Telemedicine Proof of Concept and Cost Savings During Underway Naval Operations

Military Doctors' and Nurses' Perceptions of Telemedicine and the Factors Affecting Use Intention

Purpose: This study investigated military doctors' and nurses' perceptions of telemedicine and the factors influencing their intention to use it based on the unified theory of acceptance and use of technology. Method: This study adopted a questionnaire-based, cross-sectional descriptive approach. It used a web questionnaire for data collection over a 5-week period, starting in June 2021. Results: A total of 72.6% of participants indicated that telemedicine is required in the military. The intention to use telemedicine was significantly higher among women, younger individuals (<30 years), and military nurses. In addition, factors such as voluntariness of use, performance expectancy, social influence, and facilitating conditions positively affected the intention to use telemedicine. Conclusions: To improve military doctors' and nurses' use and understanding of telemedicine, consensus must be reached regarding its use in military contexts. Discussions that incorporate opposing views should be encouraged as well. Moreover, the voluntariness of use significantly affected respondents' intention to use telemedicine. There is an urgent need, therefore, for in-depth analyses of the various factors associated with voluntariness of use of telemedicine; the resulting insights could be used to encourage military doctors and nurses to adopt telemedicine. Finally, along with promoting the use of smartphones for medical consultation among military personnel, military nurses' role should be extended to include health consultation using smartphones. This could promote the active use of telemedicine in military nursing, which could contribute to health promotion among military personnel.

Comparable quality performance between telemedicine and office‐based care for abnormal BMI screening and management

Background

Despite widespread adoption during COVID-19, there is limited evidence supporting the quality of telemedicine care in managing patients with abnormal BMI.

Objective

To evaluate the comparability of telemedicine and in-person (office) quality performance for abnormal body mass index (BMI kg/m2) screening and management in primary care.

Methods

This retrospective cohort study measured Healthcare Effectiveness Data and Information Set (HEDIS) quality performance for abnormal BMI screening (patients with BMIs <18.5 or >25 kg/m2 and a qualifying documented follow up plan) across an 8-hospital integrated health system seen via primary care from 4/1/20 - 9/30/21. Encounters were divided into three exposure groups: office (excluding telemedicine), telemedicine (excluding office), and blended telemedicine (office + telemedicine). Demographic stratification compared group composition. Chi squared tests determined statistical differences in quality performance (p = <0.05).

Results

Demographics of sub-groups for the 287,387 patients (office: 222,333; telemedicine: 1,556; blended-telemedicine: 63,489) revealed a modest female predominance, majority ages 26-70, mostly White non-Hispanics of low health risk, and the majority BMI representation was overweight, followed closely by class 1 obesity. In both HEDIS specified and HEDIS modified performance, blended-telemedicine performed better than office (12.56%, 95% CI 12.29%-13.01%; 11.16%, 95% CI: 10.85%-11.48%; p < 0.0001); office performed better than telemedicine (4.29%, 95% CI 2.84%-5.54%; 4.79%, 95% CI 3.99%-5.35%; p < 0.0001).

Conclusion

Quality performance was highest for blended-telemedicine, followed by office-only, then telemedicine-only. Given the known cost savings, adding telemedicine as a care venue might promote value within health systems without negatively impacting HEDIS performance.