Accepted for/Published in: JMIR Formative Research
Date Submitted: Sep 17, 2022
Open Peer Review Period: Sep 17, 2022 - Nov 12, 2022
Date Accepted: Apr 11, 2023
Date Submitted to PubMed: May 2, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Diagnostic concordance of telemedicine as compared to face-to-face care in primary health care clinics in rural India: a randomized crossover trial
ABSTRACT
Background:
Due to the COVID-19 pandemic, a growing number of provider-to-provider telemedicine programs have emerged that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. An important question for patients, health providers, and policymakers is whether provider-to-provider telemedicine-based care is comparable to in-person care and whether it is a safe and acceptable alternative when in-person care is not accessible.
Objective:
To compare the diagnosis and treatment decisions from teleconsultations to those of face-to-face care in teleclinics in rural Gujarat.
Methods:
We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at ten telemedicine primary care clinics. Patients received an in-person consultation followed by a teleconsultation or vice versa. The in-person doctor's diagnosis and treatment plan were considered the gold standard. In addition, we surveyed the patients reporting to the teleclinic to understand their acceptability towards telemedicine and its impact on health access.
Results:
We observed a 74% diagnostic concordance and an 80% concordance in the treatment plan between the in-person and remote doctor. The highest diagnostic concordance was seen in the management of hypertension (95%), diabetes (93%), and obstetrics (80%). The lowest was seen in cardiology (33%) and patients with non-specific issues (30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols.
Conclusions:
We found that telemedicine is a safe and effective alternative in rural primary health care delivery in India when in-person care cannot be provided.
Citation
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Copyright
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