title: Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review.
abstract: BACKGROUND
  A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine.
  
  
  METHODS
  The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant.
  
  
  CONCLUSIONS
  Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, PO Box 6060, N-9038 Tromsø, Norway. r_wootton@pobox.com
authors.forename: Richard
authors.initials: R
authors.lastname: Wootton
authors.forename: Kambiz
authors.initials: K
authors.lastname: Bahaadinbeigy
authors.forename: David
authors.initials: D
authors.lastname: Hailey
mesh_terms: D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003880:Dermatology / Q000191:economics / Q000706:statistics & numerical data*; D005069:Evaluation Studies as Topic; D005260:Female; D006282:Health Personnel / Q000191:economics; D006801:Humans; D008297:Male; D009664:Norway; D017216:Telemedicine / Q000191:economics / Q000706:statistics & numerical data*; D014195:Travel / Q000191:economics* / Q000706:statistics & numerical data