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Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial

View Article: PubMed Central - PubMed

ABSTRACT

Background: Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference.

Method: We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed.

Results: Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. ‘better’) at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as ‘good’ or ‘very good’. In the ancillary analyses, there was no significant difference between the two groups.

Conclusions: This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application.

Trial registration: ClinicalTrials.gov identifier: NCT00616837

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1717-7) contains supplementary material, which is available to authorized users.

No MeSH data available.


Flow diagram of the enrollment, allocation, follow- up and data collections points
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Fig1: Flow diagram of the enrollment, allocation, follow- up and data collections points

Mentions: Eligible patients from the four municipalities were recruited between November 2007 and August 2012 and were seen at the outpatient clinic at the first available slot after randomisation, or for follow-up patients, when scheduled. The last consultation in the study was conducted in October 2012. A review of the patient files was performed between May 2013 and October 2014. The baseline characteristics are shown in Table 2; they did not reveal any significant differences between the groups. Figure 1 shows the flow chart, including the data collection points. A total of 559 consultations (257 at UNN and 302 at RMC) from 389 patients (190 at UNN and 199 at RMC) were included. The specialists’ evaluation questionnaires were completed for all of the consultations (100 %); one consultation in each group missed all of the questions, forming the sum score (0.5 %). A total of 547 (98 %) of the patients completed the questionnaire (249 at UNN and 298 at RMC). One patient in each group did not attend their follow-up appointments due to other more serious disorders. A total of 125 (66 %) of the UNN-allocated patients versus 136 (68 %) of the RMC participants returned the 3-month questionnaire, and 143 (75 %) and 144 (73 %) returned the 12-month questionnaire. All 389 participating patients’ electronic medical records were reviewed as planned. Four patients from UNN and two from RMC died of other disorders within two years after their last consultation.Table 2


Quality of care for remote orthopaedic consultations using telemedicine: a randomised controlled trial
Flow diagram of the enrollment, allocation, follow- up and data collections points
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5017045&req=5

Fig1: Flow diagram of the enrollment, allocation, follow- up and data collections points
Mentions: Eligible patients from the four municipalities were recruited between November 2007 and August 2012 and were seen at the outpatient clinic at the first available slot after randomisation, or for follow-up patients, when scheduled. The last consultation in the study was conducted in October 2012. A review of the patient files was performed between May 2013 and October 2014. The baseline characteristics are shown in Table 2; they did not reveal any significant differences between the groups. Figure 1 shows the flow chart, including the data collection points. A total of 559 consultations (257 at UNN and 302 at RMC) from 389 patients (190 at UNN and 199 at RMC) were included. The specialists’ evaluation questionnaires were completed for all of the consultations (100 %); one consultation in each group missed all of the questions, forming the sum score (0.5 %). A total of 547 (98 %) of the patients completed the questionnaire (249 at UNN and 298 at RMC). One patient in each group did not attend their follow-up appointments due to other more serious disorders. A total of 125 (66 %) of the UNN-allocated patients versus 136 (68 %) of the RMC participants returned the 3-month questionnaire, and 143 (75 %) and 144 (73 %) returned the 12-month questionnaire. All 389 participating patients’ electronic medical records were reviewed as planned. Four patients from UNN and two from RMC died of other disorders within two years after their last consultation.Table 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Decentralised services using outreach clinics or modern technology are methods to reduce both patient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such modality. Before new technologies are implemented, it is important to investigate both the quality of care given and the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality of planned remote orthopaedic consultations by help of videoconference.

Method: We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients referred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire. The primary outcome measurement was the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority of the intervention group. The study design was based on the intention to treat principle. Ancillary analyses regarding complications, the number of consultations per patient, operations, patients who were referred again and the duration of consultations were performed.

Results: Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation and 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation, was significantly lower (i.e. ‘better’) at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence interval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98 % of the video-assisted consultations as ‘good’ or ‘very good’. In the ancillary analyses, there was no significant difference between the two groups.

Conclusions: This study supports the argument that it is safe to offer video-assisted consultations for selected orthopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments of the economic aspects and patient satisfaction are needed before we can recommend its wider application.

Trial registration: ClinicalTrials.gov identifier: NCT00616837

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1717-7) contains supplementary material, which is available to authorized users.

No MeSH data available.