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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

1055 — Patient-Centered Communication during Telemedicine versus In-Person Medical Consultations

Agha Z (VA San Diego Healthcare System), Roter D (Johns Hopkins University), Schapira R (Clement J. Zablocki Milwaukee VAMC), Laud P (Medical College of Wisconsin)

Physician-patient communication is associated with patient satisfaction, patient adherence to medical advice, and positive medical outcomes. Whether telemedicine has a negative impact on physician-patient communication is not known. The objective of this study was to compare physician-patient communication during telemedicine and in-person medical consultations.

We conducted a RCT of 221 patients at Milwaukee VA hospital. Patients were randomized to in-person (IP) or telemedicine (TM) consultation. The same group of 9 physicians representing 3 specialties (pulmonary, rheumatology, and endocrine) provided an equal number of TM and IP consultations. Each physician-patient consultation was video-recorded and later analyzed using the Roter Interaction Analyses System (RIAS). The RIAS has been validated in numerous studies and is a reliable and valid measure of physician-patient communication. In this abstract we test differences in physician communication style during TM and IP visits.

Of 221 patients enrolled, 14 patients were out of study and 7 were missing video data. RIAS analyses were conducted for 200 patients (TM=100, IP=100). Linear mixed models were used for analyses, with type of visit (TM or IP) as fixed effect and physician as random effect. Patient-centered ratio (patient-centered communication categories / physician-centered communication) was similar for TM and IP visits (0.95 vs. 1.0, p=0.39). Physician data gathering on biomedical (p=0.45) and psychosocial topics (p=0.27) was similar in TM and IP visits. There was no difference in physician counseling/education (p=0.13) and patient activation (p=0.46) statements between TM and IP visits. Rapport building was higher during TM vs. IP (p=001). For each of these analyses a significant physician effect (p < 0.001) was present.

In this study, physician communication style was not affected by telemedicine. The individual physician factor was a significant predictor of patient-centered vs. physician-centered communication. Physicians with good communication style performed well (i.e. used patient-centered communication) irrespective of type of visit (IP or TM).

The VHA uses telemedicine for extending clinical services to remote populations. However, there are concerns that telemedicine may have a negative effect on physician-patient communication. Our study is the first RCT with detailed content analyses that provides evidence that telemedicine technology does not impede patient-centered communication.

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