title: Evaluation of human immunodeficiency virus and hepatitis C telemedicine clinics.
abstract: Geographical barriers to subspecialty care may prevent optimal care of patients living in rural areas. We assess the impact of human immunodeficiency virus (HIV) and hepatitis C telemedicine consultation on patient-oriented outcomes in a rural Veterans Affairs population.
  
  
  
  This was a pre- and post-intervention study comparing telemedicine with in-person subspecialty clinic visits for HIV and hepatitis C. Eligible patients resided in 2 rural catchment areas. The primary binary outcome was clinic completion. We estimated a logistic regression model with patient-level fixed effects. This approach controls for the clustering of visits by patient, uses each patient's in-person clinic experience as an internal control group, and eliminates confounding by person-level factors. We also surveyed patients to assess satisfaction and patient-perceived reductions in health visit-related time.
  
  
  
  There were 43 patients who accounted for 94 telemedicine visits and 128 in-person visits. Clinic completion rates were higher for telemedicine (76%) than for in-person visits (61%). In regression analyses, telemedicine was strongly predictive of clinic completion (OR 2.2; 95% confidence interval [CI]: 1.0-4.7). The adjusted effect of telemedicine on clinic completion rate was 13% (95% CI: 12-13). Of the 30 patients (70%) who completed the survey, more than 95% rated telemedicine at the highest level of satisfaction and preferred telemedicine to in-person clinic visits. Patients reported a significant reduction in health visit-related time (median 340 minutes, interquartile range 250-440), mostly due to decreased travel time.
  
  
  
  HIV and hepatitis C telemedicine clinics are associated with improved access, high patient satisfaction, and reduction in health visit-related time.
authors.affiliation: Department of Medicine, VA Greater Los Angeles Health, Los Angeles, CA 90073, USA. Hemen.Saifu@va.gov
authors.forename: Hemen N
authors.initials: HN
authors.lastname: Saifu
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.forename: Jason P
authors.initials: JP
authors.lastname: Smith
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Graber
authors.forename: Dennis
authors.initials: D
authors.lastname: Schaberg
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Sun
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration; D002140:California; D002391:Catchment Area, Health; D015331:Cohort Studies; D015658:HIV Infections / Q000628:therapy*; D006526:Hepatitis C / Q000628:therapy*; D006801:Humans; D009819:Office Visits / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D012044:Regression Analysis; D019114:Remote Consultation; D012424:Rural Population