Bratton, Robert L.

We evaluated user satisfaction with realtime telemedicine for monitoring vital signs. Over eight weeks, 20 patients and 12 residents in family medicine participated in the study. At the end of the study, the patients and doctors completed a questionnaire detailing satisfaction with the service. Responses were obtained from 18 of the 20 patients and were generally positive: 61 % were comfortable using the system and 94% did not believe that the technology had a negative effect on their relationship with the health-care provider. Eleven physician responses were obtained. Physicians were more uncertain about the benefits of the service: only 45% felt that telemedicine could adequately assess patients, although 82% felt that telemedicine would be an important part of primary-care services. From a user perspective, our study showed that patients were more satisfied with the telemedicine service than were doctors.

We evaluated the accuracy of an electronic stethoscope in the detection of irregular cardiac rhythms. Ten patients with either normal sinus rhythm or atrial fibrillation previously documented by electrocardiogram (ECG) were recruited from a local retirement community. Six senior family medicine resident physicians were asked to assess the cardiac rhythms of the subjects as either regular or irregular, in both a telemedical and an in-person examination. An ECG was obtained simultaneously as the gold standard. Forty-five of the 60 in-person assessments were correct, as were 49 of the 60 telemedicine assessments. The difference was not significant. Physician confidence in telemedical examination did not affect the accuracy of examination. The results of this study suggest that telemedicine-directed auscultation of patients may be just as successful as inperson examination for the detection of cardiac arrhythmias.

Studies of patient satisfaction are continually needed to provide feedback to the medical community about rapidly changing telemedicine technology. We accumulated data during 1998 from geriatric patients living in a retirement community based on their experience with telemedicine (one encounter a week for eight weeks). Responses to the items on a Likert scale were generally positive. A similar study was conducted with random patients at the same site two and a half years later. The results were once again positive and appeared to show an even better response than those obtained in the previous study. Thus, although the pilot study was small (20 patients, 18 reporting), this trend may reflect an increased acceptance of telemedicine applications among geriatric patients. Larger studies are needed to substantiate this claim.