Interactive telemedicine: effects on professional practice and health care outcomes

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This is a summary of the systematic review article published in Cochrane database of Systematic Reviews named "Interactive telemedicine: effects on professional practice and health care outcomes" by Flodgren et al[1]


Telemedicine(TM) or Telehealth is the use of telecommunication technologies to deliver medical care remotely. Example of telemedicine are electronic visits or e-visits such as telephonic visits and Audio-Video Televisits. It can improve patient health by improved access to health care services and can also reduce health-care costs. The objective of this review was to assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care.


Researchers in The Cochrane Collaboration searched the literature up to June 2013 and found 93 eligible randomized controlled trials from the following databases: The Effective Practice and Organisation of Care (EPOC) Group's specialized register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, NHS Economic Evaluation Database, Health Technology Assessment Database, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and PubMed. The authors also searched the gray literature and trial registries.The studies recruited participants with a number of clinical conditions: cardiovascular disease (36 studies), diabetes (21 studies), respiratory conditions (nine studies), mental health problems or substance abuse (seven studies), conditions requiring a specialist consultation (six studies), complex co morbidities (three studies), urogenital conditions (three studies), neurological injuries and conditions (two studies), gastrointestinal conditions (two studies), neonatal conditions requiring specialist care (two studies), patients recovering after solid organ transplantation (one study) and cancer (one study). Telemedicine provided remote monitoring or real-time video-conferencing.


The authors found no difference in mortality of participants with heart failure receiving care through telemedicine. Disease-specific quality of life was slightly improved for heart failure participants receiving telemedicine as compared to those receiving usual care only. Seven studies that recruited participants with different mental health and substance abuse problems reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. They found that telemedicine may improve glucose control in people with diabetes. There was some evidence for a decrease in LDL cholesterol, which is considered the 'bad' cholesterol, in participants allocated to telemedicine. The authors also found a greater decrease in blood pressure in those allocated to telemedicine compared to those that were allocated to usual care. A few studies reported improvement for those with a respiratory condition. Three studies of remote monitoring with automated alerts or risk stratification reported lower hospital re-admission costs for TM as compared with usual care.


The use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care. However, there is evidence that TM can improve the control of blood glucose in those with diabetes. Patients allocated to TM also showed reduced LDL cholesterol and blood pressure. The effectiveness of TM may depend on a number of different factors, including those related to the study population (e.g. the severity of the condition and the disease trajectory of the participants), the function of the intervention (e.g., if it is used for monitoring a chronic condition), or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.


Telemedicine is relatively a new technique in health care. To observe the effect of telemedicine, provision of health care using TM must be vastly implemented. TM might lead to improvement in management of certain chronic diseases such as blood pressure or cholesterol rather than many other chronic conditions(e.g. psychological conditions or gastroenteric diseases), which need Face-to-Face delivery of care.

There are certainly many diseases that can be treated via Telemedicine and according to many studies it is cost effective. However, patient safety is always a priority. Therefore, more work and experimenting must be continued.


  1. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.