Synchronous video telemedicine in lower extremities ulcers treatment: A real-world data study

Alexander Gamus, Elad Keren, Hanna Kaufman, Gabriel Chodick

Research output: Contribution to journalArticlepeer-review


Introduction: With growing prevalence of lower extremity ulcers (LEU) and shortage of wound specialists, gaps in access to care may occur, particularly in remote areas. This gap can be mitigated with high-quality telemedicine (TM). This study aims to explore the effectiveness of synchronous video TM compared to the conventional face-to-face treatment (FTF). Methods: The study was conducted at Maccabi Healthcare Services, a 2.2-million-member sick fund in Israel. We reviewed all consecutive visits of LEU patients to wound care specialists between Jan 2013 and Jun 2017. Both TM and FTF modalities were implemented using identical treatment settings with the same nurse at each location. Study endpoint was ulcer healing as assessed by the treating specialist. Results: The study population included 650 LEU cases (n TM = 277, n FTF = 373) and contained 5203 visits. Comparable (P = 0.475) proportions of healed ulcers (52% in TM vs. 55% in FTF) were detected. Survival analyses found a non-significant advantage of TM (0.887; 0.650–1.212) compared to FTF. The non-inferiority of TM was demonstrated within the Δ = 0.15 range limits and 80% statistical power. Trial replication probability is 0.93. Conclusions: Synchronous video-conferencing based telemedicine may be a feasible and efficient method of LEU management.

Original languageEnglish
Pages (from-to)31-36
Number of pages6
JournalInternational Journal of Medical Informatics
StatePublished - Apr 2019


  • Israel
  • Lower extremities ulcers
  • Telemedicine
  • Wound therapy

All Science Journal Classification (ASJC) codes

  • Health Informatics


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