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INFORMATION IN PRACTICE: Frances Mair and Pamela Whitten Systematic review of studies of patient satisfaction with telemedicine BMJ 2000; 320: 1517-1520 [Abstract] [Full text]

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Correction: New Zealand is not a state of Australia!

Amanda Oakley   (6 June 2000)

Patient Satisfaction and Telemedicine

Victor Patterson, Richard Chua, John Craig   (12 June 2000)

Patients' satisfaction with telemedicine

Badal Pal   (14 June 2000)

Correction: New Zealand is not a state of Australia! 6 June 2000
Amanda Oakley, Clinical Director, Department of Dermatology Health Waikato Ltd, Hamilton, New Zealand Send response to journal: Re: Correction: New Zealand is not a state of Australia!	I thank Drs Mair and Whitten for including our paper [their reference 9] in their review of studies of patient satisfaction with telemedicine published between 1966 and 1998. However, their table indicating the location of such studies suggests ours was conducted in Australia - the very title of the paper should have revealed their error. The authors may be interested in a later publication [1] which includes the results of a similar patient satisfaction survey, which was completed by 73 new patients who attended a scheduled teledermatology clinic. Patients were generally delighted to attend appointments close to home. More recent studies by ourselves [2] and others have used questionnaires in an attempt to quantify the savings in time and money to be made by the telemedicine patient. [1] Oakley AMM, Duffill MB, Reeve P. Practising dermatology by telemedicine. NZ Med J 1998;111:296-9. [2] Oakley AMM, Kerr P, Duffill M, Rademaker M, Fleischl P, Bradford N, Mills C. Patient cost-benefits of realtime teledermatology - a comparison of data from Northern Ireland and New Zealand. J Telemed Telecare 2000;6:97-101
Patient Satisfaction and Telemedicine 12 June 2000
Victor Patterson, Consultant Neurologist Institute of Telemedicine, Royal Victoria Hospital Belfast BT12 6 BA, Richard Chua, John Craig Send response to journal: Re: Patient Satisfaction and Telemedicine	As practising clinicians trying to develop telemedicine applications in neurology, we were interested to read the Systematic Review of Studies of Patient Satisfaction with Telemedicine by Mair & Whitten (BMJ 3 JUNE 2000) The principal reason for the methological deficiencies they found are probably due to the place of patient satisfaction studies within telemedicine applications in general. The aim of developing any telemedicine application is to show that it is effective and cost- effective. Before doing that it is necessary to show that it is feasible, safe, reproducible and has reasonable patient satisfaction. The aim of satisfaction studies is therefore to show that the process is reasonably tolerated and acceptable to patients; it would be probably inappropriate to proceed to a full effectiveness study if, for example, more than 50% of patients were dissatisfied. Such end points are therefore much less sophisticated than those of the rather more academically rigorous studies envisaged by Mair & Whitten. Secondly, it would be interesting to compare their review to one of satisfaction with face-to-face studies, the gold standard against which much telemedicine is compared. In devising a satisfaction questionnaire for a randomized controlled study of telemedicine for neurology outpatients, we were struck by the paucity of patient satisfaction studies for face-to-face neurological consultations. Finally, Mair & Whitten urge us to use “instruments which have undergone rigorous testing and have been shown to produce repeatable results and to measure what they are intended to measure”. Do these actually exist or is this academic wishful thinking? Yours etc, Victor Patterson, Consultant Neurologist Richard Chua, Research Fellow in Teleneurology John Craig, Specialist Registrar in Neurology Institute of Telemedicine, Royal Victoria Hospital, Belfast BT12 6BA
Patients' satisfaction with telemedicine 14 June 2000
Badal Pal Send response to journal: Re: Patients' satisfaction with telemedicine	Sir - I read with interest the paper by Mair & Whitten on a systematic review of patient satisfaction with telemedicine(BMJ, 3 June 2000) . I wish to comment on some of the issues the authors felt needed addressing such as types of consultations suitable for telemedicine,effects on doctor-patient relationship, communicative factors affecting delivery of healthcare and possible limitations of telemedicine (the authors did not consider the likely advantages in their discussion). I wish to draw your readers' attention to our telemedical projects and highlight the positive aspects of our experience in the field of rheumatology and osteoporosis in contrast to the mainly negative conclusions drawn by the authors albeit their main focus was on interactive video. In 1995 I conducted a questionnaire survey of out-patients regarding a proposed telephone follow-up service.(1). As there was great enthusiasm, I commenced a pilot telephone follow-up service in rheumatology (2) and a subsequent patient -satisfaction survey of this service was so good (90% satisfied or very satisfied compared to 94% attending clinic ) that I have now been providing this routinely ever since. I have found this a very rewarding and patient-friendly service with many advantages such as saving costs and travelling times and reducing unnecessary clinic visits and non -attendance to a minimum whilst maintaining continuity of care. A substantial proportion of patients can be discharged on telephone follow- up e.g.those who have responded well to out-patient joint procedures or where the patient simply needed results of recent investigations and reiteration of advice already given. This service may also be suitable for other chronic disciplines such as neurology or dermatology. My further work has been in providing a cyberclinic service in my specialty for new referrals(3). The idea is to start off necessary investigations and provide interim advice whilst the patient waits for the crucial first appointment to the clinic which in most centres continue to be prolonged. As the main clues to a diagnosis in rheumatic disease rest on a detailed history, my on-line questionnaire is designed to do this at a minimal cost and obvious benefits to the patients and their referring doctors. Easy and fast access of patients to their specialists via e-mail (to avoid delays on telephone or post) is also of importance now (4) and very much appreciated by the patients themselves, an aspect not easily demonsrtated by reviews of the type undertaken by Mair and Whitten. Many telemedical initiatives are constrained by costs and technical failures and, therefore, acceptance by patients and providers may be limited. Simpler applications of telemedicine as demonstrated by my projects obviating these drawbacks are worthy of further exploration in the delivery of healthcare. Badal Pal, Consultant Rheumatologist, University Hospitals, South Manchester. Reference: 1. Pal B, Morris J : Will patients accept follow-up by telephone? A survey of ambulatory patients' attitudes in the UK. Rheumatology in Europe 1997:26/4: 156-158. 2. Pal B: Following up out-patients by telephone: pilot study. BMJ 1998;316:1647. 3. Pal B, L aing H, Estrach C. A cyberclinic in rheumatology. JRCP London 1999;33:161-162. 4. Pal B. Email contact between patient and doctor. BMJ 1999;318:1428.