Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting
Objective To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).Methods A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline w...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-01-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/8/1/e002164.full |
| _version_ | 1797361620496678912 |
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| author | Matthew J Gurka Youseline Cajusma Chantale Baril Eric J Nelson Molly B Klarman Xiaofei Chi Katelyn E Flaherty Anne Carine Capois Michel Daryl Vladimir Dofiné Lerby Exantus Jason Friesen Valery Madsen Beau de Rochars Torben Becker |
| author_facet | Matthew J Gurka Youseline Cajusma Chantale Baril Eric J Nelson Molly B Klarman Xiaofei Chi Katelyn E Flaherty Anne Carine Capois Michel Daryl Vladimir Dofiné Lerby Exantus Jason Friesen Valery Madsen Beau de Rochars Torben Becker |
| author_sort | Matthew J Gurka |
| collection | DOAJ |
| description | Objective To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).Methods A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference).Results A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen’s kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported ‘fast breathing’ were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for ‘no’ and ‘some’ dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered.Conclusion Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation.Trial registration number NCT03943654. |
| first_indexed | 2024-03-08T15:56:15Z |
| format | Article |
| id | doaj.art-1cd358c7e6d3423085be53a0bc55e473 |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-08T15:56:15Z |
| publishDate | 2024-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-1cd358c7e6d3423085be53a0bc55e4732024-01-08T18:10:07ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722024-01-018110.1136/bmjpo-2023-002164Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource settingMatthew J Gurka0Youseline Cajusma1Chantale Baril2Eric J Nelson3Molly B Klarman4Xiaofei Chi5Katelyn E Flaherty6Anne Carine Capois7Michel Daryl Vladimir Dofiné8Lerby Exantus9Jason Friesen10Valery Madsen Beau de Rochars11Torben Becker12Department of Pediatrics, University of Florida, Gainesville, Florida, USAPediatrics, University of Florida, Gainesville, Florida, USAPediatrics, State University Hospital of Haiti, Port Au Prince, HaitiDepartments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida, USADepartment of Pediatrics, University of Florida, Gainesville, Florida, USADepartment of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USADepartments of Emergency Medicine and Environmental and Global Health, University of Florida, Gainesville, Florida, USADepartment of Pediatrics, University of Florida, Gainesville, Florida, USADepartment of Pediatrics, University of Florida, Gainesville, Florida, USAFaculté de Médecine et de Pharmacie, Université d’État d’Haiti, Port-au-Prince, HaitiTrek Medics International, Washington, DC, USADepartment of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USADepartment of Emergency Medicine, University of Florida, Gainesville, Florida, USAObjective To develop and evaluate a guideline for a paediatric telemedicine and medication delivery service (TMDS).Methods A clinical guideline for paediatric telemedicine was derived from the World Health (WHO) Organization Integrated Management of Childhood Illness (IMCI) Handbook. The guideline was deployed at a TMDS in Haiti and evaluated through a prospective cohort study; children ≤10 years were enrolled. For non-severe cases, paired virtual and in-person examinations were conducted at the call centre and household; severe cases were referred to the hospital. The performance of virtual examination components were evaluated by comparison with the paired in-person examination findings (reference).Results A total of 391 cases were enrolled. Among the 320 cases with paired examinations, no general WHO danger signs were identified during in-person examinations; 5 cases (2%) required hospital referral due to problem-specific danger signs or other reasons for escalation. Cohen’s kappa for the virtual designation of mild cases was 0.78 (95% CI: 0.69 to 0.87). The sensitivity and specificity of a virtually reported fever were 91% (95% CI: 87% to 96%) and 69% (95% CI: 62% to 76%), respectively; the sensitivity and specificity of virtually reported ‘fast breathing’ were 47% (95% CI: 21% to 72%) and 89% (95% CI: 85% to 94%), respectively. Kappa for ‘no’ and ‘some’ dehydration indicated moderate congruence between virtual and in-person examinations (0.69; 95% CI: 0.41 to 0.98). At 10 days, 273 (95%) of the 287 cases reached by phone were better/recovered.Conclusion Critical components of the virtual examination (triage, danger signs and dehydration assessment) performed well despite varied performance among the problem-specific components. The study and associated resources represents formative steps towards an evidence-based paediatric telemedicine guideline built on WHO clinical principles. In-person examinations for select cases were important to address limitations with virtual examinations and identify cases for escalation.Trial registration number NCT03943654.https://bmjpaedsopen.bmj.com/content/8/1/e002164.full |
| spellingShingle | Matthew J Gurka Youseline Cajusma Chantale Baril Eric J Nelson Molly B Klarman Xiaofei Chi Katelyn E Flaherty Anne Carine Capois Michel Daryl Vladimir Dofiné Lerby Exantus Jason Friesen Valery Madsen Beau de Rochars Torben Becker Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting BMJ Paediatrics Open |
| title | Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting |
| title_full | Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting |
| title_fullStr | Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting |
| title_full_unstemmed | Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting |
| title_short | Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting |
| title_sort | development and evaluation of a clinical guideline for a paediatric telemedicine service in a low resource setting |
| url | https://bmjpaedsopen.bmj.com/content/8/1/e002164.full |
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