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Burns follow-up: an innovative application of telemedicine

JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 52-54页

作者： Massman, NJ Dodge, JD Fortman, KK Schwartz, KJ Solem, LD Reg Hosp Dept Surg St Paul MN 55101 USA HealthPartners Informat Syst Bloomington MN USA HealthPartners Res Fdn Bloomington MN USA

We assessed the efficiency and effectiveness of burn consultations via telemedicine. The Regions Hospital Burn Center completed 87 follow-up visits with 40 patients via telemedicine from March 1997 to August 1998. These consultations involved burn physicians, occupational therapists and a clinical psychologist. Patients were seen at 15 telemedicine sites in six states (Minnesota, Iowa, Montana, North and South Dakota, and Wisconsin). Telemedicine burn consultations were cost-effective for the patient, but were more time consuming for the physician and therapist. As remote sites become more familiar with preparing patients for teleconsultations, telemedicine will become more efficient for the physician while remaining cost-effective for the patient.

关键词：烧伤/治疗患病代价随访研究远程会诊/经济学远程会诊/方法时间因素青少年成年人老年人儿童儿童学龄前人类婴儿中年人

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Patient cost-benefit analysis of teledermatology measured in a randomized control trial

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第1-Sup期5卷 1-3页

作者： Loane, MA Bloomer, SE Corbett, R Eedy, DJ Gore, HE Hicks, N Mathews, C Paisley, J Steele, K Wootton, R Royal Grp Hosp Inst Telemed & Telecare Belfast BT12 6BA Antrim North Ireland Portadown Hlth Ctr Orchard Family Practice Portadown County Armagh North Ireland Queens Univ Belfast Dept Med Belfast Antrim North Ireland Craigavon Area Hosp Grp Trust Dept Dermatol Craigavon County Armagh North Ireland The Surgery Dromara County Down North Ireland Doctors Surg Dromore County Down North Ireland Queens Univ Belfast Dept Gen Practice Belfast Antrim North Ireland

A randomized controlled trial of the costs and benefits of teledermatology consultations compared with traditional hospital consultations was carried out. Over a nine-month period, 197 patients were referred from general practice for a dermatological opinion, 98 for a teledermatology consultation and 99 for a hospital consultation. Eighty patients required an additional subsequent hospital appointment. Patients were asked to complete an economic questionnaire after each consultation, and 164 questionnaires were returned: 62% of those randomized to the teledermatology consultation responded compared with 58% of those randomized to the hospital consultation. Patients seen by teledermatology at their own health centre had shorter distances to travel and spent less time overall attending the appointment compared with those seen at the hospital. However, the teledermatology consultations were more time-consuming for the general practitioner and dermatologist. These findings indicate that teledermatology has more benefits for the patient than for the health-care delivery team.

关键词：患病代价皮肤病学/经济学皮肤病学/方法大不列颠远程会诊/经济学远程会诊/方法遥测术/经济学遥测术/方法时间因素青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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A feasibility study of realtime teledermatology in Finland

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第2期6卷 102-107页

作者： Lamminen, H Tuomi, ML Lamminen, J Uusitalo, H Primary Hlth Care Ctr Ikaalinen Finland Tampere Univ Hosp Dept Dermatol & Venereol Tampere Finland Arcus Software Tampere Finland Tampere Univ Hosp Dept Ophthalmol Tampere Finland

We conducted a feasibility study of teleconsultation in dermatology using low-cost equipment. Patients and their general practitioners took part in consultations from the Primary Health Care Centre in Ikaalinen with a dermatologist 55 km away at the Tampere University Hospital (TAUH). Consultations were performed using standard commercial videoconferencing equipment, a modified document camera and a dermatoscope. A single ISDN line (128 kbit/s) was used for the connection. During the eight months of the study, 25 patients participated in a teledermatology consultation. Their mean age was 45 years (range 4-92). The average time the patient spent in travelling to the videoconsultation (i.e. one way) was 24 min (range 5-65 min). The mean time spent in the teleconsultation was 15 min (range 5-30 min). After the teleconsultation, patients' treatments changed in 19 cases (76%), diagnoses were changed in 13 cases (52%) and 18 patients (72%) did not need to go to the TAUH. The equipment was generally reliable and easy to use. However, the dermatoscope was not very useful and only one of the consultations relied mainly on it. The cost of the teleconsultations for the 18 patients who avoided travel to the TAUH was FM18,627. The total costs for the 18 conventional consultations in the TAUH would have been FM18,034. The main economic benefits of the videoconferencing were attributable to the reduced travelling and hospital costs. The economic benefits of medical education were more difficult to quantify.

关键词：计算机系统成本及成本分析可行性研究芬兰卫生服务易得程度病人满意度远程会诊/经济学远程会诊/仪器和设备远程会诊/方法皮肤疾病/诊断皮肤疾病/治疗遥测术/仪器和设备青少年成年人老年人老年人 80以上儿童儿童学龄前人类中年人

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Telemedicine applications in primary care: A geriatric patient pilot project

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MAYO CLINIC PROCEEDINGS 2000年第4期75卷 365-368页

作者： Bratton, RL Cody, C Mayo Clin Jacksonville Dept Family Med Jacksonville FL 32224 USA

Objective: To determine patient satisfaction with telemedicine technology. Subjects and Methods: In this pilot study, 20 generally healthy elderly residents (mean age, 77.3 years) of a Florida retirement community consulted weekly by "Electronic House Call" with a primary care physician to re cord their vital signs and discuss their condition. At the end of the 8-week study period, they were asked to complete a survey indicating their satisfaction with the telemedicine experience. Results: Eighteen of the 20 participants completed the survey. Eleven respondents (61%) reported they were comfortable using the computer system without assistance. Most (13/18;72%) believed the computer system correctly recorded vital signs. Almost all (17/18;94%) reported the computer system did not have a negative impact on their relationship with their primary health care provider, and 11 (61%) thought that the system had a positive effect. Conclusions: The participants in this small pilot study were pleased with the experience they had with telemedicine. Large-scale studies are needed to determine the widespread utility of telemedicine technology.

关键词：伦理学医学佛罗里达出诊/经济学 Medicare 病人满意度医生病人关系试点项目初级卫生保健/经济学初级卫生保健/方法问卷调查偿还途径远程会诊/经济学结果可重复性远程医学/经济学美国老年人女(雌)性人类男(雄)性

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A cost-minimization analysis of a realtime teledermatology service in northern Norway

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JOURNAL OF TELEMEDICINE AND TELECARE 2000年第5期6卷 273-277页

作者： Bergmo, TS Univ Tromso Hosp Natl Ctr Telemed N-9038 Tromso Norway

Realtime teledermatology has been a routine service provided by the University Hospital of Tromso to a primary-care centre in Kirkenes since 1989. The cost of the teledermatology service was compared with the costs of three alternative methods of treatment for the patients. The first was a combination of a visiting service and patient travel to hospital. The second was patient travel to the nearest secondary-care centre. The third was a locally employed dermatologist. At the actual 1998 workload of 375 patients, the total cost of teledermatology was NKr470,780, while the three alternatives cost NKr880,530, NKr1,635,075 and NKr958,660, respectively. Analysis of the unit costs showed that the realtime teledermatology service, including local phototherapy, was less costly than the three alternatives for annual workloads above 195 patients per year. A sensitivity analysis showed that the results were robust to changes in the assumptions about the cost structure.

关键词：成本及成本分析皮肤病学/经济学卫生保健部门挪威远程会诊/经济学人类

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Videoconferencing: what are the benefits for dental practice?

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BRITISH DENTAL JOURNAL 2000年第2期188卷 67-70页

作者： Cook, J Austen, G Stephens, C Univ Bristol Inst Learning & Res Technol Bristol BS8 1HH Avon England Univ Bristol Sch Dent Bristol BS8 1TH Avon England

For more than 3 years members of the TeleDent team from Bristol University have been looking at the potential of videoconferencing technology for dentistry Here they explain what videocanferencing is and how it can help the GDP. They discuss examples of its most promising uses for the profession, which include professional updating and providing diagnostic support at a distance. They describe the equipment that is needed, the different types of system available and give an indication of costs. A suggested procedure for using the technology for remote referrals is outlined. 'Store and forward' techniques are also discussed. These do not involve a live video but involve the sending of static electronic files. This approach is compared with videoconferencing, and the article looks at the question of which will be best suited to the GDP, and for what purposes.

关键词：计算机系统成本及成本分析开业医生牙科信息存储和检索转诊和会诊远程会诊/分类远程会诊/经济学远程会诊/仪器和设备电信/分类电信/经济学电信/仪器和设备远程医学/分类远程医学/经济学远程医学/仪器和设备录像人类

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Tele-otolaryngology consultations between two rural primary-care centres in southern Lapland and the University Hospital of Umea

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JOURNAL OF TELEMEDICINE AND TELECARE 1999年第Sup1期5卷 93-94页

作者： Made, C Carle, L Söderberg, O Hellström, S Tarnaby Sjukstuga Tarnaby Sweden Univ Umea Hosp Dept Otorhinolaryngol Umea Sweden

In 1996 a telemedicine link was established between two primary-care centres of Vasterbotten county and the University Hospital. Specialties involved at the University Hospital were otoloaryngology, orthopaedics and dermatology. Videoconferencing used ISDN at 384 kbit/s. The primary-care centres were equipped with video-endoscopes. During the first 21 months, there were 32 otolaryngology consultations. The average time for each consultation was between 15 and 30 min. Patients, general practitioners and specialists were interviewed using questionnaires with answers on a six-point scale, in which a score of six was best. Patient satisfaction produced a mean score of 5.7. The specialist doctors rated the video-consultation satisfactory for diagnosis. Roughly 40% of the referrals could be avoided by telemedicine. The general practitioners rated the educational effect of the consultation very highly.

关键词：卫生保健费用医院大学病人满意度初级卫生保健/经济学初级卫生保健/方法远程会诊/经济学远程会诊/方法乡村卫生服务/经济学瑞典人类

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Are we all just stupid?

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Ear, nose, & throat journal 2000年第9期79卷 689页

作者： T Gumprecht East Side Ear Nose and Throat Redmond Wash.

Emphasizes the need for physicians to start charging for all medical services they render through the telephone and the Internet. Implications of charging for electronic services; Four-step program to initiate change in the practice patterns of physicians; Fee exacted by lawyers and accountants to clients who consulted them through the telephone or the Internet.

关键词：费用医疗保险范围因特网/经济学病人记账和收款远程会诊/经济学远程会诊/发展趋势电信/经济学美国人类

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