Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial)
BackgroundAlthough the Brazilian Unified Health System (SUS) offers universal health coverage, access to quality care is often limited by social inequality and location. Although telemedicine has been shown to be an important tool in the efforts to overcome this problem, because it can provide acces...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2021-01-01
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| Series: | JMIR Research Protocols |
| Online Access: | https://www.researchprotocols.org/2021/1/e23679 |
| _version_ | 1798014267156332544 |
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| author | Rodrigues, Daniela Laranja Gomes Belber, Gisele Silvestre Padilha, Frederica Valle De Queiroz Spinel, Ligia Fonseca Moreira, Frederico Rafael Maeyama, Marcos Aurélio Pinho, Ana Paula Neves Marques Júnior, Álvaro Avezum |
| author_facet | Rodrigues, Daniela Laranja Gomes Belber, Gisele Silvestre Padilha, Frederica Valle De Queiroz Spinel, Ligia Fonseca Moreira, Frederico Rafael Maeyama, Marcos Aurélio Pinho, Ana Paula Neves Marques Júnior, Álvaro Avezum |
| author_sort | Rodrigues, Daniela Laranja Gomes |
| collection | DOAJ |
| description | BackgroundAlthough the Brazilian Unified Health System (SUS) offers universal health coverage, access to quality care is often limited by social inequality and location. Although telemedicine has been shown to be an important tool in the efforts to overcome this problem, because it can provide access to specialist care and break the geographical barriers to health care, there are no national studies demonstrating its use in public health.
ObjectiveThis study aims to test the hypothesis that remote consultation can be as effective as standard face-to-face consultation for type 2 diabetes mellitus in the Brazilian public health system and to assess the associated costs related to teleconsultation in public health scenarios, for patients referred from Primary Health Care units of the SUS for specialist care.
MethodsThis is a pragmatic, phase 2, unicentric, open-label, noninferiority, blinded allocation, data-blinded, centrally randomized clinical trial. The inclusion criteria will be adults, both sexes, ≥18 years old, glycated hemoglobin (HbA1c) ≥8%. Outcomes will be evaluated by assessing symptoms, laboratory exams, anthropometric measurements, blood pressure, adverse events, and satisfaction level for 6 months. The costs of the teleconsultation will be assessed using the time-driven activity-based costing (TDABC) method to compare the costs with the face-to-face consultations. The noninferiority margin was set at 0.5%. Assuming an SD of 1.3% for both groups, true difference between the means of zero, and a type I error level of 5% (one-sided), it was estimated that 117 individuals per group would be necessary to achieve 90% power. Statistical analysis of the efficacy will be done using intention-to-treat and per-protocol approaches.
ResultsThe results from this trial will be reported according to the CONSORT guidelines. The trial was approved by the institutional review board on October 5, 2019. Data collection started in January 2019 and is expected to finish in 2022. At the time of manuscript submission, 18 participants were recruited.
ConclusionsOur expectations are that providing remote access to health care will result in improvements in the health and quality of life of patients with type 2 diabetes and reduce costs and that both patients and clinicians will benefit from and be satisfied with this technology.
Trial RegistrationRegistro Brasileiro de Ensaios Clínicos RBR-8gpgyd; https://ensaiosclinicos.gov.br/rg/RBR-8gpgyd
International Registered Report Identifier (IRRID)DERR1-10.2196/23679 |
| first_indexed | 2024-04-11T15:14:50Z |
| format | Article |
| id | doaj.art-574e15def2be474eb2fea55643e2ae25 |
| institution | Directory Open Access Journal |
| issn | 1929-0748 |
| language | English |
| last_indexed | 2024-04-11T15:14:50Z |
| publishDate | 2021-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Research Protocols |
| spelling | doaj.art-574e15def2be474eb2fea55643e2ae252022-12-22T04:16:30ZengJMIR PublicationsJMIR Research Protocols1929-07482021-01-01101e2367910.2196/23679Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial)Rodrigues, Daniela Laranja GomesBelber, Gisele SilvestrePadilha, Frederica Valle De QueirozSpinel, Ligia FonsecaMoreira, Frederico RafaelMaeyama, Marcos AurélioPinho, Ana Paula Neves MarquesJúnior, Álvaro AvezumBackgroundAlthough the Brazilian Unified Health System (SUS) offers universal health coverage, access to quality care is often limited by social inequality and location. Although telemedicine has been shown to be an important tool in the efforts to overcome this problem, because it can provide access to specialist care and break the geographical barriers to health care, there are no national studies demonstrating its use in public health. ObjectiveThis study aims to test the hypothesis that remote consultation can be as effective as standard face-to-face consultation for type 2 diabetes mellitus in the Brazilian public health system and to assess the associated costs related to teleconsultation in public health scenarios, for patients referred from Primary Health Care units of the SUS for specialist care. MethodsThis is a pragmatic, phase 2, unicentric, open-label, noninferiority, blinded allocation, data-blinded, centrally randomized clinical trial. The inclusion criteria will be adults, both sexes, ≥18 years old, glycated hemoglobin (HbA1c) ≥8%. Outcomes will be evaluated by assessing symptoms, laboratory exams, anthropometric measurements, blood pressure, adverse events, and satisfaction level for 6 months. The costs of the teleconsultation will be assessed using the time-driven activity-based costing (TDABC) method to compare the costs with the face-to-face consultations. The noninferiority margin was set at 0.5%. Assuming an SD of 1.3% for both groups, true difference between the means of zero, and a type I error level of 5% (one-sided), it was estimated that 117 individuals per group would be necessary to achieve 90% power. Statistical analysis of the efficacy will be done using intention-to-treat and per-protocol approaches. ResultsThe results from this trial will be reported according to the CONSORT guidelines. The trial was approved by the institutional review board on October 5, 2019. Data collection started in January 2019 and is expected to finish in 2022. At the time of manuscript submission, 18 participants were recruited. ConclusionsOur expectations are that providing remote access to health care will result in improvements in the health and quality of life of patients with type 2 diabetes and reduce costs and that both patients and clinicians will benefit from and be satisfied with this technology. Trial RegistrationRegistro Brasileiro de Ensaios Clínicos RBR-8gpgyd; https://ensaiosclinicos.gov.br/rg/RBR-8gpgyd International Registered Report Identifier (IRRID)DERR1-10.2196/23679https://www.researchprotocols.org/2021/1/e23679 |
| spellingShingle | Rodrigues, Daniela Laranja Gomes Belber, Gisele Silvestre Padilha, Frederica Valle De Queiroz Spinel, Ligia Fonseca Moreira, Frederico Rafael Maeyama, Marcos Aurélio Pinho, Ana Paula Neves Marques Júnior, Álvaro Avezum Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) JMIR Research Protocols |
| title | Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) |
| title_full | Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) |
| title_fullStr | Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) |
| title_full_unstemmed | Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) |
| title_short | Impact of Teleconsultation on Patients With Type 2 Diabetes in the Brazilian Public Health System: Protocol for a Randomized Controlled Trial (TELEconsulta Diabetes Trial) |
| title_sort | impact of teleconsultation on patients with type 2 diabetes in the brazilian public health system protocol for a randomized controlled trial teleconsulta diabetes trial |
| url | https://www.researchprotocols.org/2021/1/e23679 |
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