Background: Decentralised services using outreach clinics or modern technology are methods to reduce both\npatient transports and costs to the healthcare system. Telemedicine consultations via videoconference are one such\nmodality. Before new technologies are implemented, it is important to investigate both the quality of care given\nand the economic impact from the use of this new technology. The aim of this clinical trial was to study the quality\nof planned remote orthopaedic consultations by help of videoconference.\nMethod: We performed a randomised controlled trial (RCT) with two parallel groups: video-assisted remote\nconsultations at a regional medical centre (RMC) as an intervention versus standard consultation in the orthopaedic\noutpatient clinic at the University Hospital of North Norway (UNN) as a control. The participants were patients\nreferred to or scheduled for a consultation at the orthopaedic outpatient clinic. The orthopaedic surgeons\nevaluated each consultation they performed by completing a questionnaire. The primary outcome measurement\nwas the difference in the sum score calculated from this questionnaire, which was evaluated by the non-inferiority\nof the intervention group. The study design was based on the intention to treat principle. Ancillary analyses\nregarding complications, the number of consultations per patient, operations, patients who were referred again and\nthe duration of consultations were performed.\nResults: Four-hundred patients were web-based randomised. Of these, 199 (98 %) underwent remote consultation\nand 190 (95 %) underwent standard consultation. The primary outcome, the sum score of the specialist evaluation,\nwas significantly lower (i.e. ââ?¬Ë?betterââ?¬â?¢) at UNN compared to RMC (1.72 versus 1.82, p = 0.0030). The 90 % confidence\ninterval (CI) for the difference in score (0.05, 0.17) was within the non-inferiority margin. The orthopaedic surgeons\ninvolved evaluated 98 % of the video-assisted consultations as ââ?¬Ë?goodââ?¬â?¢ or ââ?¬Ë?very goodââ?¬â?¢. In the ancillary analyses, there\nwas no significant difference between the two groups.\nConclusions: This study supports the argument that it is safe to offer video-assisted consultations for selected\northopaedic patients. We did not find any serious events related to the mode of consultation. Further assessments\nof the economic aspects and patient satisfaction are needed before we can recommend its wider application.
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