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      Feasibility of a Pediatric Acute Video Consultation Process Among Health Care Professionals in Primary Care in a Rural Setting: Protocol for a Prospective Validation Study

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          Abstract

          Background

          For years, in Catalonia and in the rest of Spain, there has been a deficit and an unequal geographical distribution of health professionals specializing in pediatrics, especially in rural areas. Among the proposals to improve this situation is the promotion of the use of information and communication technologies (ICT) among users and professionals. Moreover, with the outbreak of COVID-19, the use of telehealth has become an essential tool, with an overall increase in non–face-to-face visits, including in primary care pediatrics. In this context, telemedicine, when used in primary care pediatrics, can be an effective means of improving families’ access to medical care. Currently, in Catalonia, telemedicine involving patients and health professionals is used in pediatric primary care through telephone consultation and asynchronous teleconsultation (eConsulta). Video consultation is in practice not used, although it could have different applications.

          Objective

          The aim of this study is to evaluate the feasibility of a video consultation process with physical examination in acute pediatric pathology in rural areas among primary care professionals. In addition, the level of satisfaction with these remote consultations will be assessed from the perspective of both the users and the health care professionals.

          Methods

          We will conduct a prospective experimental study to analyze the possibility of using video consultation in pediatric acute care in primary care in central Catalonia (Spain). A minimum of 170 children aged between 0 and 14 years attending the primary care center (PCC) for acute illness for a period of 1 year will be included in the study. Initially, the telemetric visit, including a physical examination, will include a nurse at the patient and family’s side and a pediatrician who will participate remotely. Subsequently, the pediatrician will visit the patient in person and the physical examination and diagnosis made during the remote visit will be compared with the physical examination and diagnosis of the face-to-face visit, which is considered the gold standard.

          Results

          Recruitment was planned to begin in the second half of 2023 and continue for at least 1 year. It is anticipated to be a good resource for a variety of acute pediatric conditions in primary care. The evaluation will focus on the feasibility of performing live remote visits and comparing their diagnostic accuracy with that of face-to-face visits.

          Conclusions

          We believe that this study could provide evidence on the feasibility and diagnostic accuracy of video consultation in pediatric acute primary care in a rural setting, as well as on satisfaction with video consultations among both users and professionals. If proven useful in addressing the acute needs of children in a variety of situations, it could become a digital health tool that improves the overall pediatric primary care service in rural areas, for both families and professionals.

          International Registered Report Identifier (IRRID)

          PRR1-10.2196/52946

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          Most cited references45

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          Telemedicine in the face of the COVID-19 pandemic

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            Telemedicine: Pediatric Applications.

            Telemedicine is a technological tool that is improving the health of children around the world. This report chronicles the use of telemedicine by pediatricians and pediatric medical and surgical specialists to deliver inpatient and outpatient care, educate physicians and patients, and conduct medical research. It also describes the importance of telemedicine in responding to emergencies and disasters and providing access to pediatric care to remote and underserved populations. Barriers to telemedicine expansion are explained, such as legal issues, inadequate payment for services, technology costs and sustainability, and the lack of technology infrastructure on a national scale. Although certain challenges have constrained more widespread implementation, telemedicine's current use bears testimony to its effectiveness and potential. Telemedicine's widespread adoption will be influenced by the implementation of key provisions of the Patient Protection and Affordable Care Act, technological advances, and growing patient demand for virtual visits.
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              Paediatric primary care in Europe: variation between countries.

              Although it is known that differences in paediatric primary care (PPC) are found throughout Europe, little information exists as to where, how and who delivers this care. The aim of this study was to collect information on the current existing situation of PPC in Europe. A survey, in the form of a questionnaire, was distributed to the primary or secondary care delegates of 31 European countries asking for information concerning their primary paediatric care system, demographic data, professionals involved in primary care and details of their training. All of them were active paediatricians with a broad knowledge on how PPC is organised in their countries. Responses were received from 29 countries. Twelve countries (41%) have a family doctor/general practitioner (GP/FD) system, seven (24%) a paediatrician-based system and 10 (35%) a combined system. The total number of paediatricians in the 29 countries is 82 078 with 33 195 (40.4%) working in primary care. In only 15 countries (51.7%), paediatric age at the primary care level is defined as 0-18 years. Training in paediatrics is 5 years or more in 20 of the 29 countries. In nine countries, training is less than 5 years. The median training time of GPs/FDs in paediatrics is 4 months (IQR 3-6), with some countries having no formal paediatric training at all. The care of adolescents and involvement in school health programmes is undertaken by different health professionals (school doctors, GPs/FDs, nurses and paediatricians) depending on the country. Systems and organisations of PPC in Europe are heterogeneous. The same is true for paediatric training, school healthcare involvement and adolescent care. More research is needed to study specific healthcare indicators in order to evaluate the efficacy of different systems of PPC.
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                Author and article information

                Contributors
                Journal
                JMIR Res Protoc
                JMIR Res Protoc
                ResProt
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                1929-0748
                2024
                1 February 2024
                : 13
                : e52946
                Affiliations
                [1 ] Centre d'Atenció Primària Cardona Gerència Territorial de la Catalunya Central Institut Català de la Salut Cardona Spain
                [2 ] Cap de la Unitat de Suport a la Recerca de la Catalunya Central Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina Sant Fruitós de Bages Spain
                [3 ] Health Promotion in Rural Areas Research Group Gerència Territorial de la Catalunya Central Institut Català de la Salut Sant Fruitós de Bages Spain
                [4 ] Faculty of Medicine University of Vic–Central University of Catalonia Vic Spain
                [5 ] Direcció del Centre d'Atenció Primària Cardona Gerència Territorial de la Catalunya Central Institut Català de la Salut Cardona Spain
                [6 ] Unitat de Suport a la Recerca de la Catalunya Central Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina Sant Fruitós de Bages Spain
                [7 ] Centre for Health and Social Care Research University of Vic–Central University of Catalonia Vic Spain
                Author notes
                Corresponding Author: Josep Vidal-Alaball jvidal.cc.ics@ 123456gencat.cat
                Author information
                https://orcid.org/0000-0003-3468-7464
                https://orcid.org/0000-0002-3527-4242
                https://orcid.org/0009-0007-3438-542X
                https://orcid.org/0009-0005-9527-0541
                https://orcid.org/0000-0001-9128-9580
                https://orcid.org/0000-0001-7379-4671
                https://orcid.org/0000-0003-0977-0215
                Article
                v13i1e52946
                10.2196/52946
                10870202
                38300693
                1c883095-4c99-4ffc-8a85-51e388ac9f06
                ©Marta Castillo-Rodenas, Josep Vidal-Alaball, Núria Solanas-Bacardit, Clotilde Farràs-Company, Aïna Fuster-Casanovas, Queralt Miró Catalina, Francesc López Seguí. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 01.02.2024.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                : 20 September 2023
                : 5 November 2023
                : 25 November 2023
                : 4 December 2023
                Categories
                Protocol
                Protocol

                primary health care,pediatrics,remote consultation,telemedicine,rural health services,video consultation

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