Satellite-supplementation of Medical Outreach Clinics: a Feasibility Study

Much of the basic general medical care and chronic disease management in rural Honduras comes from groups of volunteers setting up temporary clinics run by volunteers. These clinics, also known as brigades, or medical missions, are often criticized for their lack of quality and the lack of follow-up, both of which stem, in part, from understaffing with volunteer physicians. This study is designed to assess if it is feasible, safe, and acceptable to treat patients in short-term mobile medical clinics in rural Honduras using US physicians connected with patients by videoconference.

Study Overview

• Status: Completed
• Conditions: Telemedicine; Primary Health Care; Diagnosis; Therapeutics; Developing Countries
• Intervention / Treatment: Other: Telemedicine; Other: In-person physician interaction

• Study Type: Interventional
• Enrollment (Actual): 144
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Honduras
  • Francisco Morazan
    • Tegucigalpa, Francisco Morazan, Honduras
      • Global Brigades

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Able to give informed consent
• Non-emergent medical complaints
• At least 18 yrs in age

Exclusion Criteria:

• Pregnancy
• Mental Disability

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Telemedicine First; Patients whose first physician visit during the clinic was using videoconference, a form of telemedicine, and whose second physician visit during the clinic was with a physician in-person.	Other: Telemedicine; Patients undergo a detailed history and examination to the degree that is possible using the videoconference program, skype, a digital camera for high-resolution images, and an electronic stethoscope. A clinic volunteer aids with examination, translation and documentation.; Other Names: Skype; Videoconference; Other: In-person physician interaction; Patients undergo a detailed history and examination by an in-person physician. A clinic volunteer aids with examination, translation and documentation, as needed.; Other Names: in-person visit; in-person examination; in-person consultation
Experimental: Telemedicine Second; Patients whose first physician visit during the clinic was with a physician in-person, and whose second physician visit during the clinic was using videoconference, a form of telemedicine. This is the reverse order of visits of the "Telemedicine fist" arm.	Other: Telemedicine; Patients undergo a detailed history and examination to the degree that is possible using the videoconference program, skype, a digital camera for high-resolution images, and an electronic stethoscope. A clinic volunteer aids with examination, translation and documentation.; Other Names: Skype; Videoconference; Other: In-person physician interaction; Patients undergo a detailed history and examination by an in-person physician. A clinic volunteer aids with examination, translation and documentation, as needed.; Other Names: in-person visit; in-person examination; in-person consultation
Active Comparator: Two physician visits; Patients who had two sequential visits with different in-person physicians.	Other: In-person physician interaction; Patients undergo a detailed history and examination by an in-person physician. A clinic volunteer aids with examination, translation and documentation, as needed.; Other Names: in-person visit; in-person examination; in-person consultation

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Clinical Diagnoses	The diagnoses resulting from the two physician visits will be compared and a cohen's kappa statistic will be calculated for diagnoses between the visits.	Same Day as clinic visit (less than 6 hours)
Recommended clinical treatments	After each of a patient's two physician visits, the physician's resulting recommended treatments will be gathered for comparison between the two visits.	Same Day as clinic visit (less than 6 hours)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient opinions of physician interactions	Patients will receive a survey following each interaction with a doctor. These surveys cover communication, comfort and satisfaction.	Immediately following physician interactions (less than 6 hours)
Physician opinions of patient interactions	doctors will fill out a survey about their patient interactions after they complete their experience volunteering with the clinic.	immediately following volunteer activities with the clinic (less than 48 hours)
Volunteer opinions of physician-patient interactions	Volunteers who helped with physician interactions will receive a survey about their experience concerning physician patient communication, volunteer educational value and perceived value of the experience.	immediately following experience with the clinic (Less than 48 hours)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cost	The costs of materials and services required to conduct the patient examinations will be collected to build an economic model and projected cost of scaling up the videoconference interventions.	One year (from pilot to completion of study)

Collaborators and Investigators

• Sponsor: Mayo Clinic
• Investigators: Principal Investigator: Bart Demaerschalk, MD/MSc, Mayo Clinic

Study record dates

Study Major Dates

• Study Start: February 1, 2013
• Primary Completion (Actual): June 1, 2013
• Study Completion (Actual): June 1, 2013

Study Registration Dates

• First Submitted: March 20, 2013
• First Submitted That Met QC Criteria: March 26, 2013
• First Posted (Estimate): March 29, 2013

Study Record Updates

• Last Update Posted (Estimate): May 12, 2014
• Last Update Submitted That Met QC Criteria: May 8, 2014
• Last Verified: May 1, 2014

More Information

Terms related to this study

• Keywords: Telemedicine; patient satisfaction; treatments; Videoconference; diagnoses; Diagnostic concordance; Treatment concordance; physician satisfaction; Medical Outreach Clinics; Medical Brigades; Medical Missions; Satellite Internet; VSAT; cross cultural telemedicine
• Additional Relevant MeSH Terms: Pathologic Processes; Disease
• Other Study ID Numbers: 13-000132