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Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With
Anthony K Akobeng1, Neil O'Leary2, Andy Vail2
1Royal Manchester Children's Hospital, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK ; Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Central Manchester NHS Foundation Trust, Manchester, UK ; Sidra Medical and Research Centre, Doha, Qatar.
Insights
Telephone consultations are as effective as in-person visits for pediatric inflammatory bowel disease (IBD) care, improving quality of life. This method also significantly reduces consultation time and healthcare costs for the NHS.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Telemedicine
Background:
- Limited evidence exists for telephone consultations in childhood inflammatory bowel disease (IBD).
- Assessing the effectiveness and cost implications of telephone versus traditional face-to-face consultations for pediatric IBD patients is crucial.
Purpose of the Study:
- To compare the effectiveness of telephone consultations versus face-to-face consultations for young patients with IBD.
- To evaluate the cost consequences of each consultation method for the UK National Health Service (NHS).
Main Methods:
- A randomized controlled trial involving 86 children and adolescents (aged 8-16) with IBD was conducted over 24 months.
- Patients were randomized to receive either telephone or face-to-face consultations.
- The primary outcome was the IMPACT quality of life (QOL) score at 12 months, with secondary outcomes including patient satisfaction, disease course, and costs.
Main Results:
- No significant difference in QOL scores was observed between telephone and face-to-face consultation groups at 12 months.
- Telephone consultations were significantly shorter (mean reduction of 4.3 minutes) and less costly (mean saving of £15.71 per consultation) compared to face-to-face visits.
- Patient satisfaction and disease course were comparable between the groups.
Conclusions:
- Telephone consultation is a viable and cost-effective alternative for routine outpatient follow-up in pediatric IBD.
- This approach does not compromise patient quality of life and offers significant benefits in terms of efficiency and cost savings for the NHS.
Background:
Evidence for the use of telephone consultation in childhood inflammatory bowel disease (IBD) is lacking. We aimed to assess the effectiveness and cost consequences of telephone consultation compared with the usual out-patient face-to-face consultation for young people with IBD.
Methods:
We conducted a randomised-controlled trial in Manchester, UK, between July 12, 2010 and June 30, 2013. Young people (aged 8-16 years) with IBD were randomized to receive telephone consultation or face-to-face consultation for 24 months. The primary outcome measure was the paediatric IBD-specific IMPACT quality of life (QOL) score at 12 months. Secondary outcome measures included patient satisfaction with consultations, disease course, anthropometric measures, proportion of consultations attended, duration of consultations, and costs to the UK National Health Service (NHS). Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02319798.
Findings:
Eighty six patients were randomised to receive either telephone consultation (n = 44) or face-to-face consultation (n = 42). Baseline characteristics of the two groups were well balanced. At 12 months, there was no evidence of difference in QOL scores (estimated treatment effect in favour of the telephone consultation group was 5.7 points, 95% CI - 2.9 to 14.3; p = 0.19). Mean consultation times were 9.8 min (IQR 8 to 12.3) for telephone consultation, and 14.3 min (11.6 to 17.0) for face-to-face consultation with an estimated reduction (95% CI) of 4.3 (2.8 to 5.7) min in consultation times (p < 0.001). Telephone consultation had a mean cost of UK£35.41 per patient consultation compared with £51.12 for face-face consultation, difference £15.71 (95% CI 11.8-19.6; P < 0.001).
Interpretation:
We found no suggestion of inferiority of telephone consultation compared with face-to-face consultation with regard to improvements in QOL scores, and telephone consultation reduced consultation time and NHS costs. Telephone consultation is a cost-effective alternative to face-to-face consultation for the routine outpatient follow-up of children and adolescents with IBD.
Funding:
Research for Patient Benefit Programme, UK National Institute for Health Research.
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