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      The Current State Of Telehealth Evidence: A Rapid Review

      Author(s): 1 , 2 , 3 , 4 , 5
      Publication date Created:
      Publication date (Print):
      Journal: Health Affairs
      Publisher: Health Affairs (Project Hope)

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          Abstract

          Policy makers and practitioners show a continued interest in telehealth's potential to increase efficiency and reach patients facing access barriers. However, telehealth encompasses many applications for varied conditions and populations. It is therefore difficult to draw broad conclusions about telehealth's efficacy. This rapid review examines recent evidence both about telehealth's efficacy by clinical area and about telehealth's impact on utilization. We searched for systematic reviews and meta-analyses of the use of telehealth services by patients of any age for any condition published in English in the period January 2004-May 2018. Twenty systematic reviews and associated meta-analyses are included in this review, covering clinical areas such as mental health and rehabilitation. Broadly, telehealth interventions appear generally equivalent to in-person care. However, telehealth's impact on the use of other services is unclear. Many factors should be carefully considered when weighing the evidence of telehealth's efficacy, including modality, evidence quality, population demographics, and point-in-time measurement of outcomes.

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          The Empirical Evidence for Telemedicine Interventions in Mental Disorders

          Noura Bashshur, Gary W Shannon, Rashid Bashshur … (2015)
          This research derives from the confluence of several factors, namely, the prevalence of a complex array of mental health issues across age, social, ethnic, and economic groups, an increasingly critical shortage of mental health professionals and the associated disability and productivity loss in the population, and the potential of telemental health (TMH) to ameliorate these problems. Definitive information regarding the true merit of telemedicine applications and intervention is now of paramount importance among policymakers, providers of care, researchers, payers, program developers, and the public at large. This is necessary for rational policymaking, prudent resource allocation decisions, and informed strategic planning. This article is aimed at assessing the state of scientific knowledge regarding the merit of telemedicine interventions in the treatment of mental disorders (TMH) in terms of feasibility/acceptance, effects on medication compliance, health outcomes, and cost.
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            Therapeutic alliance in videoconferencing psychotherapy: a review.

            Susan Simpson, Corinne L. Reid (2014)
            Psychotherapy services are limited in remote and rural areas in Australia and across the globe. Videoconferencing has become well established as a feasible and acceptable mode of psychological treatment delivery. Therapeutic alliance (TA) is an essential factor underlying successful therapy across therapeutic models. In order to determine the state of knowledge regarding TA in psychotherapy via videoconferencing, a literature review was conducted on research studies that formally measured TA as primary, secondary or tertiary outcome measures over the past 23 years. The databases searched were Medline, PsycArticles, PsycINFO, PsycEXTRA and EMBASE. Searching identified 9915 articles that measured satisfaction, acceptability or therapeutic rapport, of which 23 met criteria for the review. Three studies were carried out in Australia, 11 in USA, 4 in Canada, 3 in Scotland and 2 in England. Studies overwhelmingly supported the notion that TA can be developed in psychotherapy by videoconference, with clients rating bond and presence at least equally as strongly as in-person settings across a range of diagnostic groups. Therapists also rated high levels of TA, but often not quite as high as that of their clients early in treatment. The evidence was examined in the context of important aspects of TA, including bond, presence, therapist attitudes and abilities, and client attitudes and beliefs. Barriers and facilitators of alliance were identified. Future studies should include observational measures of bond and presence to supplement self-report.
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              Teledermatology for diagnosis and management of skin conditions: a systematic review.

              Erin Warshaw, Yonatan Hillman, Nancy L. Greer … (2011)
              We performed a systematic review of the literature addressing teledermatology: (1) diagnostic accuracy/concordance; (2) management accuracy/concordance; (3) clinical outcomes; and (4) costs. Peer-reviewed controlled trials published in English between 1990 and 2009 were identified through MEDLINE and PubMed searches. Of 78 included studies, approximately two-thirds comparing teledermatology and clinic dermatology found better diagnostic accuracy with clinic dermatology. Diagnostic concordance of store and forward with clinic dermatology was good; concordance rates for live interactive and clinic dermatology were higher, but based on fewer patients. Overall rates of management accuracy were equivalent, but teledermatology and teledermatoscopy were inferior to clinic dermatology for malignant lesions. Management concordance was fair to excellent. There was insufficient evidence to evaluate clinical course outcomes. Patient satisfaction and preferences were comparable. Teledermatology reduced time to treatment and clinic visits and was cost-effective if certain assumptions were met. Heterogeneity in studies (design, skin conditions, outcomes) limited the ability to pool data. The benefits of teledermatology need to be evaluated in the context of potential limitations. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
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                Author and article information

                Journal
                Title: Health Affairs
                Abbreviated Title: Health Affairs
                Publisher: Health Affairs (Project Hope)
                ISSN (Print): 0278-2715
                ISSN (Electronic): 1544-5208
                Publication date Created: December 2018
                Publication date (Print): December 2018
                Volume: 37
                Issue: 12
                Pages: 1975-1982
                Affiliations
                [1 ]Erin Shigekawa () is a consultant, John Snow, Inc. (JSI), in San Francisco, California. She was a principal analyst in the California Health Benefits Review Program, University of California Berkeley, when this work was completed.
                [2 ]Margaret Fix is a research associate at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco.
                [3 ]Garen Corbett is director of the California Health Benefits Review Program, University of California Berkeley.
                [4 ]Dylan H. Roby is an associate professor in and associate chair of the Department of Health Services Administration at the University of Maryland School of Public Health, in College Park; an adjunct associate professor in the Fielding School of Public Health, University of California Los Angeles (UCLA); and a faculty associate in the UCLA Center for Health Policy Research.
                [5 ]Janet Coffman is a full adjunct professor at the Philip R. Lee Institute for Health Policy Studies, University of California San Francisco.
                Article
                DOI: 10.1377/hlthaff.2018.05132
                PubMed ID: 30633674
                SO-VID: 5db8862e-7d27-4ae7-84c3-c4355f2c4348
                Copyright © © 2018
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