A pilot study of usefulness of clinician-patient videoconferencing for making routine medical decisions in the nursing home.
OBJECTIVE
To pilot and assess the role of videoconferencing in clinicians' medical decision-making and their interactions with nursing home residents (NHRs).


METHODS
Paired virtual and bedside examinations. Face-to-face (FTF) examination of NHRs by off-site clinicians immediately followed videoconferencing between the same clinician-NHR pair.


METHODS
A 240-bed, county-managed, urban nursing home.


METHODS
NHRs (n=35) and clinicians (n=3) receiving or providing routine care between 2002 and 2003.


METHODS
Orders generated by clinicians, clinicians' ratings of videoconferencing, and coded review of video encounters. After both examinations, clinicians rated the encounters and generated orders necessary for NHRs. Orders were categorized and counted according to timing (before or after the FTF visit). Clinician-NHR interactions were assessed using coding videos with a 31-item instrument.


RESULTS
For 71% of the encounters, clinicians stated that videoconferencing facilitated their assessment. Difficulties included sound quality (19%) and participants' familiarity with videoconferencing (7%). Although NHRs were alert in 50% of encounters, 62% of alert NHRs did not indicate understanding of the recommended treatment.


CONCLUSIONS
FTF examination was superior for most assessments, but videoconferencing was judged to be valuable, especially for wound care. Even when NHRs were alert, informed medical decision-making by NHRs with their clinicians was limited. Enhancing videoconferencing quality and providing more training about informed decision-making using videoconferencing might improve the effectiveness of the technology.
Laflamme
Mark R
MR
Regenstrief Institute, Inc., Indianapolis, Indiana 46202, USA. mlaflamme@regenstrief.org
Wilcox
David C
DC
Sullivan
Jacquelyn
J
Schadow
Gunther
G
Lindbergh
Donald
D
Warvel
Jill
J
Buchanan
Heydon
H
Ising
Terry
T
Abernathy
Greg
G
Perkins
Susan M
SM
Daggy
Joanne
J
Frankel
Richard M
RM
Dexter
Paul
P
McDonald
Clement J
CJ
Weiner
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D010817:Physician-Patient Relations; D010865:Pilot Projects; D014584:User-Computer Interface; D049269:Videoconferencing / Q000592:standards