How Effective is Telemedicine for Infectious Disease Consultations?

The clinical effectiveness of telemedicine infectious disease consultations has yet to be studied to the degree that its effectiveness can be measured until now, according to an analysis published in Open Forum Infectious Diseases.

Investigators from the Washington University School of Medicine in St. Louis (WUSTL) searched various medical databases in order to review the current evidence for clinical effectiveness of telemedicine infectious disease consultations. The team wanted to measure outcomes of mortality, hospital readmission, antimicrobial use, cost, length of stay, adherence, and patient satisfaction.

The study authors wrote that telemedicine could potentially expand infectious disease expertise to underserved areas, thereby reducing mortality and improving clinical outcomes in those areas. A shortage of infectious disease physicians, like the one seen today, may also contribute to less access to these specialists in economically disadvantaged areas.

While telemedicine is widely used in many subspecialties, there has been no research into its effectiveness for clinical outcomes in infectious disease.

They included several definitions for telemedicine all encompassed by “remote clinical services administered using a technological medium,” such as video chat, voice chat after review of electronic health records (EHR), or EHR documentation after remote chart review without direct video or voice chat between a patient and physician. These remaining studies were the only papers from the pool that focused on 30-day all-cause mortality, 30-day readmissions, patient compliance and adherence, patient satisfaction, cost or cost effectiveness, length of hospital stays, antimicrobial use, and antimicrobial stewardship.

After examining the existing literature from 1997 through August 2019, the investigators narrowed down a search pool of 1154 studies to 18 that involved telemedicine infectious disease consultation.

Of these 18 studies, clinical outcomes tracked included 30-day mortality after an infection (3 studies), readmission within 30 days after discharge from initial hospitalization with an infection (1 study), patient compliance/adherence (2 studies), patient satisfaction (9 studies), cost or cost effectiveness (4 studies), length of stay (5 studies), and antimicrobial use (5 studies).

The study authors also reported that 13 of the studies were performed only in adults, while consultant specialty was infectious diseases was only in 7 of the studies. Though more than 1 infection type could be studied in each article, the investigators noted that pneumonia, urinary tract infection, sepsis, bacteremia, endocarditis, skin and soft tissue infections, upper respiratory infectious and “other” infectious diseases were tracked in the 18 papers.

The most common type of telemedicine was face-to-face videoconferencing with a patient (13 studies), followed by telephone only (3 studies), physician-to-physician only (1 study), and 1 other study where the study authors were unable to determine the type of telemedicine employed. Infections were confirmed in 11 studies, they added.

Additionally, patient satisfaction with telemedicine was the most commonly reported outcome, the study authors found, and the percentage of satisfied patients was above 97% in 6 of the 7 studies that tracked it.

“It was surprising that so little is published on these clinical outcomes when I know that a lot telemedicine infectious disease is happening out there,” study author Jason Burnham, MD, from the Division of Infectious Diseases at WUSTL told Contagion®. “I think the implication is that people will recognize we need more data published on this practice that is becoming increasingly widespread and my hope is that some portion of the people who recognize that will begin reporting their outcomes.”

Mortality was higher among telemedicine groups in 2 studies and lower in the other 2 studies which reported this outcome, the investigators wrote. However, only 1 of these studies was statistically significant: there was lower mortality in patients who received in-person rather than telephone-only infectious disease consultations. Length of stay was also shorter in the telemedicine group in 4 of the 5 studies to report it, and the remaining study reported equivalent length of stay.

Finally, both readmission and adherence/compliance were similar between telemedicine and non-telemedicine groups, the study authors learned.

“My only other comment is really just a call to action to infectious disease physicians and researchers — publish your clinical outcomes from the telemedicine that you’re doing!” Burnham concluded.