Telehealth or telemedicine is the use of telecommunications technology to deliver health care services at-a-distance. One of the most commonly recognized benefits of telehealth is improved access to services which includes the opportunity for patients to receive care that otherwise would not be available due to lack of specialists in a geographic area, distance from health care facilities, or lack of transportation. By eliminating geographic considerations, global delivery of health care is possible. One of the barriers to the deployment and widespread use of telehealth is the lack of evaluative data or evidence to prove that this innovative model of service delivery is as effective as the traditional in-person model of delivering health care.
This study investigated the telehealth model of delivering speech-language pathology services at-a-distance. Pre-existing de-identified data were analyzed to describe the feasibility of, patient satisfaction with, and effectiveness of delivering voice therapy remotely using video-teleconferencing. The de-identified data were collected during the operationalization phase of a stepwise process to develop a telehealth vocal rehabilitation protocol. There were 31 participants in this study. Twelve participants in the control group received voice therapy in person at an urban medical center and 19 participants in the experimental telehealth group received voice therapy delivered via video-teleconferencing between the urban medical center and two remote sites: a rural satellite clinic and an overseas clinic.
Comparisons of pre- and post-treatment data on: 1) patient self-rating on the Voice Handicap Index, 2) auditory-perceptual ratings of voice samples, 3) visual-perceptual ratings of video endoscopic laryngeal exams, and 4) noise-to-harmonic ratios indicated no significant differences between participants who received voice therapy in-person and participants who received therapy remotely via video-teleconferencing. Quantitative analyses of four treatment outcome measures support the effectiveness of delivering voice therapy at-a-distance using video-teleconferencing technology.
Qualitative methods of evaluation were used to explore participants’ opinions and capture rich descriptions of their experiences with telehealth. Questionnaires and interviews focused on eliciting overall impressions including satisfaction with and comfort in receiving therapy remotely. Triangulation involved gathering accounts from participants in different roles and comparing results with different sources including existing literature and expert opinion. The following themes emerged from the data: benefits of telehealth (improved access to services, convenience, time savings, cost savings); clinical interactions via video-teleconferencing (initial approach and comfort level, therapy process, patient privacy and confidentiality, innovation); and response to telehealth services (comparing modes of receiving services, patient satisfaction, treatment outcomes). Based upon qualitative analysis of data, the telehealth vocal rehabilitation protocol appears to be: 1) feasible in terms of overcoming barriers to care, and 2) effective in terms of yielding desirable clinical outcomes. However, overcoming administrative, personnel, equipment, technical, workflow, and service delivery issues required time and effort to facilitate successful deployment.