Telemedicine in the Generals Practitioners Office

Study Overview
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Brief Summary
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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: Check practical feasability 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)

Detailed Description
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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: Check practical feasability Check whether there are no great objections for a larger study (ie. in case telemedicine consultation is much harder to do a physical examination

Official Title
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Pilotonderzoek Naar Het Gebruik Van Telemedicine Bij Het Beoordelen Van Het Benauwde Kind in de Huisartsenpraktijk English: The Use of Telemedicine in the General Practitioners Office for a Child With Respiratory Symptoms: a Pilot Study

Conditions
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Respiratory Distress Syndrome, Pneumonia, Bronchiolitis, Croup, Croup; False, Asthma, Bronchial Hyperreactivity

Intervention / Treatment
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* Device: Telemedicine


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 3 Months
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Phase 1 and Phase 2<br>20 patients studied in the emergency room with a pediatrician not presen in the ER performing the telemedicine examination from a distance (ie an office down the hall) followed directly by a face-to-face 20 patients included in the general practitioners office, telemedicine is performed from within the hospital to the GPs office. Patient is then still referred to the hospital in order to check whether the telemedicine and face-to-face examination are somewhat similarce physical examination | Device: Telemedicine<br>* Patient is examined using telemedicine<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 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 | 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 | within 30-60 minutes after inclusion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient reported experience measure | questionnaire on patient / parent satisfaction with regard to the telemedicine | within 60 minutes after telemedicine evaluation | 
| Doctor reported experience measure | Interview with participating doctors with regard to satisfaction of the telemedicine | within 4 weeks after inclusion of patients | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, Respiratory distress, Pediatric, General practitioner