG], ATA Staff [S] Nina Antoniotti, RN, MBA, PhD [Chair, SG] Richard S. Bakalar, MD [SG] Norbert Belz, MHSA RHIA [WG] Leslie Bennett, LCSW [WG] Jordana Bernard, MBA [S] Anne Burdick, MD, MPH [Vice Chair, SG] David...

Cost savings of telemedicine utilization for child psychiatry in a rural Kansas community.

The costs of pediatric telemedicine services remain underreported and understudied; however, there is evidence that telepediatric services can be cost competitive with traditional ones. For 15 years, the University of Kansas Center for Telemedicine and Telehealth has been providing telemental health outreach from the University of Kansas Medical Center (KUMC). One service site is located in Crawford County, Kansas, which provides telepsychiatry services to children and adolescents. The purpose of this study was to examine the costs of operating the Crawford County site relative to accessing services at KUMC, the likely alternative service location. The cost of travel time to parents who accompanied a dependent to either location also was estimated. Patients and parents were examined over a 6-month period in 2006. One hundred thirty-two patients received 257 telemedicine psychiatric consultations during this period. Cost estimates for using the pediatric telemedicine service were assessed for all patients; however, travel and related costs were collected from a sample of 26 patient-parent dyads. The estimated costs of services were obtained using standard cost-accounting procedures. An average cost per consultation in Crawford County was

Defining the needs of a telemedicine service.

168.61. The cost savings in travel time and other expenses to parents and patients were substantial between use of the county site and KUMC. Subtracting average savings in travel costs to patients and parents produced an average cost of a telepsychiatry consult in Crawford County of only

Feasibility of using videoconferencing to provide diabetes education: a pilot study

30.99. This study was conducted over 6 months with a small number of observations; it should be replicated over a longer study period, with more patients, and with more data that might capture marginal costs of services.

Diffusion theory and telemedicine adoption by kansas health-care providers : critical factors in telemedicine adoption for improved patient access

While telemedicine programme objectives, technologies and even philosophies will differ, certain common factors that enhance programme success can be identified. For example, a programme design which is driven by technological imperatives is likely to fail. It must also be recognized that telemedicine programmes cannot force remote sites to use their services. Thus developers must assess the needs for the proposed telemedicine service from a clinical, economic and technical perspective. From a clinical perspective, it is important to remember that certain clinical services can be provided via telemedicine while others cannot. Programme developers must recognize the significant role of the remote team in sustaining services; the on-site presenter is essential for the successful practice of telemedicine. Evaluating a telemedicine programme should be viewed as an integral step in its design and implementation. One site may define effectiveness in terms of access to services while another may measure success by cost savings. The success of future telemedicine programmes will be strongly related to their ability to recognize that they should be used to enhance current health-care delivery rather than to replace it.

A cost analysis of a tele-oncology practice in the United States

We conducted a pilot study of the effectiveness of individual counselling sessions provided by a dietician through telemedicine for patients with diabetes. All participants received a single group education session via videoconference. Those who were randomized to the intervention also received two additional follow-up sessions, four and eight weeks later. Glycosylated haemoglobin and total cholesterol were measured at the start and again 16 weeks later. The patients completed diabetes quality-of-life and telemedicine patient satisfaction surveys. Thirty-two participants consented to participate. Complete data were collected on 13 intervention and 13 control patients. There was a 1% fall in HbA1c in the intervention group from pre- to post-assessment, although this was not significant. The control group showed a significantly larger fall in HbA1c levels than the intervention group (P = 0.043). Total cholesterol decreased in both groups, although not significantly. All control and intervention group participants indicated that they would participate in videoconferencing nutritional counselling again. The results suggest that providing nutritional therapy via videoconferencing may be useful in assisting patients to manage their conditions.

Comparative and cost effectiveness of telemedicine versus telephone counseling for smoking cessation.

Twenty counties in Kansas were randomly selected from those designated as rural on the basis of their populations. A sample of 356 physicians and physicians’ assistants in these counties was chosen. A postal survey was sent to the identified providers up to three times. One hundred and eighty-six of the questionnaires were returned (a response rate of 52%). In all, 76% of the respondents were physicians, 76% were men and 42% were family practitioners. Practitioners were classified as adopters or non-adopters of telemedicine, based on their report of whether they had ever referred one or more patients for a health-care consultation via telemedicine. Of the 167 participants who marked this item, 30 (18%) were adopters and 1 37 (82%) were non-adopters. Among the adopters, 16 (53%) said that they expected to use telemedicine with about the same frequency or more often in the future. In contrast, 61 (45%) non-adopters reported that they did not expect to refer patients by telemedicine in the future and 51 (37%) were unsure. Neither age (r=0.16, P = 0.44) nor gender (χ2 = 2.35, P = 0.1 3) was related to the adoption variable or the number of referrals made to telemedicine clinics. The results suggest that adopters and non-adopters of telemedicine perceive its value very differently, and that an opportunity exists to promote the concept to non-adopters more effectively.

Urban Telepsychiatry: Uncommon Service for a Common Need

Oncology services have been provided by telemedicine from the University of Kansas Medical Center (KUMC) for almost 10 years. We have analysed the costs associated with providing tele-oncology clinics to a rural Kansas town for two fiscal years, 1995 and 2000. The aim was to compare recent tele-oncology costs with those of the first year of tele-oncology practice. A study conducted in 1995 showed that the average cost was

Experience with telehealth for sleep monitoring and sleep laboratory management

812 per telemedicine consultation. Data from fiscal year 2000 showed that the average cost was

A comparison of telehealth and face-to-face presentation for school professionals supporting students with chronic illness

410 per telemedicine consultation, a decrease of almost 50%. As the tele-oncology practice in Kansas continues to grow, it can be expected that the costs associated with providing tele-oncology services will continue to decline.