Telemedicine: Patient Satisfaction and Cost-Effectiveness

2006 ◽  
Vol 27 (Supplement) ◽  
pp. S142
Author(s):  
D M. Mertens ◽  
R J. Kagan ◽  
P Warner
2000 ◽  
Vol 92 (4) ◽  
pp. 958-967 ◽  
Author(s):  
Robert P. Hill ◽  
David A. Lubarsky ◽  
Barbara Phillips-Bute ◽  
Jennifer T. Fortney ◽  
Mary R. Creed ◽  
...  

Background In an era of growing economic constraints on healthcare delivery, anesthesiologists are increasingly expected to understand cost analysis and evaluate clinical practices. Postoperative nausea and vomiting (PONV) are distressing for patients and may increase costs in an ambulatory surgical unit. The authors compared the cost-effectiveness of four prophylactic intravenous regimens for PONV: 4 mg ondansetron, 0.625 mg droperidol, 1.25 mg droperidol, and placebo. Methods Adult surgical outpatients at high risk for PONV were studied. Study drugs were administered intravenously within 20 min of induction of nitrous oxide-isoflurane or enflurane anesthesia. A decision-tree analysis was used to group patients into 12 mutually exclusive subgroups based on treatment and outcome. Costs were calculated for the prevention and treatment of PONV. Cost-effectiveness analysis was performed for each group. Results Two thousand sixty-one patients were enrolled. Efficacy data for study drugs have been previously reported, and the database from that study was used for pharmacoeconomic analysis. The mean-median total cost per patient who received prophylactic treatment with 4 mg ondansetron, 0.625 mg droperidol, 1.25 mg droperidol, and placebo were $112 or $16.44, $109 or $0.63, $104 or $0.51, and $164 or $51.20, respectively (P = 0.001, active treatment groups vs. placebo). The use of a prophylactic antiemetic agent significantly increased patient satisfaction (P < 0.05). Personnel costs in managing PONV and unexpected hospital admission constitute major cost components in our analysis. Exclusion of nursing labor costs from the calculation did not alter the overall conclusions regarding the relative costs of antiemetic therapy. Conclusion The use of prophylactic antiemetic therapy in high-risk ambulatory surgical patients was more effective in preventing PONV and achieved greater patient satisfaction at a lower cost compared with placebo. The use of 1.25 mg droperidol intravenously was associated with greater effectiveness, lower costs, and similar patient satisfaction compared with 0.625 mg droperidol intravenously and 4 mg ondansetron intravenously.


2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Sumon Rahman Chowdhury

Structured Education is of detrimental importance for the management, counseling, and prevention of complications in diabetic patients. Different structured education programs exist that significantly improves the quality of life in diabetic patients as well as improves psychosocial outcomes by enhancing self-empowerment and self-motivation. Improvements have also been noted in bio-medical outcomes as a result of structured education most significantly in HbA1C, total cholesterol and frequency of hypoglycemia. In order to ensure patient satisfaction and improve outcomes related to complications, it is very important to identify and support patients whose psychosocial situations and reactions to the diagnosis may affect their ability to adjust or take adequate responsibility for self-care early in the course of the disease. In this review, we will discuss and highlight the evidence that support the benefits, limitations, and cost effectiveness of structured education in diabetes management.


2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 166.1-167
Author(s):  
Y. Oh ◽  
A. Hennessey ◽  
L. Young ◽  
D. Yates ◽  
C. Barrett

Background:Telehealth via phone (TPhone) or video conference (TVideo) in rheumatology has been a topic of interest for many years. Its use was rapidly expanded due to the international public health emergency of coronavirus disease-19 (COVID-19) outbreak in 2020. Australian Medicare Benefits Schedule (MBS) swiftly enabled temporary MBS telehealth items on 13 March 2020, currently extended until 31 March 20211. In the early phase of the COVID-19 pandemic, Antony et al. conducted a single-centre public survey to assess patient perception of rheumatology telehealth. Their results showed that 98.4% of patients consider telehealth acceptable during the pandemic2. It is unclear, however, whether this positive perception persists after patients experience a telehealth. In addition, a survey data in 2019 suggested more than half of Australian rheumatologists work in private practice3. Therefore, inclusion of private patients will better represent patient perception of telehealth.Objectives:The aim of this study was to evaluate patient satisfaction with telehealth during the COVID-19 pandemic. This would determine its feasibility to be integrated in future rheumatology outpatient model.Methods:A questionnaire containing 30 questions was sent to rheumatology patients who attended telehealth appointments at a level 2 public hospital and a local private clinic between April and May 2020. The questionnaires aimed to obtain information on baseline demographics (sex, age, public or private patient, employment status, visual or auditory impairment), appointment details (TPhone or TVideo, usual arrangement for face-to-face (F2F) appointment, cost effectiveness) and appointment satisfaction using a 5-point Likert scale. Descriptive statistical analysis was conducted.Results:The questionnaire was sent to 1452 patients, of which 494 patients responded (34%). Female predominance (77.1%) and a higher proportion of TPhone (79.1%) was seen in the respondents. A majority of patients were existing patients known to the services (90.9%). More than 70% of responses indicated overall satisfaction in specialist care via telehealth, and 88.7% perceived this suitable during a pandemic. Of all respondents, 21.7% were prescribed new medication, and the majority of these patients were confident in taking the new medication after the telehealth appointment. Future acceptability for TPhone was significantly lower in private patients compared to public patients (p= 0.01). Subgroup analysis revealed that higher telehealth satisfaction was associated with needing to take time off work to attend face-to-face appointment (p= 0.02), perception of cost effectiveness (p<0.001) and TVideo (p=0.03).Conclusion:This is the first study which included both public and private rheumatology patients to evaluate patient satisfaction for telehealth during the COVID-19 pandemic. Overall high level of satisfaction was seen in telehealth most notably associated with its cost effectiveness. A higher percentage of patients who had TVideo compared to TPhone were receptive to future telehealth via TVideo, supportive of the importance of visual cues. This in turn will have significant administrative and technological burdens to coordinate in comparison to a F2F or TPhone review. This qualitative study provides valuable insight of patient perception of telehealth, which has the potential to compliment the traditional rheumatology outpatient model of care following the pandemic.References:[1]COVID-19 Temporary MBS Telehealth Services 2020 [Available from: http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-TempBB.[2]Antony A, Connelly K, De Silva T, Eades L, Tillett W, Ayoub S, et al. Perspectives of Patients With Rheumatic Diseases in the Early Phase of COVID-19. Arthritis Care & Research. 2020;72(9):1189-95.[3]Association AR. Workforce Survey Exective Summary 2019 2019 [Available from: https://rheumatology.org.au/members/documents/WorkforceSurveyExecutiveSummary-websiteMay2019.pdf.Acknowledgements:University of QueenslandNursing staff at Redcliffe Hospital and Administration officers at Redcliffe & Northside RheumatologyDisclosure of Interests:None declared


BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044033
Author(s):  
Geva Greenfield ◽  
Liora Shmueli ◽  
Amy Harvey ◽  
Harumi Quezada-Yamamoto ◽  
Nadav Davidovitch ◽  
...  

ObjectivesTo review the characteristics and motivations of patients seeking second opinions, and the impact of such opinions on patient management, satisfaction and cost effectiveness.Data sourcesEmbase, Medline, PsycINFO and Health Management Information Consortium (HMIC) databases.Study designA systematic literature search was performed for terms related to second opinion and patient characteristics. Study quality was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.Data collection/extraction methodsWe included articles focused on patient-initiated second opinions, which provided quantitative data on their impact on diagnosis, treatment, prognosis or patient satisfaction, described the characteristics or motivating factors of patients who initiated a second opinion, or the cost-effectiveness of patient-initiated second opinions.Principal findingsThirty-three articles were included in the review. 29 studies considered patient characteristics, 19 patient motivating factors, 10 patient satisfaction and 17 clinical agreement between the first and second opinion. Seeking a second opinion was more common in women, middle-age patients, more educated patients; and in people having a chronic condition, with higher income or socioeconomic status or living in central urban areas. Patients seeking a second opinion sought to gain more information or reassurance about their diagnosis or treatment. While many second opinions confirm the original diagnosis or treatment, discrepancies in opinions had a potential major impact on patient outcomes in up to 58% of cases. No studies reported on the cost effectiveness of patient initiated second opinions.ConclusionsThis review identified several demographic factors associated with seeking a second opinion, including age, gender, health status, and socioeconomic status. Differences in opinion received, and in the impact of change in opinion, varies significantly between medical specialties. More research is needed to understand the cost effectiveness of second opinions and identify patient groups most likely to benefit from second opinions.


1998 ◽  
Vol 89 (Supplement) ◽  
pp. 1335A
Author(s):  
Frank J Overdyk ◽  
Susan C Harvey ◽  
Doug Baldwin ◽  
Philip Rust

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