The objective of this research is to determine whether the physical separation between patient and physician required during telemedicine has an effect on physician-patient communication and related outcomes, including patient and physician satisfaction, patient compliance, and patient understanding of medical care.

Condition	Treatment or Intervention
Telemedicine Physician-patient Relations Patient Satisfaction	Procedure: Telemedicine Care

The Veterans Administration system supports telemedicine to extend medical services to veterans in remote locations. This includes medical consultations between patients and physicians via videoconference telemedicine. At present, little is known about the impact of such telemedicine consultations on physician-patient communication and related outcomes of care for these medical encounters. Analyses of in-person medical encounters have shown that effective physician-patient communication is associated with improved health outcomes.

The randomized controlled trial will randomize 238 patients to receive either consultative care at the remote site via telemedicine with a consultant physician located at the Milwaukee VA (intervention) or by an in-person consultation with a consultant physician at the Milwaukee VA (control). The same group of consultant physicians (n = 9) will provide both in-person and telemedicine consultations. Patterns and quality of physician-patient communication for the telemedicine and in-person encounters will be measured and compared using the Roter Interaction Analysis System for assessment of communication. Outcomes of care, including patient and physician satisfaction with the medical encounter, patient compliance, and patient understanding of their health care after medical encounter will be assessed.

Patients in both arms of the study will have their medical encounter video recorded. The Roter Interaction Analysis System will be used for coding of the verbal and nonverbal communication during these encounters. Data on patient and physician satisfaction with the encounter and patient understanding of their medical problems will be collected at the end of each medical encounter. Patient compliance (medication refill behavior) will be assessed at 90 days by VA pharmacy database review. The frequency of key communication behaviors during the telemedicine and in-person encounters will be compared using the analysis of a Linear Mixed Model. Comparison of patient satisfaction, physician satisfaction, patient compliance, and patient knowledge measures between telemedicine and in-person groups will be conducted with similar Linear Mixed Models.

Ages Eligible for Study:  18 Years and above,  Genders Eligible for Study:  Both

Criteria

Inclusion Criteria:

• Only adult (age>18) patients referred from the Appleton Clinic are eligible
• All Appleton patients who are considered new patient referrals (ie, have never been seen in the pulmonary, rheumatology, and endocrine clinics at the Milwaukee VA) will be eligible
• Appleton patients who have previously been seen by any of the nine participating endocrine, pulmonary, and rheumatology physicians at the Milwaukee VA will be eligible. These follow-up patients will be scheduled with the previously seen participating physician, so there is no disruption of the ongoing patient-provider relationship
• Patients with disabilities other than those mentioned will be eligible

Exclusion Criteria:

• Patients that have established care with a non-participating provider will not be eligible
• Patients that have been referred to the specialist for an outpatient procedure (eg, request to perform pulmonary function testing or bronchoscopy) will not be eligible
• Repeat visits to the same or any other participating physician will not be eligible
• Adult patients who have a significant communication disability (severe speech and hearing impairment, severe dementia, or mental health condition resulting in a non-communicative patient) and are considered mentally competent to provide informed written consent will not be eligible

Wisconsin
      Clement J. Zablocki VA Medical Center, Milwaukee,  Wisconsin,  53295,  United States

Study ID Numbers:  TEL 20-036
Record last reviewed:  March 2004
Record first received:  March 27, 2003
ClinicalTrials.gov Identifier:  NCT00057083
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2004-11-09