A prospective evaluation of ENT telemedicine in remote military populations seeking specialty care.

This study evaluated telemedicine use in remote military treatment facilities (MTFs) ashore over a 4-month period to help guide telemedicine applications for shipboard medical departments. A prospective study design was used to evaluate specialty care provided by an ear/nose/throat (ENT) physician via videoconferencing (VC) for patients at remote MTFs in TRICARE Region 9. The study provided a complete and continuous sample of ENT consultations during a planned 4-month period. Data sources included a telemedicine database and telephone interviews to assess attitudes of physician and nonphysician medical personnel. A total of 193 VC consultations (hereafter referred to as teleconsultations) were conducted following referrals from primary providers. Patients were mostly young, male, active-duty personnel. Forty-five percent of the 193 teleconsultations resulted in changed diagnosis by the ENT specialist relative to initial diagnosis by the referring provider. This rate of clinical impact was substantial, and it generalized across various ENT conditions, demographics, and MTFs. Medical personnel reported generally positive attitudes about telemedicine technologies and the telemedicine process in TRICARE Region 9. Nonphysician providers reported slightly more favorable attitudes compared to physicians. These results suggest that ENT telemedicine has substantial clinical impact in the military populations treated at MTFs. A high rate of changed diagnoses (45%) was observed across age, gender, military status, ENT conditions, and treatment facilities. Medical personnel reported positive attitudes about using the telemedicine system. These results support the use of telemedicine in shipboard medical departments.