More than 3 years of teleconsultations: A retrospective cohort study in specialized outpatient palliative care

Background: Telemedicine in palliative care is advancing to conquer challenges like staff shortages and limited access. Though feasibility and acceptance are proven, the clinical effects of teleconsultations (a nurse on-site consulting with a remote physician) have yet to be studied. The impact on physicians' workload or which patients it suits best, remain unclear. Aim: This study analyses the effect of teleconsultations on physician quota (number of physician-attended home visits divided by total number of home visits) and hospitalizations in specialized outpatient palliative care (SOPC) after 3 years of use in Aachen, Germany. Design: In a single-center, retrospective cohort study (September 2019-March 2023), clinical data was retrieved from a palliative care provider. Setting/Participants: 1756 patients with diseases from all medical disciplines received care during the observation period. By clinicians' choice 384 received teleconsultations, while 1372 did not. Results: 833 teleconsultations were conducted. Telemedicine patients were younger (72.8 +/- 12.5 years vs. non-telemedicine 74.4 +/- 12.8 years, p = 0.011), presented more diagnoses (p < 0.001), while scope of symptoms and diagnoses was equivalent. Telemedicine patients had a longer duration of stay within the SOPC and more home visits. Physician quota in the telemedicine group was lower (p < 0.001). A matched pairs analysis (n = 726) showed no significant difference in hospitalizations. Conclusions: Telemedicine can reduce physician quota, alleviating personnel shortages while providing time for care-intensive patients and creating capacity for more patients. Telemedicine seems suited for multimorbid, long-term patients. A matched pairs analysis showed no difference in hospitalizations in telemedicine patients.