Telemedicine in the Generals Practitioners Office

Rijnstate Hospital40 enrolled

Overview

Pediatrician does physical examination through telemedicine and in real life to see whether the telemedicine consultation corresponds with the real life examination. Goal is to determine: 1. Check practical feasability 2. Check whether there are no great objections for a larger study (ie. in case telemedicine consultation is much more unreliable to do a physical examination a larger study is deemed unsafe)

40 pediatric patients seen by a general practitioner (GP) whom the GP has referred or wants to refer to a pediatrician for clinical evaluation are included in this study. Study is designed in 2 parts. Part 1 is at the emergency room in the hospital Part 2 is at the GPs office The pediatrician sees the patient through a telemedicine consultation. Then sees the patient in real life to see if what was seen during telemedicine corresponds with the real life consultation. With telemedicine and real life consultation the pediatrician rates the patient as either a candidate to go home or to be admitted. With the telemedicine consultation there is also an option "in doubt: i want to see the patient in real life". Also with both telemedicine and real life examination the pediatrician scores the patient using the respiratory observation scale (Siew et al, 2016) Goal is to: 1. Check practical feasability 2. Check whether there are no great objections for a larger study (ie. in case telemedicine consultation is much harder to do a physical examination

Study Type

OBSERVATIONAL

Enrollment

Conditions

Respiratory Distress Syndrome Pneumonia Bronchiolitis

Eligibility

Sex: ALLMin age: 3 MonthsMax age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pediatric patients with respiratory symptoms whom are referred by a general practitioner to be evaluated by a pediatrician Exclusion Criteria: * Infants younger than 2 months of age * 19 years and older * Ex-premature with post-conceptional age \<48 weeks * Congenital heart disease * Down Syndrome * Immune deficiency * Pre-existent pulmonary disorder (Broncho-pulmonary dysplasia, Cystic Fibrosis) * Pre-existent neurological disorders * Apnea's * Patients with respiratory distress with dehydration symptoms * Patients who have already been treated with salbutamol inhalers of nebulizer - Emergency patient with respiratory insufficiency * Technical problems which cause a delay longer than 10 minutes before a video-connection is made * expected delay before commencing telemedicine consultation of longer than 30 minutes

Outcomes

Primary Outcomes

Discharge or admitted?

Patients are categorized in one of three categories through telemedicine-evaluation Group 1: "Patient can safely go home" Group 2: "Patient will need to be admitted" Group 3: "In doubt between group 1 and group 2, emergency room consultation required" FTF evaluation: Group 1: "Patient can safely go home" Group 2: "Patient will need to be admitted"

Time frame: within 30-60 minutes after inclusion

Respiratory Observation Scale

Observe the presence of: tachypnea, nasal flaring, perioral cyanosis, tripoding, thoracoabdominal asynchrony, supraclavicular-, substernal- or intercostal retractions, mental status and patient in respiratory distress

Time frame: within 30-60 minutes after inclusion

Secondary Outcomes

Patient reported experience measure

questionnaire on patient / parent satisfaction with regard to the telemedicine

Time frame: within 60 minutes after telemedicine evaluation

Doctor reported experience measure

Interview with participating doctors with regard to satisfaction of the telemedicine

Time frame: within 4 weeks after inclusion of patients