Travelers book plane tickets online, bank customers can check their accounts at any computer, and busy families can grocery shop online. Someday, even doctor visits could be among the conveniences offered via the Internet. Researchers considering the feasibility and effectiveness of virtual doctors visits report that patients and physicians found that evaluations done through videoconferencing were similar to face-to-face visits on most measures, according a study published in the May issue of the Journal of Telemedicine and Telecare.
"There is growing evidence that the use of videoconferencing in the medical environment is useful for a variety of acute and chronic issues," says Ronald F. Dixon, MD, an internist at Massachusetts General Hospital and the study's senior author. "Videoconferencing between a provider and patients allows for the evaluation of many issues that may not require an office visit and can be achieved in a shorter time."
The healthcare delivery model in the United States is under scrutiny. Reduced access to providers, rapidly increasing costs and an aging population represent major challenges for the healthcare system. Telemedicine projects, including virtual visits (a patient-physician real-time encounters using videoconferencing technology) are being examined to evaluate their capacity to improve patient access to care and lower healthcare costs.
This study, the largest trial of virtual visits versus face-to-face visits done to date, randomized patients to one of two arms. In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face with two different physicians. All physicians and patients completed evaluation questionnaires after each visit.
Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians scored virtual visits similar to face-to-face visits on measures including history taking and medication dispensing, and though they were less satisfied on measures of clinical skill and overall satisfaction those ratings were still in the good to excellent range. The diagnostic agreement between physicians was 84 percent between face-to-face and virtual visits; it was 80 percent between the two face-to-face visits.
"The tradition of medicine is to lay hand on the patients, which has always been considered paramount to patient care in the minds of physicians," says Dixon. "However, these findings suggest that virtual visits could be a viable option in circumstances where patients need to be monitored routinely for chronic conditions like diabetes, hypertension, obesity or depression, and self-management strategies are not working. Virtual visits may also be effective for triage of acute, non-urgent issues like back pain or respiratory infections."
Among the benefits of virtual visits are reduce overhead costs for a physicians' practices by reducing the space and resource requirements. For patients, a virtual visit can minimize time taken away from work and transportation costs. The study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care.
The co-author of this study is James E. Stahl, MD, internist and technology adoption researcher at Massachusetts General Hospital. The study was supported by the Center for the Innovation of Medicine and Innovative Technology (CIMIT) and the MGH Department of Medicine.
Founded in 1811, the MGH is the third oldest general hospital in the United States and the oldest and largest in New England. The 900-bed medical center offers sophisticated diagnostic and therapeutic care in virtually every specialty and subspecialty of medicine and surgery. Each year the MGH admits more than 46,000 inpatients and handles nearly 1.5 million outpatient visits at its main campus and health centers. Its Emergency Department records nearly 80,000 visits annually. The surgical staff performs more than 35,000 operations and the MGH Vincent Obstetrics Service delivers more than 3,500 babies each year. The MGH conducts the largest hospital-based research program in the country, with an annual research budget of more than $500 million. It is the oldest and largest teaching hospital of Harvard Medical School, where nearly all MGH staff physicians serve on the faculty. The MGH is consistently ranked among the nation's top hospitals by US News and World Report.