The Veterans Administration system supports telemedicine to provide medical consultations between patients and physicians via videoconference. At present, little is known about the impact of such telemedicine consultations on physician-patient communication and related health outcomes. Analyses of in-person medical encounters have shown that effective physician-patient communication is associated with improved health outcomes. To determine whether the physical separation between patient and physician required during telemedicine has an affect on physician-patient communication and related outcomes, including, patient and physician satisfaction, patient compliance, and patient understanding of medical care. The randomized controlled trial will randomize 238 patients to receive either consultative care at the remote site via telemedicine with a consultant physician located 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 will provide both in-person and telemedicine consultations.

Patients in both arms of the study will have their medical encounter video recorded. Patterns and quality of physician-patient communication for the telemedicine and in-person encounters will be compared using the Roter Interaction Analysis System. 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 post visit. The frequency of 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.

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

Further Study Details: 

Expected Total Enrollment:  238

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

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 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. Patients with disabilities other than those mentioned will be eligible.

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

Study ID Numbers:  TEL 20-036
Record last reviewed:  March 2005
Last Updated:  March 18, 2005
Record first received:  March 27, 2003
ClinicalTrials.gov Identifier:  NCT00057083
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08