Telehealth, E-Visits Gaining Steam as Cost-Effective Senior Care Method

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Substantial growth is projected for the field of telehealth as the government tries to control skyrocketing healthcare costs, and a new study supports remote patient monitoring through virtual doctors visits as an effective, cheaper method than an in-person office visit.

Telehealth is expected to reach 1.8 million patients by 2017 up from 2012’s estimated 308,000 patients being remotely monitored worldwide by their healthcare providers for congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension, and mental health conditions, according to a new report from InMedica analyzing the world market for telehealth.

Virtual doctors appointments can be more efficient and cheaper than traditional office visits, says a new Mayo Clinic study comparing care between the two methods published recently in the JAMA Internal Medicine, and they may be more beneficial for seniors.

With Internet capabilities enabling “e-visits” where physicians and patients interact virtually rather than face-to-face, Mayo Clinic researchers decided to examine the differences between virtual consultations and those that take place in offices for two conditions, sinusitis and urinary tract infections (UTIs).

Patients using the e-visit method can log into a secured personal health record Internet portal and answer a series of questions about their condition. The written information is then sent to the physicians, who can make a diagnosis, order necessary care, and put a note in the patient’s electronic medical record.

Advantages of virtual doctors visits include convenience and efficiency, as patients can avoid travel and time expenditures, along with lower costs, the researchers found. Virtual consultations with doctors may be especially useful for seniors, who are prone to infections such as UTIs and for whom doctors visits may pose significant interruptions to daily life.

“Because they have more chronic illnesses, seniors are more likely to need to go to the doctor more often,” says Ateev Mehrotra, MD, MPH Associate Professor of Medicine, Division of General Internal Medicine, Health Policy Researcher, RAND Corporation. “My own instinct is that e-visits for management of chronic illness could be very beneficial for seniors.”

Use of telehealth technology is still a developing concept in senior care, but it’s gaining steam.

Nearly 17% of senior living providers pointed to teleheath/remote patient monitoring as a future area of investment in a September 2012 Ziegler-CAST Technology Spending Survey. A majority (70%) indicated plans to invest or increase investment in electronic medical records (EMRs) and another 29% are looking into video conferencing for residents and clients.

Outcomes for remote monitoring are still somewhat mixed. While the Mayo Clinic researchers’ findings refuted some concerns surround e-visits, they supported others, including higher prescription rates.

The number of patients receiving follow-up care was similar to those making office visits, and half of e-visit users reported willingness to use an e-visit for a subsequent illness within the next year and appeared generally satisfied with the virtual appointments.

Additionally, data collected from the study suggests that e-visits could lower healthcare spending. Using Medicare reimbursement data and prior studies, the researchers estimated costs of UTI visits in a virtual or office setting. While antibiotic prescription rates were higher among e-visits, particularly for UTIs, the researchers found that the lower rate of testing for the infection among e-visits outweighs the higher rate of prescriptions.

In total, the estimated cost of a virtual doctors visit for a suspected UTI was $74, versus $93 for office visits.

“When physicians cannot directly examine the patient, physicians may use a ‘conservative’ approach and order antibiotics,” say the researchers, although they added that the high antibiotic prescribing rate for sinusitis for both virtual and office visits was a concern “given the unclear benefit of antibiotic therapy for sinusitis.”

The researchers did acknowledge the limitations of their study, but concluded that the results of their research “highlight key differences between office visits and e-visits and emphasize the need to assess the clinical impact of e-visits as their popularity grows.”

Written by Alyssa Gerace





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