Summary

The diagnostic hypothesis and test request agreement were good between telemedicine and face-to-face medical attention.

Abstract

Background

Telemedicine is a tool that has made it possible to improve access to medical care. However, there are few studies on the diagnostic agreement of telemedicine compared with a face-to-face medical attention in patients who consult for knee pain. Therefore, the study aims to evaluate the agreement between observers of the diagnostic hypothesis of patients with knee pain evaluated by telemedicine versus face-to-face medical care . The secondary aim was to evaluate the agreement in the indication of exams, user satisfaction, and technical difficulties of telemedicine.

Method

Quasi-experimental study. A sample of >18 years old who presented to an outpatient center for knee pain. Sample size calculation considered a moderate agreement between telemedicine and face-to-face attention, with kappa =0.6 (n=20). Two knee subspecialists (>15 years of experience) evaluated all patients. All patients were first evaluated by telemedicine, where they did not receive any information from the doctor regarding the diagnosis or treatment, and then attended a face-to-face consultation with a specialist (different from the first one who evaluated them), with a maximum interval of 7 days. The diagnostic hypothesis and requested exams were recorded. After both medical attention, the patients answered an online survey on satisfaction with care (Likert scale). In the case of telemedicine, it was also evaluated whether there were technical difficulties in the session. Numerical variables with medians (interquartile range) and categorical variables with relative and absolute frequencies were summarized and compared with the McNemar test. For interobserver agreement, Cohen's kappa was calculated. significant p <0.05, STATA software v.16

Results

Twenty-one patients were evaluated, 57% (n=12) male and a median age of 52 years (IQR 30-63 years). Agreement on the diagnostic hypothesis and test indication was good (kappa 0.64 [95% CI 0.40-0.89] and 0.78 [95% CI 0.34-1.00], respectively). 70% (n=14) of the patients indicated that they were delighted with telemedicine versus 80% (n=16) with the face-to-face attention (p=0.46). In the telemedicine evaluation, no patient had difficulties seeing the doctor on the screen, 10% (n=2) had audio difficulties, and 14% (n=3) required help from a family member during the online consultation.

Conclusion

The diagnostic hypothesis and test request agreement were good between telemedicine and face-to-face medical attention. There were no significant differences in patient user satisfaction, even though a small group of patients presented technical difficulties in telemedicine care. Telemedicine could be a complement to face-to-face consultation in patients with knee pain.