Telemedicine journal and e-health : the official journal of the American Telemedicine Association
-
Introduction: Veterans with low vision who live in rural communities have limited access to low-vision rehabilitation services, unless they are able to travel several miles to a specialty low-vision clinic. A low-vision optometry telerehabilitation evaluation is a thorough assessment of patient's functional vision. Following each low-vision optometry telerehabilitation evaluation is a low-vision telerehabilitation initial assessment with a blind rehabilitation therapist. ⋯ Adding low-vision telerehabilitation services from fiscal year (FY) 13 to FY 17 resulted in a 24% increase in low-vision patient care. The median saving of travel miles for rural veterans was 122 miles per veteran, and the median saving of travel time was 2.09 h per veteran. Overall, the median saving of the travel cost was $65.29 per veteran. Conclusions: This study shows and supports low-vision telerehabilitation as an accepted, practical, time-saving, and cost-saving alternative option to traditional face-to-face consultations with a low-vision optometrist and blind rehabilitation therapist.
-
Background: Value enhancing telehealth (TH) lacks a robust body of formal clinically focused quality assessment studies. Innovations such as telehealth must always demonstrate that it preserves or hopefully advances quality. Introduction: We sought to determine whether adherence to the evidence-based Choosing Wisely (CW) recommendations (antibiotic stewardship) for acute sinusitis differs for encounters through direct-to-consumer (DTC) telemedicine verses "in-person" care in an emergency department (ED) or an urgent care (UC) center. Materials and Methods: Study design was a retrospective review. Patients with a symptom complex consistent with acute sinusitis treated through DTC were matched with ED and UC patients, based upon time of visit. ⋯ The predominant chief complaints were upper respiratory infection (36%), sore throat (25%), and sinusitis (18%). Overall, there was a 67% (95% CI 62.3-71.7) adherence rate with the CW guidelines for sinusitis: DTC visits (71%), ED visits (68%), and UC visits (61%). There was a nonsignificant difference (p = 0.29) in adherence to CW guidelines based upon type of visit (DTC, UC, and ED). Discussion: The challenge is to demonstrate whether or not DTC TH compromises quality. Conclusion: In this study, DTC visits were associated with at least as good an adherence to the CW campaign recommendations as emergency medicine (EM) and UC in-person visits.