Perceptual and clinical impacts of the use of telemedicine technologies on rural hemodialysis patients and healthcare providers

Background: For people living in Michigan's rural Upper Peninsula, access to health services is a challenge. Hemodialysis patients are particularly vulnerable to the challenges of accessing specialty healthcare services. Geographic constraints, treatment times, interruption of activities, and complications that arise from their health status drain the quality of life for these individuals. The most frequent reason for refusal of dialysis in the UP is the disruption of lifestyle combined with difficulty of travel. Objective/Purpose: This study investigated clinical outcomes and patient/provider perceptions of a telemedicine program connecting rural dialysis centers in Michigan's Upper Peninsula to tertiary medical center Marquette General Health System (MGHS). This telemedicine program was designed to reduce patient/provider travel while assuring compliance with the new CMS standard of care structure change which required patients to visit nephrologists 3-4 times per month. Methods: To understand perceptions of patients/providers utilizing the telemedicine services, telephone surveys were conducted with 34 patients and 6 providers. To document clinical outcomes from telemedicine, clinical data from six months were analyzed for 45 telemedicine patients and compared against the Renal Network 11 recommendations for dialysis centers. Results: Survey data indicate that patients and providers have positive perceptions of the telemedicine system and the level of care. Furthermore, analysis indicated that patient/provider consults via telemedicine were effective as patients averaged clinical measures that met or exceeded recommendations set forth by Renal Network 11 in 6 of 8 benchmarks. Discussion/Conclusions: As patients and providers report positive perceptions of the telemedicine system and results indicate that the level of care provided is acceptable, it is concluded that providing consults via telemedicine technologies is a viable solution to challenges encountered by rural dialysis patients. However, traditional barriers to telehealth adoption documented in prior research by the study authors must be addressed to impact widespread diffusion of this application.