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



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.



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.



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.



ClinicalTrials.gov identifier: NCT00616837.
Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway. Astrid.Buvik@unn.no.
Astrid
0000-0002-4808-6849
A
Buvik
Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway.
Einar
E
Bugge
Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway.
Gunnar
G
Knutsen
Department of Orthopaedic Surgery, University Hospital of North Norway, P.O. Box 4, N-9038, Tromsø, Norway.
Arvid
A
Småbrekke
Centre for Clinical Research and Education, University Hospital of North Norway, P.O. Box 20, N-9038, Tromsø, Norway.|Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.
Tom
T
Wilsgaard
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009664:Norway; D009985:Orthopedics / Q000592:standards*; D011787:Quality of Health Care; D019114:Remote Consultation / Q000592:standards*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000191:economics / Q000592:standards*; D049269:Videoconferencing; D055815:Young Adult
Evaluation; Orthopaedic; Outpatient clinic consultation; Physicians; Randomised; Safety; Telemedicine; Videoconference