JMIR Publications

ABSTRACT

Background:

Benefits of telemedicine include cost savings and decentralized care. Video-consultation is one form that enables early detection of deteriorating patients and promotion of self-efficacy in anxious-well patients. This facilitates early discharge and remote follow-up of patients not requiring admission, and may help address the overcrowding of hospitals and emergency departments (EDs).

Objective:

Evaluate the efficacy and safety of digital telereview for patients presenting with undifferentiated acute abdominal pain.

Methods:

This is a prospective randomised-controlled trial (RCT) whereby follow-up via existing telephone-based telereview (TT, control) is compared against digital telereview (DT, intervention). Consecutive patients with undifferentiated acute abdominal pain discharged from the ED observation ward are studied based on intention to treat (ITT). The control arm received routine provider-led scheduled TT with missed reviews actively coordinated and rescheduled by ED staff. The intervention arm received access to a platform for DT that enabled hybrid asynchronous-synchronous and patient-led appointment rescheduling. Patients were followed-up for 2 weeks for outcomes of service utilisation, efficacy (compliance to disposition plan), and safety (re-presentation for same condition).

Results:

70 patients were studied with 35 randomised to each arm. Patients had a mean age of 40.0 + 13.8 (range 22-71) with a predominance of female gender (n=47/70, 67.1%) and Chinese ethnicity (n=39/70, 55.7%). Telereview service was utilised by 32 control subjects (n=32/35, 91.4%) and 18 intervention subjects (n=18/35, 51.4%). Most patients in control (n=33/35, 94.3%, 95CI: 79.5%, 99.0%) and intervention (n=34/35, 97.1%, 95CI: 83.4%, 99.9%) arms were compliant to final disposition. There was a low rate of re-presentation at 72hrs for both arms (n=2/35, 5.7%, 95CI: 1%, 20.5%) and at 2 weeks for both control (n=2/35, 5.7%, 95CI: 1%, 20.5%) and intervention (n=3/35, 8.6%, 95CI: 2.2%, 24.2%) arms. There was no significant difference in efficacy and safety between them (P>.05).

Conclusions:

Application of DT for the follow-up of patients with abdominal pain may be safe and efficacious. Future studies are needed to evaluate cost effectiveness and utility for broader clinical application. Clinical Trial: This study was registered in Singhealth, Singapore General Hospital, and International Standard Randomised Controlled Trial Number registry (ISRCTN28468556).