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Industry: Email Alert RSS FeedMulticentre randomised control trial comparing real time teledermatology with conventional outpatient dermatological care: societal cost-benefit analysis
British Medical Journal, May 6, 2000 by R Wootton, S E Bloomer, R Corbett, D J Eedy, N Hicks, H E Lotery, C Mathews, J Paisley, K Steele, M A Loane
Equipment
Standard commercial videoconferencing units (VC7000, BT) connected by basic rate ISDN lines at 128 kbit/s were installed at each of the participating sites. An additional video camera was connected to the videoconferencing unit at each health centre to enable the general practitioner to transmit close up images to the dermatologist.
Procedure
Patients with dermatological conditions requiring a specialist referral were invited to participate in the trial by their general practitioner. Sealed envelopes containing a referral form and consent form were distributed at each health centre. The referral form contained details of the randomisation to either a teledermatology consultation or traditional hospital consultation.
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Prior randomisation of the referral forms had taken place by using a table of random numbers. Each referral form had an assigned trial identification number for all subsequent patient communication between the dermatologist and general practitioner. The patient signed the consent form and was given a scheduled appointment time.
Patients randomised to a teledermatology consultation attended their own health centre and, in the company of a general practitioner, were seen by a hospital dermatologist over the videolink. Patients randomised to a hospital consultation were seen by the dermatologist in the outpatient department as normal. The dermatologist recorded a diagnosis, management plan, clinical outcome of consultation, and length of consultation time. All patients received an accelerated referral and were seen within 10 days.
Patients were asked to complete an anonymous economic questionnaire assessing the time spent and costs incurred by them immediately after their initial consultation and after the first return visit to hospital. Patient reattendance to general practice or hospital and the clinical outcome of the initial consultation were ascertained from a follow up review of patient records. A minimum period of three months elapsed before patient records were reviewed. The medical staff in the study were subsequently interviewed by an economic consultancy firm to obtain quantitative data on the costs and benefits of teledermatology.
Results
Over 12 months, 204 patients participated in the trial; 102 were randomised to teledermatology and 102 to conventional hospital appointment. Eighty five (42%) were male and 119 (58%) female. Age ranged from 4 months to 89 years (mean (SD) 38.6 (23.8) years). In all, 125 (63%) were registered with an urban practice and 76 (37%) a rural practice.
Clinical outcome
Table 1 shows the clinical outcome of the initial consultation. The dermatologist recommended a further hospital appointment for 47 (46%) patients seen by telemedicine and 46 (45%) patients seen conventionally. A review of patient records showed that 42 (41%) of patients seen by telemedicine and 41 (40%) patients seen conventionally actually attended a hospital follow up appointment.
Table 1 Recorded and actual clinical outcome of initial consultation. Values are numbers (percentages) of patients
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