A large scale telemedicine trial published in The Lancet demonstrates that virtual outpatient appointments conducted using videoconference technology can reduce unnecessary and duplicated tests and improve patient satisfaction.

Unexpectedly, however, the study did not produce a drop in the number of follow up appointments needed after the initial consultation. In fact 52% of patients in the telemedicine group were offered follow up appointments compared with 41% in a group who attended a standard outpatient appointment.

The study involved 2094 patients in London and Shrewsbury and researchers and staff from the Royal Free and University College Medical School, London; the London School of Hygiene and Tropical Medicine; University College Hospitals R&D Directorate, London; the MRC Biostatistics Unit, Cambridge; and the University of Wales’ School of Health Science, Swansea.

Patients were randomly allocated to standard outpatient appointments or “virtual outreach” appointments in which the specialist, GP and patient link up together via a videoconference. Patients in both groups were followed up for six months.

The researchers say that the higher rate of follow up appointments for telemedicine patients varied substantially between hospitals and specialties and was probably due to the specialists’ differing needs to see the patient again in hospital for a direct examination.

Paul Wallace, professor of primary care and population sciences at the Royal Free and University College Hospitals, commented,”The findings of this trial have important implications for the design and implementation of virtual outreach services within healthcare systems and suggest that appropriate selection of patients, significant service reorganisation and provision of logistical support for arranging consultations will be require to enabled such services to operate efficiently.

”The extent to which virtual outreach is actually implemented will also be dependant on factors such as demand by patients, costs, incentives for GPs to allocate additional time to this activity and the attitudes of staff working in GP and hospital settings.”