Study protocol of a randomized controlled trial to assess safety of teleconsultation compared with face-to-face consultation: the ECASeT study
Authors: Rodríguez-Molinero Alejandro , Carot-Sans Gerard , Escrig Roser , Tebé Cristian , Arce Jacobo , Pérez-López Carlos , Ballesta Silvia , Verdejo Guillermo , Cedeño Ángel , Riera-Pagespetit Mar , Vivas-Angeles Sofia , Alarcon Jose L. , Navarro Itziar , Toro Silvia , Mateo Llorenç , Torres Ana J. , Delmás Gerard , Camell Helena , Chamero Antonio , Gasol Montse , Piera-Jiménez Jordi ,   ECASeT Research Group, Benaiges David , Tikhomirova Lidia , Torrente Vicenç , Marimón Jesús , Saavedra David , Menendez Violeta , Franquet Elisabet , Sierra Luis M. , López-Diéguez María , Rodríguez Nuria , Gonzales Jessica , Macho-Pérez Oscar , Huguet Sandra , Degano Lucas , Pineda Francisco , Errando Javier 
Published: December 2023

Abstract
Background
The use of remote consultation modalities has exponentially grown in the past few years, particularly since the onset of the COVID-19 pandemic. Although a huge body of the literature has described the use of phone (tele) and video consultations, very few of the studies correspond to randomized controlled trials, and none of them has assessed the safety of these consultation modalities as the primary objective. The primary objective of this trial was to assess the safety of remote consultations (both video and teleconsultation) in the follow-up of patients in the hospital setting.

Methods
Multicenter, randomized controlled trial being conducted in four centers of an administrative healthcare area in Catalonia (North-East Spain). Participants will be screened from all individuals, irrespective of age and sex, who require follow-up in outpatient consultations of any of the departments involved in the study. Eligibility criteria have been established based on the local guidelines for screening patients for remote consultation. Participants will be randomly allocated into one of the two study arms: conventional face-to-face consultation (control) and remote consultation, either teleconsultation or video consultation (intervention). Routine follow-up visits will be scheduled at a frequency determined by the physician based on the diagnostic and therapy of the baseline disease (the one triggering enrollment). The primary outcome will be the number of adverse reactions and complications related to the baseline disease. Secondary outcomes will include non-scheduled visits and hospitalizations, as well as usability features of remote consultations. All data will either be recorded in an electronic clinical report form or retrieved from local electronic health records. Based on the complications and adverse reaction rates reported in the literature, we established a target sample size of 1068 participants per arm. Recruitment started in May 2022 and is expected to end in May 2024.

Discussion
The scarcity of precedents on the assessment of remote consultation modalities using randomized controlled designs challenges making design decisions, including recruitment, selection criteria, and outcome definition, which are discussed in the manuscript.

Trial registration
NCT05094180. The items of the WHO checklist for trial registration are available in Additional file 1. Registered on 24 November 2021.