Tischler Luisa, Pfeuffer Nils, Jordan Yvonne, Heimbuch Sarah, Krause Heiko, Beyer Angelika, Zach Maria, Bertsche Astrid, Gesser Udo, Krohn Markus, Fleßa Steffen, Hoffmann Wolfgang, van den Berg Neeltje
Section Epidemiology of Health Care and Community Health, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstr. 1-2, 17489, Greifswald, Germany.
German Center for Child and Adolescent Health (DZKJ), Partner Site Greifswald/Rostock, Greifswald, Germany.
BMC Health Serv Res. 2025 Sep 17;25(1):1201. doi: 10.1186/s12913-025-13097-7.
Mutual support of paediatric hospital departments through a telemedical network can support paediatric care particularly in rural areas with structural deficits. Using a participatory approach, a (RTP-Net) was developed and implemented in the northeast of Germany. The tele-paediatric network provides the following functionalities: 1) telemedical triage, 2) subspecialist (video) consultation, 3) virtual background services (24/7) and 4) video consultation with patients at home and was available both for patients of the emergency room and for inpatients. The aim of the present analysis was to identify which functionalities of the tele-paediatric network were most frequently used and in which diagnostic and treatment contexts they were applied. Additionally, the study examined the impact of telemedicine consultations for paediatric patients on their subsequent treatment.
Patients under 18 years of age who received telemedical treatment in a participating hospital during the observation period from February 2021 to March 2024 were included in the analysis. The telemedical contact was documented by both, the clinic on site and the telemedicine contact clinic, in a digital patient file on a shared documentation platform (eHealth platform). The documentation included patient data and documents and the diagnostic and treatment recommendations resulting from each telemedical contact quantitative data on utilization, reasons for the telemedicine consultation, and treatment consequences of the telemedical contact were collected using electronic case report forms and were then analysed descriptively.
In the study period, 146 physicians from 13 hospitals participated in the development and implementation of RTP-Net (ranging from small hospitals for basic care to university hospitals). = 403 paediatric patients (thereof 198 female patients) with a total of 507 cases were included, resulting in 519 telemedical contacts. Telemedicine was particularly used for children under 3 years of age ( = 150/403; 37.2%). The most frequently used functionality was the subspecialist consultation ( = 290/519; 55.9%), followed by virtual background duty services ( = 169/519; 32.6%), which were often used as a supplement to the internal on-call duty service. The most common reason for tele-paediatric care were consultations to evaluate symptoms and findings in children with diseases of the nervous system (ICD-10-GM: G00-G99) ( = 161/507; 31.8%), e.g. the joint evaluation of Electroencephalographies (EEGs). In 51/519 cases (9.8%), a hospital admission at the local clinic followed the telemedicine consultation, and in 27/519 cases (5.2%), the patient was transferred to the telemedicine contact clinic. The most frequent outcome was a change in the ongoing treatment ( = 198/519; 38.2%). Hospital admission ( = 51/519) was more common for younger children (median age 6 years) with respiratory system diseases ( = 13), whereas for older children (median age 8 years) with nervous system diseases ( = 124) the telemedicine physician mostly recommended therapy adjustments and these patients usually remained at the clinic on site ( = 198).
The is suitable to support regional paediatric healthcare. Neuropaediatric cases are frequent but often have nonspecific symptoms, which would otherwise require transfer to a more specialized clinic. In the network most paediatric patients could be treated at the clinic on site (local clinic) without needing to seek care at a distant hospital. This avoids long travel distances for the patients and provides economic benefits to the clinic on site, which can continue the treatment of the child locally.
This study was registered under the title ‘Implementation und Evaluation of a Regional Tele-Paediatric Network in Mecklenburg-Western Pomerania and Brandenburg’ (registration no. DRKS00024002, https://drks.de/search/de/trial/DRKS00024002) at the German Registry for Clinical Trials (date of registration 07.01.2021).
通过远程医疗网络实现儿科医院科室间的相互支持，可尤其为存在结构缺陷的农村地区的儿科护理提供支持。采用参与式方法，在德国东北部开发并实施了区域远程儿科网络（RTP-Net）。该远程儿科网络具备以下功能：1）远程医疗分诊；2）专科医生（视频）会诊；3）虚拟后台服务（全天候）；4）与家中患者进行视频会诊，急诊室患者和住院患者均可使用。本分析的目的是确定远程儿科网络的哪些功能使用最为频繁，以及它们应用于哪些诊断和治疗场景。此外，该研究还考察了儿科患者远程医疗会诊对其后续治疗的影响。
纳入2021年2月至2024年3月观察期内在参与医院接受远程医疗治疗的18岁以下患者进行分析。现场诊所和远程医疗联系诊所均在共享文档平台（电子健康平台）的数字患者档案中记录远程医疗接触情况。文档包括患者数据和文件以及每次远程医疗接触产生的诊断和治疗建议。使用电子病例报告表收集关于利用情况、远程医疗会诊原因和远程医疗接触治疗后果的定量数据，然后进行描述性分析。
在研究期间，来自13家医院的146名医生参与了RTP-Net的开发和实施（范围从小型基层护理医院到大学医院）。纳入n = 403名儿科患者（其中198名女性患者），共507例病例，产生519次远程医疗接触。远程医疗尤其用于3岁以下儿童（n = 150/403；37.2%）。最常使用的功能是专科医生会诊（n = 290/519；55.9%），其次是虚拟后台值班服务（n = 169/519；32.6%），其常被用作内部值班服务的补充。远程儿科护理最常见的原因是对患有神经系统疾病（ICD-10-GM：G00-G99）儿童的症状和检查结果进行会诊评估（n = 161/507；31.8%），例如脑电图（EEG）的联合评估。在51/519例（9.8%）中，远程医疗会诊后患者在当地诊所住院，在27/519例（5.2%）中，患者被转至远程医疗联系诊所。最常见的结果是正在进行的治疗发生改变（n = 198/519；38.2%）。呼吸系统疾病（n = 13）的年幼儿童（中位年龄6岁）住院（n = 51/519）更为常见，而患有神经系统疾病（n = 124）的年长儿童（中位年龄8岁），远程医疗医生大多建议调整治疗方案，这些患者通常留在现场诊所（n = 198）。
区域远程儿科网络适用于支持区域儿科医疗保健。神经儿科病例常见，但症状往往不具特异性，否则需要转至更专业的诊所。在该网络中，大多数儿科患者可在现场诊所（当地诊所）接受治疗，无需前往远处医院就医。这避免了患者长途奔波，并为现场诊所带来经济效益，使其能够在当地继续对儿童进行治疗。
本研究在德国临床试验注册中心以“梅克伦堡-前波美拉尼亚和勃兰登堡区域远程儿科网络的实施与评估”为题注册（注册号DRKS00024002，https://drks.de/search/de/trial/DRKS00024002）（注册日期2021年1月7日）。
