Proactive Telemedicine to Improve Healthcare Access and Prevention in Rural Primary Care (PTM) (PTM)

December 22, 2025 updated by: Robert Panades Zafra, Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Evaluation of the Efficiency of Proactive Telemedicine vs Face-to-Face Visits for Universal Access and Health Prevention in a Rural Primary Care Team: Randomized Non-Inferiority Clinical Trial

The study evaluates whether Proactive Telemedicine (PTM) can improve healthcare access for individuals who have not contacted their primary care team for at least one year, compared with face-to-face visits. PTM consists of brief, remote behavioral interventions addressing modifiable risk factors such as tobacco use, alcohol consumption (AUDIT-C: Alcohol Use Disorders Identification Test - Consumption), physical activity (IPAQ: International Physical Activity Questionnaire), and Mediterranean diet adherence (PREDIMED: Prevención con Dieta Mediterránea). PTM follows national preventive protocols including PAPPS (Programa de Actividades Preventivas y de Promoción de la Salud) and uses validated tools such as EuroQol-5D-5L (EQ-5D-5L) to measure healthcare accessibility and quality-of-life outcomes. This randomized non-inferiority trial aims to determine whether PTM is as effective and safe as traditional in-person consultations.

Study Overview

Status

Active, not recruiting

Conditions

Intervention / Treatment

Detailed Description

Healthcare systems, particularly in rural and aging populations, face persistent challenges in ensuring equitable and universal access. Many individuals do not regularly engage with primary care services due to geographical, socioeconomic, organizational, or personal barriers. Digital health initiatives, including the World Health Organization's Global Strategy on Digital Health 2020-2025, highlight telemedicine as a key tool to improve accessibility and support preventive care.

Proactive Telemedicine (PTM) is a model in which primary care professionals initiate remote contact with individuals who have not interacted with their healthcare team for at least one year. The intervention uses synchronous (telephone) and asynchronous (secure messaging) communication to deliver brief behavioral counseling based on cognitive-behavioral and motivational interviewing principles. These interventions target modifiable lifestyle factors such as smoking, alcohol consumption, physical inactivity, and dietary patterns, and are aligned with national preventive care recommendations.

This randomized non-inferiority trial evaluates whether PTM provides accessibility, preventive impact, and user experience comparable to face-to-face consultations. The study examines whether proactively delivered telemedicine can serve as a scalable and acceptable strategy to increase engagement with primary care services in underserved rural areas. The information obtained will help determine the feasibility, effectiveness, and future implementation potential of PTM within broader healthcare systems.

Study Type

Interventional

Enrollment (Actual)

120

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Spain
    • Barcelona
      • Igualada, Barcelona, Spain, 08700
        • EAP Anoia rural. Gerència d'Atenció Primària i a la comunitària Penedès. Institut Català de la Salut. Departament de Salut. Generalitat de Catalunya

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Registered patients of EAP Anoia Rural
  • Age ≥18 years
  • No contact with the primary care team within the previous 12 months
  • Able to provide informed consent (electronic or paper)

Exclusion Criteria:

  • Proxy care (consulted by caregivers without patient present).
  • Inability to communicate.
  • Severe cognitive or psychiatric impairment.
  • Advanced or palliative chronic conditions (MACA: Modelo de Atención Crónica Avanzada - Advanced Chronic Care Model).
  • Outdated contact information.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Health Services Research
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Arm 1: Proactive Telemedicine (PTM)
Participants receive proactive remote contact by telephone or secure electronic messaging. A standardized brief behavioral intervention is delivered at baseline, four months, and eight months, focusing on smoking status, alcohol consumption, Mediterranean diet adherence, and physical activity. The stage of behavioral change is assessed to tailor motivational strategies. Participants then enter an observational phase to monitor natural healthcare utilization.
Behavioral: Telemedicine Brief Behavioural Lifestyle Intervention
Participants received proactive digital contact via phone or e-consultation. They underwent a brief behavioural intervention addressing modifiable lifestyle factors such as smoking, alcohol consumption, physical activity, and diet. Additionally, access to the rural primary healthcare system will also be measured.
Active Comparator: Arm 2: Face-to-Face Consultation

Participants attend in-person appointments at the health center at baseline, four months, and eight months. Each visit includes the same standardized behavioral intervention used in the PTM arm. Participants then enter an observational phase.

Intervention: Face-to-Face Brief Behavioral Lifestyle Intervention
Behavioral: Face to face Brief Behavioural Lifestyle Intervention
Participants attend in-person visits where they undergo a brief behavioural intervention addressing modifiable lifestyle factors (smoking, alcohol, physical activity, diet). Additionally, access to the rural primary healthcare system is also measured.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Access to Primary Healthcare
Time Frame: 12-month post-intervention

Proportion of participants who initiate any contact with primary care during the 12-month post-intervention observation period.

Unit of Measure: Proportion (%)
12-month post-intervention
Health-Related Quality of Life, EuroQol-5D-5L (EQ-5D-5L)
Time Frame: Baseline, 4 months, 8 months
Change in quality-of-life score measured using the EuroQol-5D-5L instrument. Unit of Measure: Index score (0-1)
Baseline, 4 months, 8 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Smoking Status
Time Frame: Baseline, 4 months, 8 months
Change in categorical smoking status (smoker/non-smoker). Unit of Measure: Categorical.
Baseline, 4 months, 8 months
Alcohol Consumption (AUDIT-C)
Time Frame: Baseline, 4 months, 8 months
Change in score on the AUDIT-C questionnaire. Unit of Measure: Score (0-12).
Baseline, 4 months, 8 months
Mediterranean Diet Adherence (PREDIMED)
Time Frame: Baseline, 4 months, 8 months
Change in PREDIMED score. Unit of Measure: Score (0-14).
Baseline, 4 months, 8 months
Physical Activity (IPAQ)
Time Frame: Baseline, 4 months, 8 months
Change in physical activity level. Unit of Measure: MET-minutes/week (Low: <600, Moderate: 600-2999, High: ≥3000)
Baseline, 4 months, 8 months
Stage of Behavioral Change
Time Frame: Baseline, 4 months, 8 months
Change in stage of change using transtheoretical model. Unit of Measure: Categorical (precontemplation, contemplation, preparation, action, maintenance, relapse)
Baseline, 4 months, 8 months
Coronary Risk (REGICOR Score)
Time Frame: Baseline and 8 months
Change in 10-year coronary risk percentage calculated using REGICOR function. Unit of Measure: Percentage (%),
Baseline and 8 months
Morbidity Assessment
Time Frame: Baseline to 8 months

Change in number and type of chronic conditions documented in electronic health records (ECAP).

Unit of Measure: Count of conditions.
Baseline to 8 months
Patient Satisfaction
Time Frame: At 8 months

Satisfaction score using validated telemedicine satisfaction survey (adapted from Tovar-Martínez et al.).

Unit of Measure: Score (Likert scale).
At 8 months
Adverse Effects
Time Frame: Baseline to 8 months
Number of intervention-related adverse events. Unit of Measure: Count
Baseline to 8 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Collaborators

Institut Catala de Salut

Investigators

  • Study Director: Josep Vidal Alaball, PhD, Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina
  • Principal Investigator: Robert Panadés Zafra, MD, Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

June 25, 2024

Primary Completion (Actual)

July 16, 2025

Study Completion (Estimated)

March 16, 2026

Study Registration Dates

First Submitted

November 26, 2025

First Submitted That Met QC Criteria

December 22, 2025

First Posted (Actual)

December 23, 2025

Study Record Updates

Last Update Posted (Actual)

December 23, 2025

Last Update Submitted That Met QC Criteria

December 22, 2025

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • 23/282-P

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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