Telemedicine in the treatment of chronic diseases is no less safe, accessible, and effective than a visit to the doctor, according to a study at Soroka-University Medical Center in Beersheba. According to the researchers, phone, computer, and video visits don’t harm the quality of medical care, and they may even reduce hospitalizations and emergency room visits.
The study, just published in the Journal of Medical Internet Research under the title “Evaluating Clinical Outcomes and Physician Adoption of Telemedicine for Chronic Disease Management: Population-Based Retrospective Cohort Study,” found that the use of telemedicine for the management of chronic diseases leads to medical outcomes as good as face-to-face visits and doesn’t elevate the rate of emergency room visits or hospitalizations, even among patients with several such conditions.
Although telemedicine has demonstrated benefits in diverse clinical settings and patient populations, its implementation did not significantly accelerate until the COVID-19 pandemic, which led to its widespread adoption around the world. In addition, other factors that emerged in the last decade as contributing to the growth in the use of telemedicine included widespread high-speed Internet access, the use of mobile devices, advances in information and communication technology, and the growing adoption of electronic health records.
Recently, the Health Ministry in Jerusalem announced the promotion and implementation of telemedicine as one of its goals. The study was promoted by hospital director-general Dr. Shlomi Codish.
“Understanding the effectiveness, strengths, and shortcomings of telemedicine for various chronic diseases and patient populations can inform decision makers of health care policy on how best to implement and maximize its benefits,” they wrote. This encouraged the researchers to go ahead.
“We aimed to compare the use of telemedicine for outpatient visits versus in-person visits across different medical specialties; assess its association with clinical outcomes; and examine the influence of patient and physician characteristics on telemedicine use in a large, tertiary, teaching hospital,” said Dr. Ido Peles, a medical data analyst and epidemiologist at the hospital and the chief researcher in an interview with The Jerusalem Post.
The benefits of telemedicine
The records of 32,445 Jewish and Arab adult patients who had been treated in five medical fields – psychiatry, hemato-oncology, gastroenterology, endocrinology, and nephrology between 2019 until the beginning of 2020. Telemedicine used during the period of 2019 to 2021 was the researchers’ main interest, and the main outcomes were emergency department (ED) referrals and hospitalizations.
The analysis used models and analyses by patient demographic characteristics, chronic disease medical fields, and the characteristics of the doctors. “Fully 75% of those using telemedicine were in touch by phone, and the rest by their computer or phone. We have a large Bedouin population, however, and telemedicine is less used by them,” Peles added.
“It won’t replace doctors or coming to the clinic; it’s an extra tool that especially benefits those living in the periphery and those who have a difficult time reaching the clinic. Such patients need not fear that they aren’t getting good medical treatment if they don’t see their doctors in person. Physicians are getting more skilled in telemedicine, and this benefits the patient. Telemedicine techniques are not taught in medical schools, but when students go to hospitals for clinical work, they see doctors using the tool to check up on patients who are at home.
“It would be a good idea for it to be included in medical school curricula,” suggested Peles, who, with his team, spent three years on the study and wants to do another one in about a year.
In 2019, a total of 99.6% (83,000) of visits were in person, and by 2020 to 2021, a total of 22.6% of patients had used telemedicine. Those who were followed up by telemedicine were slightly older and with more chronic illnesses than in-person patients or patients who did not visit their doctors during that time.
Peles and his team found no evidence of worsening outcomes for telemedicine users relative to in-person care. Health care providers with higher telemedicine use even had reduced rates of emergency department referrals (and hospitalizations than providers with lower telemedicine use.
The development of telemedicine over the years has been remarkable, the team said.
“In the US, telemedicine adoption in hospitals rose from 46% in 2017 to 72% in 2021, driven primarily by larger teaching hospitals leading the transformation. In China, for example, a regional telemedicine platform experienced substantial growth in remote consultations, providing critical benefits to underserved regions and older adults.
These trends reflect a broader recognition of telemedicine’s potential to revolutionize health care delivery.
“The American College of Cardiology and other medical societies have declared that telemedicine not only improves access to care but also enhances patient satisfaction, reduces manpower requirements, and fosters equity in health care delivery. Nevertheless, alongside the potential benefits of telemedicine, there are challenges, including the lack of a physical examination, which is an inherent part of the visit and diagnosis.”
The researchers stressed that telemedicine should be tailored to the individual needs of patients and physicians and consider the nature of the patient’s disease.
Although the timing of infectious pandemics is unpredictable, their recurrence is likely, they concluded.
“It is evident that telemedicine has a critical role in emergency responses, underscoring its importance. Our findings emphasize the importance of integrating telemedicine into health care systems and policies to ensure consistent patient outcomes across various situations and optimize health care resource allocation.