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

Astrid Buvik, Einar Bugge, Gunnar Knutsen, Arvid Småbrekke, Tom Wilsgaard, Astrid Buvik, Einar Bugge, Gunnar Knutsen, Arvid Småbrekke, Tom Wilsgaard

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.

Keywords: Evaluation; Orthopaedic; Outpatient clinic consultation; Physicians; Randomised; Safety; Telemedicine; Videoconference.

Figures

Fig. 1
Fig. 1
Flow diagram of the enrollment, allocation, follow- up and data collections points
Fig. 2
Fig. 2
Observed treatment differences for video-assisted consultation (RMC) minus standard consultation (UNN) for sum-score of the specialist evaluation of the consultation. Blue dashed line = 0.3 non-inferiority margin, CI = Confidence interval

References

    1. Ministry of Health and Care Services: Meld. St. 16 (2010–2011) Report to the Storting (white paper) Summary- National Health and Care Services Plan (2011–2015). (). Accessed 09 Oct 2015.
    1. Kristiansen FB. Reported from the university North Norway’s Center for Financial Affairs (2014)2015.
    1. Tachakra S, Lynch M, Newson R, Stinson A, Sivakumar A, Hayes J, Bak J. A comparison of telemedicine with face-to-face consultations for trauma management. J Telemed Telecare. 2000;6(Suppl 1):S178–S181. doi: 10.1258/1357633001934591.
    1. Benger JR, Noble SM, Coast J, Kendall JM. The safety and effectiveness of minor injuries telemedicine. Emergency Medicine Journal: EMJ. 2004;21(4):438–445.
    1. Brennan JA, Kealy JA, Gerardi LH, Shih R, Allegra J, Sannipoli L, Lutz D. Telemedicine in the emergency department: a randomized controlled trial. J Telemed Telecare. 1999;5(1):18–22. doi: 10.1258/1357633991932342.
    1. Haukipuro K, Ohinmaa A, Winblad I, Linden T, Vuolio S. The feasibility of telemedicine for orthopaedic outpatient clinics--a randomized controlled trial. J Telemed Telecare. 2000;6(4):193–198. doi: 10.1258/1357633001935347.
    1. Couturier P, Tyrrell J, Tonetti J, Rhul C, Woodward C, Franco A. Feasibility of orthopaedic teleconsulting in a geriatric rehabilitation service. J Telemed Telecare. 1998;4(Suppl 1):85–87. doi: 10.1258/1357633981931597.
    1. Aarnio P, Lamminen H, Lepisto J, Alho A. A prospective study of teleconferencing for orthopaedic consultations. J Telemed Telecare. 1999;5(1):62–66. doi: 10.1258/1357633991932405.
    1. Vuolio S, Winblad I, Ohinmaa A, Haukipuro K. Videoconferencing for orthopaedic outpatients: one-year follow-up. J Telemed Telecare. 2003;9(1):8–11. doi: 10.1258/135763303321159620.
    1. Lambrecht CJ, Canham WD, Gattey PH, McKenzie GM. Telemedicine and orthopaedic care. A review of 2 years of experience. Clinical Orthopaedics and Related Research. 1998(348):228–32.
    1. Ohno G, Watanabe K, Okada Y, Higuchi K. Practical experience of telehealth between an Antarctic station and Japan. J Telemed Telecare. 2012;18(8):473–475. doi: 10.1258/jtt.2012.GTH111.
    1. Hailey D, Roine R, Ohinmaa A. Systematic review of evidence for the benefits of telemedicine. J Telemed Telecare. 2002;8(Suppl 1):1–30. doi: 10.1258/1357633021937604.
    1. Taylor P. Evaluating telemedicine systems and services. J Telemed Telecare. 2005;11(4):167–177. doi: 10.1258/1357633054068955.
    1. Hersh W, Helfand M, Wallace J, Kraemer D, Patterson P, Shapiro S, Greenlick M. A systematic review of the efficacy of telemedicine for making diagnostic and management decisions. J Telemed Telecare. 2002;8(4):197–209. doi: 10.1258/135763302320272167.
    1. Currell R, Urquhart C, Wainwright P, Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Nurs Times. 2001;97(35):35.
    1. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. The Cochrane Database of Systematic Reviews. 2015;9:Cd002098.
    1. Tachakra S, Hollingdale J, Uche CU. Evaluation of telemedical orthopaedic specialty support to a minor accident and treatment service. J Telemed Telecare. 2001;7(1):27–31. doi: 10.1258/1357633011936101.
    1. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18. doi: 10.1186/1741-7015-8-18.
    1. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489–497. doi: 10.1002/nur.20147.
    1. Wan AC, Gul Y, Darzi A. Realtime remote consultation in the outpatient clinic--experience at a teaching hospital. J Telemed Telecare. 1999;5(Suppl 1):S70–S71. doi: 10.1258/1357633991932621.
    1. Aarnio P, Rudenberg H, Ellonen M, Jaatinen P. User satisfaction with teleconsultations for surgery. J Telemed Telecare. 2000;6(4):237–241. doi: 10.1258/1357633001935301.
    1. Ohinmaa A, Vuolio S, Haukipuro K, Winblad I. A cost-minimization analysis of orthopaedic consultations using videoconferencing in comparison with conventional consulting. J Telemed Telecare. 2002;8(5):283–289. doi: 10.1258/135763302760314252.
    1. Lambrecht CJ. Telemedicine in trauma care: description of 100 trauma teleconsults. Telemedicine Journal: The Official Journal of the American Telemedicine Association. 1997;3(4):265–268. doi: 10.1089/tmj.1.1997.3.265.
    1. Wallace P, Haines A, Harrison R, Barber J, Thompson S, Jacklin P, Roberts J, Lewis L, Wainwright P. Joint teleconsultations (virtual outreach) versus standard outpatient appointments for patients referred by their general practitioner for a specialist opinion: a randomised trial. Lancet. 2002;359(9322):1961–1968. doi: 10.1016/S0140-6736(02)08828-1.

Source: PubMed

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