Abstract：
Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to health care for children in low-resource settings.
We implemented a TMDS called \'MotoMeds\' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10 years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility.
A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had \"improved\" or \"recovered\". Overall, 99% (344) rated the TMDS as \"good\" or \"great\". The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total case time was 114 minutes.
The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.
clinicaltrials.gov: NCT03943654.
We implemented a TMDS called \'MotoMeds\' in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤ 10 years contacted the call center (6 PM-5 AM). A nurse provider used decision support tools to triage cases (mild, moderate, or severe). Severe cases were referred to emergency care. For nonsevere cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the virtual call center exam. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility.
A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were nonsevere (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Among all cases, respiratory problems were the most common complaint (63%; 246). At 10 days, 95% (329) of parents reported their child had \"improved\" or \"recovered\". Overall, 99% (344) rated the TMDS as \"good\" or \"great\". The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total case time was 114 minutes.
The TMDS was a feasible health care delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.
clinicaltrials.gov: NCT03943654.
摘要：
目的：确定实施远程医疗和送药服务（TMDS）的临床安全性和可行性，以解决资源匮乏地区儿童夜间获得医疗保健的差距。
方法：我们在海地实施了一项名为“MotoMeds”的TMDS，作为一项前瞻性队列研究。≤10岁的患病儿童的父母/监护人联系了呼叫中心（下午6点至凌晨5点）。一名护士提供者使用决策支持工具对病例进行分类(轻度，中度,严重)。重症病例被转诊至急诊护理。对于非严重病例，提供者收集临床发现以生成评估和计划.对于交付区内的案例，我们派遣了提供者和驾驶员,并且提供者进行了配对的当面检查,作为呼叫中心评估的参考标准.家庭在10天接到了后续电话。对数据进行临床安全性和可行性分析。
结果：从2019年9月9日至2021年1月19日，共纳入391例病例。大多数病例并不严重（92％；361）；其中89％（347）的病例完成了家庭访问。在30例严重病例中，67%(20)寻求转诊护理。呼吸系统问题最为常见（63%；246）。在10天，95％（329）的父母报告他们的孩子“改善”或“康复”。总体来说，99%（344）将TMDS评为“好”或“好”。电话咨询时间中位数为20分钟，家庭到达的时间是73分钟，总时间为114分钟/例。
结论：TMDS是一种可行的医疗服务模式。尽管许多病例可能是自限的，TMDS与10天时报告的临床状态改善率较高相关.
方法：我们在海地实施了一项名为“MotoMeds”的TMDS，作为一项前瞻性队列研究。≤10岁的患病儿童的父母/监护人联系了呼叫中心（下午6点至凌晨5点）。一名护士提供者使用决策支持工具对病例进行分类(轻度，中度,严重)。重症病例被转诊至急诊护理。对于非严重病例，提供者收集临床发现以生成评估和计划.对于交付区内的案例，我们派遣了提供者和驾驶员,并且提供者进行了配对的当面检查,作为呼叫中心评估的参考标准.家庭在10天接到了后续电话。对数据进行临床安全性和可行性分析。
结果：从2019年9月9日至2021年1月19日，共纳入391例病例。大多数病例并不严重（92％；361）；其中89％（347）的病例完成了家庭访问。在30例严重病例中，67%(20)寻求转诊护理。呼吸系统问题最为常见（63%；246）。在10天，95％（329）的父母报告他们的孩子“改善”或“康复”。总体来说，99%（344）将TMDS评为“好”或“好”。电话咨询时间中位数为20分钟，家庭到达的时间是73分钟，总时间为114分钟/例。
结论：TMDS是一种可行的医疗服务模式。尽管许多病例可能是自限的，TMDS与10天时报告的临床状态改善率较高相关.
