Satellite-supplementation of Medical Outreach Clinics: a Feasibility Study

Overview

Much of the basic general medical care and chronic disease management in rural Honduras comes from groups of volunteers setting up temporary clinics run by volunteers. These clinics, also known as brigades, or medical missions, are often criticized for their lack of quality and the lack of follow-up, both of which stem, in part, from understaffing with volunteer physicians. This study is designed to assess if it is feasible, safe, and acceptable to treat patients in short-term mobile medical clinics in rural Honduras using US physicians connected with patients by videoconference.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Diagnostic
    • Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
  • Study Primary Completion Date: June 2013

Interventions

  • Other: Telemedicine
    • Patients undergo a detailed history and examination to the degree that is possible using the videoconference program, skype, a digital camera for high-resolution images, and an electronic stethoscope. A clinic volunteer aids with examination, translation and documentation.
  • Other: In-person physician interaction
    • Patients undergo a detailed history and examination by an in-person physician. A clinic volunteer aids with examination, translation and documentation, as needed.

Arms, Groups and Cohorts

  • Experimental: Telemedicine First
    • Patients whose first physician visit during the clinic was using videoconference, a form of telemedicine, and whose second physician visit during the clinic was with a physician in-person.
  • Experimental: Telemedicine Second
    • Patients whose first physician visit during the clinic was with a physician in-person, and whose second physician visit during the clinic was using videoconference, a form of telemedicine. This is the reverse order of visits of the “Telemedicine fist” arm.
  • Active Comparator: Two physician visits
    • Patients who had two sequential visits with different in-person physicians.

Clinical Trial Outcome Measures

Primary Measures

  • Clinical Diagnoses
    • Time Frame: Same Day as clinic visit (less than 6 hours)
    • The diagnoses resulting from the two physician visits will be compared and a cohen’s kappa statistic will be calculated for diagnoses between the visits.
  • Recommended clinical treatments
    • Time Frame: Same Day as clinic visit (less than 6 hours)
    • After each of a patient’s two physician visits, the physician’s resulting recommended treatments will be gathered for comparison between the two visits.

Secondary Measures

  • Patient opinions of physician interactions
    • Time Frame: Immediately following physician interactions (less than 6 hours)
    • Patients will receive a survey following each interaction with a doctor. These surveys cover communication, comfort and satisfaction.
  • Physician opinions of patient interactions
    • Time Frame: immediately following volunteer activities with the clinic (less than 48 hours)
    • doctors will fill out a survey about their patient interactions after they complete their experience volunteering with the clinic.
  • Volunteer opinions of physician-patient interactions
    • Time Frame: immediately following experience with the clinic (Less than 48 hours)
    • Volunteers who helped with physician interactions will receive a survey about their experience concerning physician patient communication, volunteer educational value and perceived value of the experience.

Participating in This Clinical Trial

Inclusion Criteria

  • Able to give informed consent – Non-emergent medical complaints – At least 18 yrs in age Exclusion Criteria:

  • Pregnancy – Mental Disability

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Mayo Clinic
  • Provider of Information About this Clinical Study
    • Principal Investigator: Bart M. Demaerschalk, PI – Mayo Clinic
  • Overall Official(s)
    • Bart Demaerschalk, MD/MSc, Principal Investigator, Mayo Clinic

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