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RRP 09-127 – HSR&D Study

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RRP 09-127
Evaluation of HIV and Hepatitis C Telemedicine Services
Benjamin C. Sun MD
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: October 2009 - April 2011

BACKGROUND/RATIONALE:
HIV and Hepatitis C are leading causes of mortality and morbidity in the United States. Patients with HIV infection and on treatment for Hepatitis C infection require close and frequent monitoring, and lack of readily available subspecialty care may negatively affect patient outcomes. To address this clinical need, the VA Greater Los Angeles Healthcare System is implementing HIV and Hepatitis C Teleconsultation services to two rural clinics. This project is an evaluation of these telemedicine efforts.

OBJECTIVE(S):
The objective of this study is to assess the impact of HIV/ Hepatitis C Teleconsultation Services on patient oriented outcomes, such as visit completion rates, health-care related travel, and patient satisfaction.

METHODS:
We performed a prospective cohort of study of patients assigned to HIV or Hepatitis C teleconsultation clinic. Specialty HIV or Hepatitis C providers at an urban based medical center performed clinical evaluations of patients at rural clinics using video-teleconferencing technology. Visit completion rates were compared to geography and condition matched historic controls. Data about health-care related travel and patient satisfaction were collected through semi-structured interview.

FINDINGS/RESULTS:
Telemedicine consultations began in 2009 for the HIV and Hepatitis C clinics. As of April 2011, there were 31 scheduled telemedicine visits. The visit completion rate for telemedicine was 77%, compared to 60% in a historic control group of 436 in-person clinic appointments (p<0.05). All 24 patients who attended their scheduled telemedicine clinic completed an interview. All respondents rated the highest level of overall satisfaction with telemedicine on a five-level Likert scale and all preferred telemedicine to an in-person visit. The median reduction in patient perceived health visit related time was 315 minutes (IQR 265-475, p<.0001), through reductions in both travel time (median 260 minutes, IQR 190-380) and time spent in clinic (median 102 minutes, IQR 45 -180).

IMPACT:
Telemedicine specialty services for HIV and Hepatitis C improves visit completion rates and is associated with high patient satisfaction and perceived reduction in health visit related time. Our study suggests that telemedicine services improve access and patient-oriented outcomes for Veterans with chronic HIV and hepatitis C infection. Long-term follow-up will be necessary to assess the safety and clinical outcomes of telemedicine care compared to conventional 'in-person' appointments.

PUBLICATIONS:
None at this time.


DRA: Infectious Diseases
DRE: Treatment - Observational, Technology Development and Assessment, Research Infrastructure
Keywords: Access, HIV/AIDS, QUERI Implementation, Telemedicine
MeSH Terms: none

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