VP19.06: A cost‐savings analysis of a novel telemedicine tool compared to face‐to‐face obstetric ultrasound examinations in New Mexico

Objective: Telemedicine allows physicians to provide medical care remotely through audiovisual technology. Telemedicine may address many challenges facing our society: an aging population, chronic disease management, and healthcare cost. With this work, we attempt to evaluate how telemedicine can effect a change in these challenges, and evaluate what obstacles prevent some providers from using it.Methods: In this work, the cost-effectiveness, success of telemedicine care, usefulness in reaching developing and underdeveloped areas, difficulties preventing the use of telemedicine, and proposals to overcome these challenges were reviewed and analyzed.Results: Cost of telemedicine was reported 19% less expensive than traditional face-to-face care. In several studies, telemedicine was documented to have had equal or better outcomes for obstructive sleep apnea, geriatrics, heart failure, preventative medicine, and patient compliance. Difficulties in using telemedicine include affordability of equipment, lack of technical support in developing or underdeveloped areas, legality of licensure and patient privacy and satisfaction.Conclusions: Although cost savings and convenience are major advantages of this technology, concerns with delivery barriers and challenges require cautious embracement of telemedicine. A great deal of research is needed to show that telemedicine improves patient centered outcomes.

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A prospective clinical, cost and environmental analysis of a clinician-led virtual urology clinic

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2018.0151 ◽

2019 ◽

Vol 101 (1) ◽

pp. 30-34 ◽

Cited By ~ 8

Author(s):

S Miah ◽

C Dunford ◽

M Edison ◽

D Eldred-Evans ◽

C Gan ◽

...

Keyword(s):

Carbon Footprint ◽

Cost Savings ◽

Environmental Benefits ◽

Face To Face ◽

Enterprise Value ◽

Working Age ◽

Mode Of Transport ◽

Urology Clinic ◽

Virtual Clinic

Introduction A virtual clinic is a form of telemedicine where contact between clinical teams and patients occur without face-to-face consultation. Our study aims to quantify the clinical, financial and environmental benefits of our virtual urology clinic. Material and methods We collected data prospectively from our weekly follow-up virtual clinic over a continuous four-month period between July and September 2017. Results In total, we reviewed 409 patients. Following virtual clinic consultation, 68.5% of our patients were discharged from further follow-up. The majority of our patients (male 57.7%, female 55.5%) were of working age. The satisfaction scores were high, at 90.1%, and there were no reported adverse events as a result of using the virtual clinic. Our calculated cost savings were £18,744, with a predicted 12-month cost saving of £56,232. The creation of additional face-to-face clinic capacity has created an estimated 12-month increase in tariff generation for our unit of £72,072. In total, 4623 travel miles were avoided by patients using the virtual clinic, with an estimated avoided carbon footprint of 0.35–1.45 metric tonnes of CO2e, depending on mode of transport. Our predicted 12-month avoided carbon footprint is 1.04–4.04 metric tonnes of CO2e. Conclusions Our virtual clinic model has demonstrated a trifecta of positive outcomes, namely, clinical, financial and environmental benefits. The environmental importance and benefits of a virtual clinic should be promoted as a social enterprise value when engaging stakeholders in setting up such a urological service. We propose the adoption of our virtual clinic model in those urological units considering this method of telemedicine.

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‘It’s the soft stuff that’s hard’: Investigating the role played by low carbon small- and medium-sized enterprise advisors in sustainability transitions

Local Economy The Journal of the Local Economy Policy Unit ◽

10.1177/0269094218778526 ◽

2018 ◽

Vol 33 (4) ◽

pp. 384-404 ◽

Cited By ~ 6

Author(s):

Sam Hampton

Keyword(s):

Cost Savings ◽

Building Energy ◽

Business Practices ◽

Low Carbon ◽

Face To Face ◽

Environmental Objectives ◽

Business Support ◽

Regional Basis ◽

Energy Audits ◽

The Uk

Significant public funds are invested in low carbon advisors to support small- and medium-sized enterprises to reduce carbon emissions on a regional basis. Little research has been conducted on their experiences and practices, nor their place within the context of local business support policy. Findings draw on interviews with 19 advisors in the UK as well as the author’s four years’ experience as an environmentally focused business support practitioner. Establishing and sustaining engagements with small- and medium-sized enterprises on the topic of pro-environmental behaviours is a multifaceted problem. Advisors typically approach businesses with promises of cost savings rather than using environmental messaging and focus their resources on the provision of building energy audits and technical advice. Advisors rarely engage small- and medium-sized enterprises in values-based discussions or by seeking to understand how and why energy is used in the course of everyday business practices. The paper argues that face-to-face meetings could be better utilised if ‘softer’ skills were deployed alongside technical expertise. It discusses the limitations of growth-focused support in the context of environmental objectives and calls for a shift in the culture of advice-giving, supported by social scientifically informed policy.

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Reimbursements for telehealth services are likely to be lower than non-telehealth services in the United States

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16652288 ◽

2016 ◽

Vol 23 (4) ◽

pp. 497-500 ◽

Cited By ~ 7

Author(s):

Fernando A Wilson ◽

Sankeerth Rampa ◽

Kate E Trout ◽

Jim P Stimpson

Keyword(s):

United States ◽

Patient Outcomes ◽

Health Care Cost ◽

Cost Savings ◽

Low Complexity ◽

The United States ◽

Office Visits ◽

Diagnosis Code ◽

Face To Face ◽

Telehealth Service

Telehealth technologies promise to increase access to care, particularly in underserved communities. However, little is known about how private payer reimbursements vary between telehealth and non-telehealth services. We use the largest private claims database in the United States provided by the Health Care Cost Institute to identify telehealth claims and compare average reimbursements to non-telehealth claims. We find average reimbursements for telehealth services are significantly lower than those for non-telehealth for seven of the ten most common services. For example, telehealth reimbursements for office visits for evaluation and management of established patients with low complexity were 30% lower than the corresponding non-telehealth service. Reimbursements by clinical diagnosis code also tended to be lower for telehealth than non-telehealth claims. Widespread adoption of telehealth may be hampered by lower reimbursements for telehealth services relative to face-to-face services. This may result in lower incentives for providers to invest in telehealth technologies that do not result in significant cost savings to their practice, even if telehealth improves patient outcomes.

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2341. Effectiveness of Interventions Targeting Stewardship of Clostridium difficile Testing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2019 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S805-S805

Author(s):

Stephanie Sterling ◽

Hochman Sarah ◽

Natalie Kappus ◽

Alexis Reed ◽

Preston Kramer

Keyword(s):

Clostridium Difficile ◽

Best Practice ◽

Cost Savings ◽

Oral Contrast ◽

Healthcare Associated Infection ◽

Post Intervention ◽

Symptomatic Disease ◽

Face To Face ◽

Guideline Compliance ◽

Laxative Use

Abstract Background Clostridium difficile infection (CDI) is the most common healthcare-associated infection. C. difficile PCR assays do not differentiate between colonization (seen in up to 21% of inpatients) and symptomatic disease, highlighting the importance of testing only symptomatic patients. Methods Interventions included system-wide implementation of C. difficile testing guidelines, face-to-face education of licensed providers, and Best Practice Alerts (BPAs) embedded in the electronic health record (EHR) C. difficile PCR order. The guidelines recommend testing only when ≥ 3 liquid bowel movements within a 24-hour period, without laxatives, oral contrast or new enteral feeds in the preceding 24 hours, and without recent C. difficile PCR test (negative ≤ 7 days or positive < 30 days). We reviewed 100 consecutive C. difficile PCR orders across two hospitals pre- and post-intervention to assess compliance with guidelines; performed weekly review of all C. difficile PCRs, all BPA responses and all hospital-onset CDI. Cost savings were calculated based on published estimates of CDI attributable costs. Results Hospital-onset CDI rates fell from 0.75 to 0.48 cases per 1000 patient-days, with an estimated costs savings of $259,555 per quarter and $1.04 million per year. There were no deaths due to CDI and no morbidity due to delayed CDI diagnosis. C. difficile PCR guideline compliance increased from 39% to 53%; orders decreased by 50% post-intervention. Receipt of laxatives and < 3 episodes of diarrhea were the most common reasons for guideline noncompliance. BPAs fired an average of 150 times/month. The most common trigger for BPA was laxative use. Providers canceled PCR orders in 40% of BPA events. Conclusion Interventions incorporating testing guidelines, face-to-face education, and EHR-embedded decision support resulted in fewer C. difficile PCRs orders, increased guideline compliance, lower rates of hospital-onset CDI and cost savings of $1 million per year without an increase in CDI-attributable death or morbidity. Disclosures All authors: No reported disclosures.

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EP15 Switching to biosimilar adalimumab: a real world study

Rheumatology ◽

10.1093/rheumatology/keaa109.014 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Julie Begum ◽

Muhammad K Nisar

Keyword(s):

Adverse Events ◽

Injection Site Reaction ◽

Cost Savings ◽

Close Monitoring ◽

Information Sheet ◽

Dose Administration ◽

Face To Face ◽

Disease Outcomes ◽

One Year ◽

Activity Indices

Abstract Background Since the introduction of anti-TNF biosimilars in routine clinical practice, there has been a drive to implement the switch program for all biosimilars at the point of availability. Our Trust was aligned to NHS England strategy which required adoption of biosimilar within three months for new patients and one year for switchers. This could help deliver significant savings to the NHS whilst achieving similar clinical outcomes. We report our early experience of introducing adalimumab biosimilar (Imraldi®). Methods A list of all patients prescribed adlimumab was extracted through our database. A ‘switch’ letter was drafted and sent to all patients including Imraldi information sheet. Patients were given the opportunity to contact nurse helpline as needed. We reviewed all relevant records and collected data on any adverse events and disease outcome on either side of the switch. Results 198 patients were identified established on adalimumab. All had switched by October 2019 to Imraldi. Mean age of switchers was 48 (range 16-83 years). Gender distribution was equal (99 each). 35 (17%) were Asian, two Afro-Caribbean, four other and the remaining 157 (80%) were White Caucasian. 54 (27%) had RA, 81 (41%) PsA, 57 (29%) AS and six had JIA. Co-prescribed DMARDs included methotrexate (n = 53, 27%), sulfasalazine (n = 15, 7.5%), hydroxychloroquine (n = 14, 7%) and leflunomide in two individuals. 83 (42%) participants were prescribed adalimumab monotherapy. Prior to switch, median DAS28 for RA group was 2.28 (0.57 - 6.29). Median BASDAI and spinal VAS for AS cohort was 3.3 (0.8 - 8.8) and 3.0 (0 - 9) respectively. Tender and swollen joint components for PsARC were median three (0-8 tender, 0-6 swollen) in PsA group. Only 30% of the patients had been reviewed face-to-face following the switch. Their respective median disease activity indices were not significantly different from pre-switch assessments. Eleven patients had complained of adverse events including injection site reaction (n = 7) and loss of disease control (n = 6). Six of these decided against further biosimilar and requested to return to the originator. No obvious precipitating factors were identified. Conclusion Our experience of switching adalimumab patients has been reasonably successful. All were happy to switch after receiving a letter and having the opportunity to contact if necessary. Substantial annual cost savings of over £300,000 have been projected for this financial year. At group level there were no major differences in disease outcomes and 90% reported no issues. However, just under 10% of those reviewed have decided to return to the originator within three months of switch with loss of efficacy and thereby confidence in the drug. We support the routine switching from originator to biosimilar adalimumab however close monitoring is required certainly in the first few weeks of dose administration. Disclosures J. Begum None. M.K. Nisar None.

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Community Pharmacy Minor Ailment Service (PMAS): An Untapped Resource for Children and Their Carers

Pharmacy ◽

10.3390/pharmacy9020102 ◽

2021 ◽

Vol 9 (2) ◽

pp. 102

Author(s):

Tami Benzaken ◽

Godwin Oligbu ◽

Michael Levitan ◽

Subrina Ramdarshan ◽

Mitch Blair

Keyword(s):

Cost Savings ◽

Cost Effective ◽

Paediatric Population ◽

Face To Face ◽

The Public ◽

Minor Ailment ◽

Healthcare Settings ◽

Minor Ailments ◽

The Uk ◽

Untapped Resource

Background: The Pharmacy Minor Ailment Service (PMAS) was introduced in the UK over 15 years ago for use in treating minor ailments and has been shown to be effective and acceptable by the public in reducing the burden on high-cost healthcare settings (such as general practice and emergency departments). This paper aims to review the use of a PMAS in the paediatric population. Methods: PMAS was established in a London Borough in 2013. Data were collected from 33 pharmacists and 38 GPs on demographics, service utilization and costs. Results: In total, 6974 face-to-face consultations by 4174 patients were provided by pharmacies as part of the PMAS over a 12-month period. Moreover, 57% of patients were children with fever, hay fever and sore throat, accounting for 58% of consultations. Only 2% were signposted to other services. Sixty-nine percent of patients reported being seen within 5 min and 96% of patients were seen within 10 min with high levels of satisfaction. Cost savings of over GBP 192,000 were made during the scheme. Conclusions: PMAS is a highly cost effective, accessible and acceptable service for children with minor illnesses.

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Web-Face-to-Face Mixed-Mode Design in a Longitudinal Survey: Effects on Participation Rates, Sample Composition, and Costs

Journal of Official Statistics ◽

10.1515/jos-2017-0019 ◽

2017 ◽

Vol 33 (2) ◽

pp. 385-408 ◽

Cited By ~ 8

Author(s):

Annamaria Bianchi ◽

Silvia Biffignandi ◽

Peter Lynn

Keyword(s):

Mixed Mode ◽

Large Scale ◽

Cost Savings ◽

Longitudinal Survey ◽

Potential Cost ◽

Face To Face ◽

Mode Design ◽

Cumulative Response ◽

Sample Composition ◽

The Uk

AbstractSequential mixed-mode designs are increasingly considered as an alternative to interviewer-administered data collection, allowing researchers to take advantage of the benefits of each mode. We assess the effects of the introduction of a sequential web-face-to-face mixed-mode design over three waves of a longitudinal survey in which members were previously interviewed face-to-face. Findings are reported from a large-scale randomised experiment carried out on the UK Household Longitudinal Study. No differences are found between the mixed-mode design and face-to-face design in terms of cumulative response rates and only minimal differences in terms of sample composition. On the other hand, potential cost savings are evident.

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Economic modelling of telehealth substitution of face-to-face specialist outpatient consultations for Queensland correctional facilities

Australian Health Review ◽

10.1071/ah17135 ◽

2018 ◽

Vol 42 (5) ◽

pp. 522 ◽

Cited By ~ 2

Author(s):

Monica Taylor ◽

Liam J. Caffery ◽

Paul A. Scuffham ◽

Anthony C. Smith

Keyword(s):

Correctional Facility ◽

Cost Savings ◽

Healthcare Services ◽

Correctional Facilities ◽

Economic Modelling ◽

Correctional Staff ◽

Potential Cost ◽

Face To Face ◽

The Government ◽

The Cost

Objective The provision of healthcare services to inmates in correctional facilities is costly and resource-intensive. This study aimed to estimate the costs of transporting prisoners from 11 Queensland correctional facilities to the Princess Alexandra Hospital Secure Unit (PAHSU) in Brisbane for non-urgent specialist outpatient consultations and identify the cost consequences that would result from the substitution of face-to-face visits with telehealth consultations. Methods A 12-month retrospective review of patient activity at the PAHSU was conducted to obtain the number of transfers per correctional facility. The total cost of transfers was calculated with estimates for transport vehicle costs and correctional staff escort wages, per diem and accommodation costs. A cost model was developed to estimate the potential cost savings from substituting face-to-face consultations with telehealth consultations. A sensitivity analysis on the cost variables was conducted. Costs are reported from a government funding perspective and presented in 2016 Australian dollars (A$). Results There were 3539 inmate appointments from July 2015 to June 2016 at the PAHSU, primarily for imaging, general practice, and orthopaedics. Telehealth may result in cost savings from negligible to A$969 731, depending on the proportion, and travel distance, of face-to-face consultations substituted by telehealth. Wages of correctional staff were found to be the most sensitive variable. Conclusions Under the modelled conditions, telehealth may reduce the cost of providing specialist outpatient consultations to prisoners in Queensland correctional facilities. Telehealth may improve the timeliness of services to a traditionally underserved population. What is known about the topic? Specialist medical services are located in only a few metropolitan centres across Australia, which requires some populations to travel long distances to attend appointments. Some face-to-face specialist outpatient consultations can be substituted by telehealth. What does this paper add? Prisoners from correctional facilities represent one specific population that requires complex travel arrangements for specialist medical appointments. Transportation of prisoners for specialist health appointments represents a substantial cost to the government. This paper quantifies the annual cost in Queensland for transporting prisoners, taking into account fuel and vehicle costs, staff wages, per diem rates, and accommodation. In addition, it quantifies the costs of substituting face-to-face consultations with telehealth consultations. What are the implications for practitioners? This research encourages practitioners to consider using telehealth services for prisoners, as well providing an argument for tertiary centres to include telehealth as a model of care for this population. Telehealth can result in major cost savings and state and federal governments should consider implementation especially in Australia where correctional facilities and specialist services are separated by great geographic distances.

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Towards a Student Advisory System for E-learning

10.28945/3075 ◽

2007 ◽

Author(s):

Raafat Saade ◽

Dennis Kira ◽

Dani Dogmoch

Keyword(s):

Learning Experience ◽

Research Work ◽

Cost Savings ◽

Bottom Line ◽

Web Based ◽

Face To Face ◽

Advisory System ◽

Web Based Learning ◽

E Learning ◽

Improved Performance

Web-based courses are being introduced by higher education institutions at an increasing rate, such that a systematic shift from face-to-face teaching to web-based teaching has become evident. This enthusiasm in web-based education is primarily driven by cost savings and bottom line net profits to institutions. However, research work in the field still has a long way to demonstrate the effectiveness and benefits of web-based learning in general and more specifically, which student can benefit most. Regardless of all the benefits reported, difficulties are still encountered by students, professors, and institutions alike. In fact, many studies show that the web environment for learning is not appropriate for everyone. Therefore, the primary question should be “who is appropriate to take web-based courses?” This of course is in the context of success as it relates to enhanced learning experience and improved performance. Considering the reported benefits and difficulties, this paper identifies seven factors characterizing student success in a web-based learning environment. In addition, we use those factors within a decision support advisory system to help screen students for their appropriateness to take a web-based course. The system was used with few students and this paper reports on one case. The advisory system identifies unfavorable conditions for success to the student and suggests remedial activities to enhance the student’s success.

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