Original Title: Diseño y plan de implementación de la telemedicina en áreas clínicas específicas: telemonitorización y teledermatología. Evaluación de puesta en marcha y costes

Authors' objectives: 1. To assess the results of a home telemonitoring intervention in patients with heart failure and chronic obstructive pulmonary disease. 2. To set up and subsequently evaluate a store-and-forward teledermatology system between a tertiary hospital and a health centre. 3. To assess the acceptance of teledermatology by health professionals and to identify possible barriers for the adoption of this new technology. 4. To analyse the economic results of the teledermatology experience.

Authors' results and conclusions: In this study we designed and assessed the first stages of two telemedicine applications (telemonitoring and teledermatology) following a specifically designed research protocol for telemedicine projects. We have observed that the use of incident books and other specifically designed tools constitutes a useful system to gather and identify any technical problems that might arise during the telemedicine activity, as stated in the aforementioned research protocol. The preliminary results referring to the impact of telemonitoring on the use of health services show that there are no statistically significant differences between the control group and the intervention group. Nevertheless, all the result variables show precise estimations in favour of the experimental intervention.Once the teledermatology system was set up, the first 22 diagnoses were carried out using this new telemedicine service. The level of confidence with the diagnosis issued using the teledermatology system was high in 72.7% of the cases. One of the main problems identified was the poor quality of the images (recorded in 86.4% of the diagnosed cases). The maximum amount of time that elapsed from the date of the request for the teleconsultation and the date on which the dermatologists sent the report to the family doctor wasthree working days.The analysis of the results of the TAM questionnaire indicates that in order to improve the level of acceptance of this new technology among medical staff, it is necessary to create the conditions that facilitate the use of teledermatology (by providing the necessary infrastructure, training and technical support). Likewise, the results show that professionals would accept teledermatology easier if they could see the usefulness of the new technology for their work. Based on the TAM results, 65.4% of dermatologists interviewed were against teledermatology while 81.4% of primary care professionals were in favour of using this new technology. The chi-square analysis shows that the intention to use teledermatology depends on the medical speciality and that the differences observed are statistically significant with a confidence level of 99%.The total direct cost of the store-and-forward teledermatology procedure is 110.19€ per patient compared to the 169.86€ of the traditional dermatology consultation. This difference means an incremental cost of -59.67€ per patient, in favour of the teledermatology procedure. The total direct cost for the 1,263 patients estimated for 2008 means a cost difference in favour of teledermatology of 75,364.82€. The results of the sensitivity analysis show that the total cost of teledermatology for the 1,263 patients is 39,884.62€ cheaper than the conventional procedure.

Authors' methods: For the assessment of the telemonitoring system we carried out a randomised clinical trial. The technical evaluation of the telemonitoring system was conducted by recording data in an incident book and subsequently examining the critical incidents. The impact of telemonitoring on the use of health services was assessed by calculating the incident rates of the number of hospital admissions, the duration of the hospital stay, the number of consultations with the specialist and the number of visits to the emergency services for both the control group and the intervention group. Before setting up the teledermatology service, a computer application was designed. Health professionals were trained in the usage of the teledermatology software and dermatological photographic techniques to ensure the efficiency of the system. Data relating to the technical operation of the system was gathered by means of the teledermatology software. The reliability of the teledermatology procedure was assessed with a consecutive sample of patients. In order to assess the acceptance of teledermatology by health professionals, a web-based questionnaire was developed based on the Technology Acceptance Model (TAM), which was distributed to all dermatologists in the Basque Autonomous Region and to family doctors and paediatricians in the Province of Biscay. The content validity of the questionnaire was assessed by a panel of experts in health technology assessment. Cronbach alpha were calculated to measure the reliability of the model. A chi-square test was run to examine the differences in the intention to use telemedicine according to the clinical speciality. Regarding the economic analysis, we calculated the total direct costs per patient of the teledermatology procedure and the conventional dermatological consultation taking into account the 1263 dermatological patients referred in 2008. We carried out a sensitivity analysis to prove the reliability of the cost analysis results. The perspective of the healthcare provider was adopted in the study.

Project Status: Completed

Year Published: 2010

URL for published report: https://www.euskadi.eus/contenidos/informacion/2010_osteba_publicacion/es_def/adjuntos/e_10_03_dis_plan.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>