Telemedicine in remote orthopaedic consultations: A randomised controlled trial

Abstract

Decentralised services using outreach clinics or modern technology are methods to reduce the patient burden by reducing transport time and costs to the health care system. The aim of this study was to evaluate the quality of planned remote orthopaedic consultations with the help of videoconferences. From 2007 to 2012, we performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote consultations at a regional medical centre (RMC) (intervention) versus standard consultation in the orthopaedic outpatient clinic at the University Hospital of North Norway (UNN) ( control). The participants had been referred to or were scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons evaluated each consultation they performed by completing a questionnaire, with five five-level questions, each measuring five categories of experience. The primary outcome was 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. The secondary outcomes were patient satisfaction and cost effectiveness. The sum score of the specialist evaluation was significantly lower (i.e. “better”) at UNN compared to the RMC but was within the non-inferiority margin. The orthopaedic surgeons involved evaluated 98% of the video-assisted consultations as “good” or “very good” and equal to a standard consultation. In the ancillary analyses concerning professional quality, no significant difference between the two groups was noted. We did not observe any significant difference in patient-reported health outcomes (EQ-5D; EQ VAS). In terms of patient satisfaction, a significantly higher proportion of patients preferred remote consultation as their next consultation. We found that telemedicine service in this setting is cost-effective from societal and health sector perspectives. The study demonstrated that video-assisted consultations for selected orthopaedic patients is preferred to standard consultation in terms of clinician reported quality, patient-reported health outcomes and cost-effectiveness.