Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL.
Departments of Pediatrics and Environmental and Global Health, University of Florida, Gainesville, FL; Department of Emergency Medicine, University of Florida, Gainesville, FL.
J Pediatr. 2023 Jun;257:113304. doi: 10.1016/j.jpeds.2022.12.005. Epub 2022 Dec 14.
Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to health care for children in low-resource settings.
We implemented a TMDS called 'MotoMeds' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10 years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility.
A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had "improved" or "recovered". Overall, 99% (344) rated the TMDS as "good" or "great". The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total case time was 114 minutes.
The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.
clinicaltrials.gov: NCT03943654.
确定远程医疗和药物输送服务（TMDS）实施的临床安全性和可行性，以解决资源匮乏环境下儿童夜间获得医疗服务的差距问题。
我们在海地实施了一种名为“MotoMeds”的 TMDS，作为一项前瞻性队列研究。生病的≤10 岁儿童的家长/监护人联系呼叫中心（下午 6 点至凌晨 5 点）。护士提供者使用决策支持工具对病例进行分诊（轻度、中度或重度）。严重病例转至紧急护理。对于非严重病例，提供者收集临床发现以生成评估和计划。对于在配送区域内的病例，派遣一名提供者和司机，提供者进行面对面检查，作为虚拟呼叫中心检查的参考标准。家庭在第 10 天接到随访电话。对临床安全性和可行性进行数据分析。
从 2019 年 9 月 9 日至 2021 年 1 月 19 日，共纳入 391 例病例。大多数病例为非严重病例（92%；361 例），其中 89%（347 例）的病例完成了家访。在 30 例严重病例中，67%（20 例）寻求转介治疗。所有病例中，呼吸问题是最常见的主诉（63%；246 例）。在第 10 天，95%（329 例）的家长报告其孩子“好转”或“康复”。总体而言，99%（344 例）的人对 TMDS 的评价为“好”或“很好”。电话咨询的中位数时间为 20 分钟，家庭到达的中位数时间为 73 分钟，总病例时间为 114 分钟。
TMDS 是一种可行的医疗服务提供模式。尽管许多病例可能是自限性的，但 TMDS 与第 10 天报告的临床状况改善率高有关。
clinicaltrials.gov：NCT03943654。
