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Evaluation of Distance Medicine Technology

E. Andrew Balas, MD, PhD; Farah Jaffrey, MSc; Gilad J. Kuperman, MD, PhD; Suzanne Austin Boren, MHA; Gordon D. Brown, PhD; Francesco Pinciroli, LEE; Joyce A. Mitchell, PhD

JAMA. 1997;278(2):152-159.

Abstract
Objective.
—To evaluate controlled evidence on the efficacy of distance medicine technologies in clinical practice and health care outcome.

Data Sources.
—Systematic electronic database and manual searches (1966-1996) were conducted to identify clinical trial reports on distance medicine applications.

Study Selection.
—Three eligibility criteria were applied: prospective, contemporaneously controlled clinical trial with random assignment of the intervention; electronic distance technology application in the intervention group and no similar intervention in the control group; and measurement of the intervention effect on process or outcome of care.

Data Extraction.
—Data were abstracted by independent reviewers using a standardized abstraction form and the quality of methodology was scored. Distance technology applications were described in 6 categories: computerized communication, telephone follow-up and counseling, telephone reminders, interactive telephone systems, after-hours telephone access, and telephone screening.

Data Synthesis.
—Of 80 eligible clinical trials, 61 (76%) analyzed providerinitiated communication with patients and 50 (63%) reported positive outcome, improved performance, or significant benefits, including studies of computerized communication (7 of 7), telephone follow-up and counseling (20 of 37), telephone reminders (14 of 23), interactive telephone systems (5 of 6), telephone access (3 of 4), and telephone screening (1 of 3). Significantly improved outcomes were demonstrated in studies of preventive care, management of osteoarthritis, cardiac rehabilitation, and diabetes care.

Conclusions.
—Distance medicine technology enables greater continuity of care by improving access and supporting the coordination of activities by a clinician. The benefits of distance technologies in facilitating communication between clinicians and patients indicate that application of telemedicine should not be limited to physician-to-physician communication.

Author Affiliations
From the Health Services Management Program and Integrated Technology Services. School of Medicine, University of Missouri. Columbia (Drs Balas. Brown, and Mitchell and Mss Jaffrey and Boren); Brigham and Women's Hospital, Boston, Mass (Dr Kuperman); and Politecnico di Milano, Milan, Italy (Mr Pinciroli).

Footnotes
Reprints: E. Andrew Balas, MD, PhD. School of Medicine, University of Missouri—Columbia, 324 Clark Hall. Columbia, MO 65211 (e-mail: E._Andrew_Balas@ muccmail.missouri.edu).

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