JMIR Publications

ABSTRACT

Background:

Telemedicine has demonstrated efficacy as a supplement to traditional in-person care in treating certain diseases. Nevertheless, more investigation is needed to comprehensively assess its potential as an alternative to in-person care and its influence on access to care. The successful treatment of short stature relies on timely and regular intervention, particularly in rural and economically disadvantaged regions where the disease is more prevalent.

Objective:

This study evaluated the clinical outcomes, health seeking behaviours and cost of telemedicine integrated care mode in children with short stature in China.

Methods:

Our study involved 1241 individuals diagnosed with short stature at the paediatric outpatient clinic of Peking University Third Hospital between 2012 and 2023. Patients were divided into in-person care group (IPC, 1183 patients receiving only in-person care) and telemedicine integrated care group (ITC, 58 patients receiving both in-person and virtual care). For both groups, the initial 71.43% visits were categorised into the pre-telemedicine phase. We employed propensity score matching to select individuals with similar baseline conditions. Seven variables such as age, gender and medical insurance type were used for the 1:5 closest neighbour match. Eventually, 115 patients in the IPC group and 54 patients in the TIC group were selected. The primary clinical outcome was the change in standard height percentage value. The health seeking behaviour was described by visit intervals in the pre- and post-telemedicine phases. The cost analysis compared costs both in different groups and in different visit modalities of the TIC group in the post-telemedicine phase.

Results:

In terms of clinical effectiveness, we demonstrated that increase in height among the TIC group (△zTIC=0.74) was more substantial than those who were in the IPC group (△zIPC=0.51, p<0.05), while no unfavourable changes were observed in other endpoints such as BMI or IGF-1 levels. As for health seeking behaviours, results showed that during the post-telemedicine phase, the IPC group had visit interval of 71.08 [50.75, 90.73] days, significantly prolonged compared to the prior period (51.25 [34.75, 82.00] days, p<0.001), whereas the TIC group's visit interval remained unchanged. As for the cost per visit, there was no difference in the average cost per visit between the two groups, nor between the pre- and post-telemedicine phases. During the post-telemedicine phase, within the TIC group, in-person visits had higher average total cost, elevated medical and labour expenses, and greater medical cost compared to virtual visits.

Conclusions:

We contend that the rise in medical visits facilitated by telemedicine integrated care mode effectively restored the previously constrained number of medical visits to their usual levels, without increasing costs. Our research underscores that administering prompt treatment may enable physicians to seize the crucial treatment opportunity for children with short stature, thus attaining superior results.