Article Text

Original research
Development and evaluation of a clinical guideline for a paediatric telemedicine service in a low-resource setting
  1. Molly B Klarman1,
  2. Xiaofei Chi2,
  3. Youseline Cajusma1,
  4. Katelyn E Flaherty3,
  5. Anne Carine Capois1,
  6. Michel Daryl Vladimir Dofiné1,
  7. Lerby Exantus4,
  8. Jason Friesen5,
  9. Valery Madsen Beau de Rochars6,
  10. Torben K Becker7,
  11. Chantale Baril4,
  12. Matthew J Gurka8,
  13. Eric J Nelson9
  1. 1Department of Pediatrics, University of Florida, Gainesville, Florida, USA
  2. 2Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
  3. 3Departments of Emergency Medicine and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
  4. 4Faculté de Médecine et de Pharmacie, Université d’État d’Haiti, Port-au-Prince, Haiti
  5. 5Trek Medics International, Washington, DC, USA
  6. 6Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
  7. 7Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
  8. 8Departments of Pediatrics and Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
  9. 9Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Eric J Nelson; eric.nelson{at}ufl.edu

Abstract

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.

  • Health services research

Data availability statement

Data are available upon reasonable request. Deidentified data from this study are available from the corresponding author (EJN) upon request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Deidentified data from this study are available from the corresponding author (EJN) upon request.

View Full Text

Supplementary materials

Footnotes

  • MBK and XC contributed equally.

  • Contributors MBK and EJN conceptualised and designed the study. MBK, YC, JF, LE, CB and EJN completed the investigation and provided supervision/oversight. MBK, YC, XC, KEF, ACC, MDVD and MJG contributed to data curation and carried out the formal analysis. MBK, JF, TB, VMBdR and EJN contributed to funding acquisition and obtained/maintained resources. MBK and EJN drafted the initial manuscript, and all authors reviewed/edited the final version. EJN is the guarantor of this work.

  • Funding This work was supported by grants from the National Institutes of Health (DP5OD019893 to EJN) and the Florida Children’s Miracle Network (00126439 to EJN).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.