Design and performance of a multi-centre randomised controlled trial and economic evaluation of joint tele-consultations [ISRCTN54264250]

Abstract

Background: Appropriate information flow is crucial to the care of patients, particularly at the interface between primary and secondary care. Communication problems can result from inadequate organisation and training, There is a major expectation that information and communication technologies may offer solutions, but little reliable evidence. This paper reports the design and performance of a multi-centre randomised controlled trial (RCT), unparalleled in telemedicine research in either scale or range of outcomes. The study investigated the effectiveness and cost implications in rural and inner-city settings of using videoconferencing to perform joint tele-consultations as an alternative to general practitioner referral to the hospital specialist in the outpatient clinic.

Virtual outreach: a randomised controlled trial and economic evaluation of joint teleconferenced medical consultations

“…As reported elsewhere, 63 the number of tests was larger in the standard outpatients group, and this is reflected in the higher mean costs for tests and procedures. However, the cost impact of this excess is modified by the fact that the greatest difference occurred in the subcategory of laboratory investigations, which are generally cheaper than less routine tests and investigations.…”

“…The PEI scale was developed specifically for general practice consultations. To the authors' knowledge it had not been used previously in the context of either standard outpatients or joint consultations, but following the start of the trial, a report appeared of its use in a hospital outpatients department, which found a mean score of 47, some 50% higher than either Howie 63 or the present results. 78 Many factors in the consultation have been found to correlate with enablement, including length of consultation and continuity of care, 79 but the recent outpatient study suggests that the patient's expectation, the doctor's empathy (as perceived by the patient) and the doctor's own confidence in the therapeutic relationship are key factors.…”

“…The study required 250 patients in each speciality, and allowing for imbalance in anticipated numbers between specialities and a potential 30% of missing outcome data, the study required a total of 1950 patients. 63 The statistical analysis followed a prespecified plan, considering the groups as randomised. Primary and secondary outcomes were specified a priori.…”

Economic Evaluation of Manitoba Health Lines in the Management of Congestive Heart Failure

“…Of the nine included studies of COPD, four [83][84][85][86] compared home telemonitoring with usual care, and five [87][88][89][90][91] compared telephone support with usual care. All the studies comparing telephone support with usual care were RCTs, and one RCT 84 compared home telemonitoring with usual care.…”

“…Two studies were from Canada, 83,87 two from Spain, 84,90 one from Spain and Belgium, 88 one from Australia, 89 one from the Netherlands, 85 one from Greece, 86 and one from China. 91 One study was funded by industry, 87 five received funding from the government, [83][84][85]88,89 and three did not report the source of funding. 86,90,91 The number of participants ranged from 36 to 191.…”