Acceptability, feasibility, and cost of telemedicine for nonacute headaches: A randomized study comparing video and traditional consultations
Permanent link
https://hdl.handle.net/10037/10650Date
2016-05-30Type
Journal articleTidsskriftartikkel
Peer reviewed
Abstract
Backgr
ound:
The
feasibility
of
telemedicine
in
diagnosing
and
treating
nonacute
headaches,
such
as
primary
headaches
(migraine
and
tension-type)
and
medication-overuse
headaches
has
not
been
previously
investigated.
By
eliminating
the
need
of
travel
to
specialists,
telemedicine
may
of
fer
significant
time
and
money
savings.
Objectives:
Our
objective
was
to
estimate
the
acceptance
of
telemedicine
and
investigate
the
feasibility
and
cost
savings
of
telemedicine
consultations
in
diagnosing
and
treating
nonacute
headaches.
Methods:
From
September
2012
to
March
2015,
nonacute
headache
patients
from
Northern
Norway
who
were
referred
to
neurologists
through
an
electronic
application
system
were
consecutively
screened
and
randomized
to
participate
in
either
telemedicine
or
traditional
specialist
visits.
All
patients
were
consulted
by
two
neurologists
at
the
neurological
department
in
T
romsø
University
Hospital.
Feasibility
outcomes
were
compared
between
telemedicine
and
traditional
groups.
Baseline
characteristics
and
costs
were
then
compared
between
rural
and
urban
patients.
T
ravel
costs
were
calculated
by
using
the
probabilistic
method
of
the
Norwegian
traveling
agency:
the
cheapest
means
of
public
transport
for
each
study
participant.
Loss
of
pay
was
calculated
based
on
the
Norwegian
full-time
employee’
s
average
salary:
<
3.5
hours=a
half
day’
s
salary
,
>
3.5
hours
spent
on
travel
and
consultation=one
day’
s
salary
.
Distance
and
time
spent
on
travel
were
estimated
by
using
Google
Maps.
Results:
Of
557
headache
patients
screened,
479
were
found
eligible
and
402
accepted
telemedicine
participation
(83.9%,
402/479)
and
were
included
in
the
final
analyses.
Of
these,
202
received
traditional
specialist
consultations
and
200
received
telemedicine.
All
patients
in
the
telemedicine
group
were
satisfied
with
the
video
quality
,
and
198
(99%,
198/200)
were
satisfied
with
the
sound
quality
.
The
baseline
characteristics
as
well
as
headache
diagnostics
and
follow-up
appointments,
and
the
investigation,
advice,
and
prescription
practices
were
not
statistically
dif
ferent
between
the
two
randomized
groups.
In
addition,
telemedicine
consultations
were
shorter
than
traditional
visits
(38.8
vs
43.7
min,
P
<.001).
The
travel
cost
per
rural
individual
(292/402,
73%)
was
€249,
and
estimated
lost
income
was
€234
per
visit.
The
travel
cost
in
the
urban
area
(1
10/402,
27%)
was
€6,
and
estimated
lost
income
was
€1
17
per
visit.
The
median
traveling
distance
for
rural
patients
was
526
km
(range
1892
km),
and
the
median
traveling
time
was
7.8
hours
(range
27.3
hours).
Rural
patients
had
a
longer
waiting
time
than
urban
patients
(64
vs
47
days,
P
=.001),
and
fewer
women
were
referred
from
rural
areas
(
P
=.04).
Rural
women
reported
higher
pain
scores
than
urban
women
(
P
=.005).
Conclusion:
Our
study
shows
that
telemedicine
is
an
accepted,
feasible,
time-saving,
and
cost-saving
alternative
to
traditional
specialist
consultations
for
nonacute
headaches.
T
rial
Registration:
Clinicaltrials.gov
NCT02270177;
http://clinicaltrials.gov/ct2/show/NCT02270177
(Archived
by
W
ebCite
at
http://www
.webcitation.or
g/6hmoHGo9Q)
Description
Source: doi:10.2196/jmir.5221