Study Shows VA HIV and Hepatitis C Telemedicine Clinics Improve Patient Outcomes among Rural Veterans

BACKGROUND:
Limited access to subspecialty care is a major barrier to optimal care of patients infected with HIV and/or hepatitis C, particularly for those who live in rural settings. VA has taken a leadership role by heavily investing in telemedicine to better serve the 20% of Veterans who reside in rural areas. Expanding telemedicine access to HIV and hepatitis C subspecialty care has been identified as a top priority by VA leadership and VA/HSR&D's HIV/Hepatitis Quality Enhancement Research Initiative (QUERI). This HIV/Hepatitis-QUERI study assessed the impact of HIV and hepatitis C telemedicine consultation on patient-oriented outcomes in a rural VA patient population. The VA Greater Los Angeles Healthcare System's (VAGLAHS) HIV clinic initiated telemedicine consultations in February 2009, and the VAGLAHS hepatitis C clinic initiated telemedicine consultation in February 2010. Investigators collected both pre- and post-intervention data from 6/08 to 6/11 for 43 rural-dwelling Veterans who accounted for 94 telemedicine visits and 128 in-person visits to the HIV or hepatitis C subspecialty clinic.

FINDINGS:

• Among this rural-dwelling study sample, HIV and hepatitis C telemedicine clinics were associated with improved access, high patient satisfaction, and a reduction in health visit-related time.
• Clinic completion rates (proxy for access) were higher for telemedicine (76%) than for in-person visits (61%). Of the 43 Veterans in the study, 30 (70%) completed a telemedicine-facilitated survey. More than 95% of these Veterans rated telemedicine at the highest level of satisfaction and preferred telemedicine to in-person visits.
• Veterans estimated that total health visit time was 340 minutes less for telemedicine compared to in-person visits. The majority of perceived time reduction was related to travel.

NOTE:

• This intervention was implemented within an existing telemedicine infrastructure, without the need to hire additional staff or to purchase equipment.

LIMITATIONS:

• This was a convenience sample of patients with stable disease.
• Clinical markers of disease progression (e.g., viral load) were not tracked.
• Because only 70% of study participants completed the survey, there is the possibility of response bias.

AUTHOR/FUNDING INFORMATION:
This study was funded by VA/HSR&D's HIV/Hepatitis-QUERI (RRP 09-127). Drs. Asch and Goetz are part of HIV/Hepatitis-QUERI, and all authors are part of the VA Greater Los Angeles Healthcare System.

Saifu H, Asch S, Goetz M, Smith J, Graber C, Schaberg D, and Sun B. Evaluation of HIV and Hepatitis C Telemedicine Clinics. The American Journal of Managed Care April 2012;18(4):207-212.