Evaluation of a Scalable Design for a Pediatric Telemedicine and Medication Delivery Service: A Prospective Cohort Study in Haiti.

Abstract

Early access to health care is essential to avert morbidity and mortality. A telemedicine and medication delivery service (TMDS) is an innovative solution to address this need; however, pathways to scalability are unclear. We sought to evaluate a scalable pediatric TMDS. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, nonsevere cases with higher clinical uncertainty to in-person examinations at households, and nonsevere cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients 10 years old or younger. Clinical and operational metrics were compared with a formative reference study in which all nonsevere patients received an in-person examination. The primary outcomes were rates of clinical improvement/recovery and in-person care seeking at 10 days. In total, 1,043 cases were enrolled in the scalable TMDS mode, and 19% (190) of nonsevere cases received an in-person examination; 382 cases were enrolled in the reference study, and 94% (338) of nonsevere cases received an in-person examination. At 10 days, rates of improvement were similar for the scalable and reference modes. Rates of participants who sought follow-up care were 15% in the scalable mode and 24% in the reference mode. In the context of a 5-fold reduction of in-person examinations, participants in the scalable mode had noninferior rates of improvement at 10 days. These findings highlight an innovative and now scalable solution to improve early access to health care without compromising safety.