Introduction
In the context of limited healthcare funding and a rapidly expanding population of older people, it is increasingly difficult for healthcare systems to provide high-quality specialty care to rural populations [1]. Further, patients may be unwilling or unable to travel for healthcare due to costs, difficulty with transport, disability, and/or frailty. Consequently, telehealth has increasingly become a viable option for providing long distance healthcare for rural and remote residents, many who lack primary care and have limited access to specialist care.
Telehealth is an umbrella term for a variety of approaches to care including use of telephone, videoconferencing (VC), short message systems (SMS), apps, or some combination of these modalities [2]. Research has involved comparison of these very broadly defined, multifaceted telehealth interventions to usual care. Systematic reviews comparing telehealth modalities to usual care in patients with chronic diseases have reported reductions in all-cause mortality and hospital admissions in patients with heart failure (HF) and decreases in glycosated hemoglobin (A1C) in type 2 diabetics [[3], [4], [5]].
There has been limited comparison of the effectiveness of specific technologies, such as telephone and videoconference [4]. The use of telephone for long distance health care has been compared to face-to-face (FTF) visits and to other modalities such as telemonitoring [1]. In a review of five studies examining general practitioner telephone consultations with FTF consultations, Downes et al. [6] found patients more satisfied, consultation times reduced, and consultation follow-up increased with telephone compared to FTF. Inglis and colleagues [1] similarly found that structured telephone support and telemonitoring programs for patients with HF reduced all-cause mortality and HF-related hospitalizations, improved quality of life, HF knowledge, and self-care behaviors. VC, used in management of chronic diseases such as COPD [7], diabetes [8], and depression [9], has similarly been shown to be equivalent to, or better than FTF care. In the treatment of depression, there were no significant differences in symptoms, quality of life, and satisfaction between VC and FTF modalities [9]. VC used with diabetics resulted in significant decreases in A1C and cholesterol compared to a FTF educational session [8] while COPD patients receiving VC showed non-significant improvements in quality of life and walking distance compared with controls [7].
Despite telephone as the most widely studied form of telehealth [4] and the growing use of VC in distance healthcare delivery, comparison of these two modalities has been surprisingly limited and there has been no synthesis of existing evidence. Comparing different approaches to telehealth to obtain evidence that maximizes outcomes while reducing costs is of considerable importance. Further, evidence is limited as to the impact of different telehealth modalities on patient, provider, and system outcomes [10]. Therefore, the purpose of this review was to directly compare the effectiveness of telephone versus VC on patient, provider, and health system outcomes.