Patient attitudes toward a Web-based system for monitoring chronic wounds

This study evaluated patient attitudes toward a store-and-forward telemedicine system for monitoring chronic wounds treated topically, as well as chronic wounds that have been excised and surgically closed. The system involved collection and transmission via the Internet of digital photos and other patient and wound data by a nurse, and assessment by the telemedicine physician via the Web at a later time. For each patient, wound status was assessed in-person by a physician, as well as by the telemedicine system. Our hypotheses posited that patient attitudes toward telemedicine would improve over time as they become more accustomed to the telemedicine procedures. Sixty-nine patients from two Veterans Affairs medical centers participated, including inpatients and outpatients with pressure ulcers at stage 2, 3, or 4, surgically repaired pressure ulcers, diabetic foot ulcers, or venous stasis ulcers. A questionnaire developed for the study was administered to each participant at the first and third visits. Patients were generally comfortable with the use of a telemedicine system to assess wound status. Less than 25% of the patients felt that using telemedicine at home would be worse than visiting their physician in terms of the quality of care, even though about 85% of the patients felt that it was "important" or "very important" to be seen in person by a doctor for a pressure sore. Perhaps more importantly, less than 12% of the patients felt "somewhat or very unconfident" that their doctors would be able to know about the pressure sore by the use of this system instead of seeing the wound in person. Considerable effort was required for collecting the telemedicine data; however, a significant decrease was seen in time spent collecting these data from first visit to subsequent visits (mean difference = 25.2 min, p < 0.01), and a significant difference in time spent was seen across different wound types. These findings suggest that the ideal system of care, as perceived by patients, might be routine monitoring using the telemedicine system, with occasional in-person visits to a physician, and that the value of the system may vary by wound type and setting.