Expanding Telemedicine to Include Primary Care for the Urban Adult

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Acute illness in adults remains a major morbidity and economic burden across the socioeconomic spectrum. Inner city families are least equipped to deal with the challenges presented during acute illness, limiting their engagement in activities that might improve their economic circumstances. Often, the challenge of illness is complicated by child care, multiple bus transfers, absenteeism from work or school, and inappropriate use of the emergency department (ED) due to inconvenient office hours. Care can be delivered too late, without regard to patient preference or values. Lack of timeliness of care can result in physical harm, emotional distress and higher costs. This article describes the effective use of telemedicine for the urban adult patient. A successful pediatric telemedicine program was expanded to include care for adults. The pilot program resulted in high levels of patient satisfaction, decreased loss of work time, and decrease in inappropriate use of the emergency department.