Acute illness among children in day care has a high cost for parents, particularly those of low socioeconomic status, because they are often forced to miss work and lose pay to care for a sick child. The telemedicine model was designed to enable diagnosis and treatment decisions for acute problems that commonly arise in child care settings, using both real-time and store-and-forward information exchange between a child and telemedicine assistance in child care and an office-based telemedicine clinician. This descriptive study assesses its impact on absence from child care due to illness (ADI) in five inner-city child care centers in Rochester, N.Y., over a period of two and a half years. Child care staff with no prior health care training were trained to function as telemedicine assistants using commercially available computer equipment and telemedicine peripheral devices and broadband connections.

Parent survey responses were obtained from 229 parents of the 301 families who had a child evaluated through telemedicine. Among these respondents, 91.2 percent indicated that the telemedicine contact allowed them to stay at work, with the amount of time saved estimated on average at 4.5 hours per telemedicine visit. In addition, 93.8 percent indicated that the problem managed by telemedicine would otherwise have led to an office or emergency department visit. The authors observed a 63 percent reduction in ADI, but this may underestimate the potential for impact, because complex innovations do not mature in 2.5 years. Most often the telemedicine clinician both completed the visit and provided reassurance that exclusion from child care was not required. Even when a telemedicine visit leads to exclusion from child care, use of usual health services is generally avoided, which may reduce some ADI and some work loss.

The authors conclude that telemedicine holds substantial potential to reduce the impact of illness on children and families using child care.