Assessment of Approaches to Evaluating Telemedicine. E. Indian Health Service

12/01/2000

The Indian Health Service (IHS) is funding 40-50 small telemedicine programs across the country. To date, the IHS has performed few formal evaluations. It performed a cost-benefit analysis on teleradiology, which included exclusively store-and-forward technology. The IHS also evaluated patient and clinician perceptions of a telepsychiatry program for Sioux children with Attention Deficit Hyperactivity Disorder (ADHD) in South Dakota. The focus of the evaluation was to compare measures of satisfaction between in-person and two-way interactive clinical encounters. Interactions were systematically rated by the evaluating physician, the child patient, and the child's parent or guardian. Provider reaction to and judgment about the interaction was evaluated by an 8-item questionnaire (containing a 5-point Likert scale) modified from Simonian et al., 1993. Child satisfaction with the interaction was measured using 7 of the 8 items of the Metro Assessment of Child Satisfaction (Simonian et al. 1993). Parent satisfaction with their child's health care visit was measured using the Pediatric Satisfaction Questionnaire (Finney et al., 1990), a modification of the Medical Interview Satisfaction Scale (Wolf et al., 1978). A total of 48 clinical interactions were included in the study, 20 of which were initial consultations. The results were as follows.

  • The clinician was significantly less satisfied with the initial encounter in the audiovisual (AV) mode. This difference was not found for follow-ups, perhaps because the clinician felt the therapeutic relationship with the family was already established.
  • The Child Satisfaction evaluation yielded no significant differences between onsite and AV interactions for either initial consultations or follow-ups.
  • The parent questionnaire yielded no significant differences between the AV and the onsite conditions for either initial evaluations or follow-ups.

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