Telemedicine on the rise but lagging in Canada

Brian Owens

doi:10.1503/cmaj.109-5634

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(Cost-)Effectiveness of telemedicine
Martin Hofmeister

Posted on: 14 November 2018

Posted on: (14 November 2018)
Page navigation anchor for (Cost-)Effectiveness of telemedicine
(Cost-)Effectiveness of telemedicine
Martin Hofmeister, PhD, Nutrition scientist, Consumer Centre of the German Federal State of Bavaria, Department Food and Nutrition, Germany
It is very much appreciated that in recent decades CMAJ readers have been regularly briefed on developments in telemedicine - as is currently the case in the article by Brian Owens in one of the September issues [1]. The first interesting telemedicine report in the CMAJ came from House and Roberts over 40 years ago [2]. Meanwhile, the general usability and effectiveness of telemedicine is documented by recent systematic reviews for the management of various diseases such as chronic heart disease, heart failure, diabetes, asthma, digestive disease or malnutrition [3-8]. Current meta-analyses of randomized controlled trials also showed that telemedicine intervention programs with a duration of six months or longer lead to a significantly greater reduction in HbA1c level and body mass index in patients compared to usual care [9, 10].
In the evaluated common barriers to implementing telemedicine, the high costs are always mentioned in addition to technological difficulties (lack of telematics infrastructure such as high-speed internet), lack of computer / eHealth literacy, resistance to change, lack of reimbursements, and age as well as level of education of the patient [11]. Focusing on the shared responsibility of the state and the economy, of society and the individual, I would like to point out that numerous current cost-benefit analyses of telemedicine confirm their healthcare cost-effectiveness in various health fields such as cardiology, diabetes management, ophth...
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It is very much appreciated that in recent decades CMAJ readers have been regularly briefed on developments in telemedicine - as is currently the case in the article by Brian Owens in one of the September issues [1]. The first interesting telemedicine report in the CMAJ came from House and Roberts over 40 years ago [2]. Meanwhile, the general usability and effectiveness of telemedicine is documented by recent systematic reviews for the management of various diseases such as chronic heart disease, heart failure, diabetes, asthma, digestive disease or malnutrition [3-8]. Current meta-analyses of randomized controlled trials also showed that telemedicine intervention programs with a duration of six months or longer lead to a significantly greater reduction in HbA1c level and body mass index in patients compared to usual care [9, 10].
In the evaluated common barriers to implementing telemedicine, the high costs are always mentioned in addition to technological difficulties (lack of telematics infrastructure such as high-speed internet), lack of computer / eHealth literacy, resistance to change, lack of reimbursements, and age as well as level of education of the patient [11]. Focusing on the shared responsibility of the state and the economy, of society and the individual, I would like to point out that numerous current cost-benefit analyses of telemedicine confirm their healthcare cost-effectiveness in various health fields such as cardiology, diabetes management, ophthalmology (especially diabetic retinopathy), pulmonary, dermatology or emergency medicine [3, 12-18]. For example, a recent evaluation of the diabetic retinopathy tele-ophthalmology screening program in Manitoba showed an average cost savings of 1,007 Canadian dollars per tele-ophthalmology examination [19]. Another recent French study by Le Goff-Pronost et al. on the clinical effects and costs of telemedicine for wound care management observed a shortened healing time in the telemedicine group (137 days) compared to control group with standard practice (174 days) and travel cost savings of 4,583 Euro per patient over the period of nine months [20]. The potential of telemedicine to generate cost savings for general practitioners was already reported more than 20 years ago [21]. Policy makers, local organizations, national funders, healthcare professionals and patients should remember that telemedicine-based healthy welfare (welfare = good health + happiness + prosperity) of the individual in summation is also an essential component of overall economic prosperity, which is expressed in monetary units [22].
Similar to Canada, the fear of telemedicine was also tremendous in Germany. Fortunately, the 121th Congress of German Physicians has relaxed the previously existing ban on exclusive advice and treatment via communication media in May 2018. In the future, physicians will be able to treat their patients exclusively on the telephone or via the internet in individual cases without prior personal first contact - a clear vote in favor of the expansion of telemedicine in Germany. It remains to be seen to what extent the Canadian health care system will also continue to ease state licensing limitations in the foreseeable future.

References

1. Owens B. Telemedicine on the rise but lagging in Canada. CMAJ 2018;190(38):E1149-50.

2. House AM, Roberts JM. Telemedicine in Canada. Can Med Assoc J 1977;117(4):386-8.

3. Kruse CS, Soma M, Pulluri D, Nemali NT, Brooks M. The effectiveness of telemedicine in the management of chronic heart disease - a systematic review. JRSM Open 2017;8(3):2054270416681747.

4. Tse G, Chan C, Gong M, Meng L, Zhang J, Su XL, et al. Telemonitoring and hemodynamic monitoring to reduce hospitalization rates in heart failure: A systematic review and meta-analysis of randomized controlled trials and real-world studies. J Geriatr Cardiol 2018;15(4):298-309.

5. Lee SWH, Chan CKY, Chua SS, Chaiyakunapruk N. Comparative effectiveness of telemedicine strategies on type 2 diabetes management: A systematic review and network meta-analysis. Sci Rep 2017;7(1):12680.

6. Chongmelaxme B, Lee S, Dhippayom T, Saokaew S, Chaiyakunapruk N, Dilokthornsakul P. The effects of telemedicine on asthma control and patients' quality of life in adults: A systematic review and meta-analysis. J Allergy Clin Immunol Pract 2018 Jul 25. pii: S2213-2198(18)30450-1. doi: 10.1016/j.jaip.2018.07.015. [Epub ahead of print].

7. Helsel BC, Williams JE, Lawson K, Liang J, Markowitz J. Telemedicine and mobile health technology are effective in the management of digestive diseases: A systematic review. Dig Dis Sci 2018;63(6):1392-408.

8. Marx W, Kelly JT, Crichton M, Craven D, Collins J, Mackay H, et al. Is telehealth effective in managing malnutrition in community-dwelling older adults? A systematic review and meta-analysis. Maturitas 2018;111:31-46.

9. Tchero H, Kangambega P, Briatte C, Brunet-Houdard S, Retali GR, Rusch E. Clinical effectiveness of telemedicine in diabetes mellitus: A meta-analysis of 42 randomized controlled trials. Telemed J E Health 2018 Aug 20. doi: 10.1089/tmj.2018.0128. [Epub ahead of print].

10. Huang JW, Lin YY, Wu NY. The effectiveness of telemedicine on body mass index: A systematic review and meta-analysis. J Telemed Telecare 2018 Jan 1:1357633X18775564. doi: 10.1177/1357633X18775564. [Epub ahead of print].

11. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018;24(1):4-12.

12. Delgoshaei B, Mobinizadeh M, Mojdekar R, Afzal E, Arabloo J, Mohamadi E. Telemedicine: A systematic review of economic evaluations. Med J Islam Repub Iran 2017;31:113.

13. Lee JY, Lee SWH. Telemedicine cost-effectiveness for diabetes management: A systematic review. Diabetes Technol Ther 2018;20(7):492-500.

14. Warren R, Carlisle K, Mihala G, Scuffham PA. Effects of telemonitoring on glycaemic control and healthcare costs in type 2 diabetes: A randomized controlled trial. J Telemed Telecare 2018;24(9):586-95.

15. Lee JJ, English JC 3rd. Teledermatology: A review and update. Am J Clin Dermatol 2018;19(2):253-60.

16. Vidal-Alaball J, Garcia Domingo JL, Garcia Cuyàs F, Mendioroz Peña J, Flores Mateo G, Deniel Rosanas J, et al. A cost savings analysis of asynchronous teledermatology compared to face-to-face dermatology in Catalonia. BMC Health Serv Res 2018;18(1):650.

17. Natafgi N, Shane DM, Ullrich F, MacKinney AC, Bell A, Ward MM. Using tele-emergency to avoid patient transfers in rural emergency departments: An assessment of costs and benefits. J Telemed Telecare 2018;24(3):193-201.

18. Langabeer JR 2nd, Champagne-Langabeer T, Alqusairi D, Kim J, Jackson A, Persse D, Cost-benefit analysis of telehealth in pre-hospital care. J Telemed Telecare 2017;23(8):747-51.

19. Kanjee R, Dookeran RI, Mathen MK, Stockl FA, Leicht R. Six-year prevalence and incidence of diabetic retinopathy and cost-effectiveness of tele-ophthalmology in Manitoba. Can J Ophthalmol 2017;52 Suppl 1:S15-8.

20. Le Goff-Pronost M, Mourgeon B, Blanchère JP, Teot L, Benateau H, Dompmartin A. Real-World clinical evaluation and costs of telemedicine for chronic wound management. Int J Technol Assess Health Care 2018 Oct 29:1-9. doi: 10.1017/S0266462318000685. [Epub ahead of print].

21. Armstrong IJ, Haston WS. Medical decision support for remote general practitioners using telemedicine. J Telemed Telecare 1997;3(1):27-34.

22. Pigou AC. The economics of welfare. - 2nd ed. - London: MacMillan & Co.;1924.
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Competing Interests: None declared.