OBJECTIVE: This study compared direct costs of conducting structured clinical interviews via real-time interactive videoconferencing (known as telehealth) versus standard in-person methods with American Indians in rural locations. METHODS: Psychiatrists administered in person and via telehealth on two occasions the Structured Clinical Interview for DSM-III-R to 53 non-VA male, American-Indian veterans. Telehealth interviews were conducted by an integrated services digital network (ISDN) connection at 384 kbps. Direct costs were compared for the two interview modalities. Models for starting telehealth in new clinics and established clinics were created, and the models were further subdivided to examine 2003 and 2005 differences in transmission fees. Direct costs included transmission, personnel, travel, and equipment (where applicable). RESULTS: The model of conducting interviews via telehealth in new clinics cost about $6,000 more than in-person interviews in 2003. However, reduced transmission fees and a different videoconferencing setup resulted in telehealth interviews' costing $8,000 less than in-person interviews in 2005. The same pattern held true for the model for established clinics. Telehealth interviews cost $1,700 more than in-person interviews in 2003 but $12,000 less in 2005. Scenarios using nonphysician interviewers and current, rather than historical, transmission costs favored telehealth as a cost-effective means for clinical research. CONCLUSIONS: On the basis of current transmission costs, telehealth proved less expensive than in-person interviews. Telehealth may therefore increase the efficiency and decrease the cost of research with rural, remote, and underserved populations, facilitating the ease with which one can investigate health disparities in these otherwise neglected settings.
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