Telehealth

One concern about the use of telehealth in pediatrics is whether the care is the same as it would be for in-person visits. Given the real or perceived parental desire for antibiotics for viral illnesses, it’s legitimate to wonder if telehealth visits for minor viral infections would produce more prescriptions for antibiotics. This study of claims data compared a number of telehealth visits (n = 4604) to a much larger collection of urgent-care visits (n = 38,408) and primary-care provider visits (n = 485,201). Antibiotic prescribing was somewhat higher for visits (52%, vs. 42% urgent care and 31% PCP). This study raises the question of whether expectations of parents are different under telehealth conditions. If expectations of antibiotic prescribing are higher using telehealth, it remains to be studied whether this is real or simply perceived by providers.

[su_cite_pediatrics url_fragment=”143/5/e20182491″ author=”Ray” year=”2019″] | PubMed 30962253 | Author Search

The objective of this study was to estimate the costs of providing 386 telemedicine clinical consults at 10 school clinics during the 1999-2000 school year. The average costs of a telemedicine consult ranged from a high of $7328.17 when only one consult was done to a low of $173.13 when 129 consults were completed. At 165 consults, the average costs of a telemedicine consult and a medical center pediatric ambulatory consult were approximately equal. At 200 consults, telemedicine was estimated to be equal to or less costly than conventional ambulatory care visits by some 9.5%.

Doolittle 2003 (Link) | PubMed 12544547 | Author Search

An evaluation of the telemedicine (vs. in-person) application of the Yale Observation Scale and the Respiratory Observation Checklist in febrile children age 2 to 36 months. ,as implemented via a telemedicine system. Strong agreement was found between bedside and telemedicine observers. Excellent agreement between bedside and telemedicine observers was found for the impression of respiratory distress. [su_cite_pediatrics url_fragment = ‘137/3/e20150712’ author = ‘Siew’ year = ‘2016’] | PubMed 26908666 | Author Search

Study to evaluate the validity and reliability of a rating scale for remote assessments of tympanic membrane status using video-otoscopy recordings in an unselected pediatric population. Concordance between onsite otomicroscopy and asynchronous assessments of video-otoscopy recordings was found to be encouraging (weighted kappa range 0.66-0.79), and inter-rater agreement was excellent.

| PubMed 25017799 | Author Search

This report, from a number of American eye-care academies, reviews the literature on remote digital fundus imaging evaluations for retinopathy of prematurity (as opposed to the traditional, bedside, binocular, indirect ophthalmoscopy). It discusses the risk management considerations that should be used when including this technology in an ROP care program.

[su_cite_pediatrics url_fragment = ‘135/1/e238’ author = ‘Fierson’ year = ‘2014’] | PubMed 25548330 | Author Search

Update on pediatric applications to telehealth from the AAP, a technical report from the Section on Telehealth Care. Acknowledges the ongoing financial barriers but summarizes recent progress in getting paid for telehealth services.

[su_cite_pediatrics url_fragment = ‘136/1/e293’ author = ‘2015’ year = ‘Burke’] | PubMed 26122813 | Author Search

Compared web-based follow-up with standard, hospital-based follow-up via a retrospective cohort study of two low-risk newborn patient groups in 2011. They used ED visits (unexpected need for care) and costs as the outcomes of interest. The first group got standard care and the subsequent group used the web-based monitoring system. 16% of newborns who received the standard hospital-based follow-up had an ED visit in the first month of life compared with less than 6% of infants monitored by the web-based system. The cost of care in the hospital-based follow-up group was over double the cost for the web-based follow-up group, suggesting that this kind of follow-up would be cost-effective.

Isetta 2013 (J Med Internet Res)

| PubMed 23419609 | Author Search