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TN: Telenutrition Interventions by Registered Dietitians (2012)

Citation:
 
Study Design:
Class:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To report on patient satisfaction with the Kentucky TeleCare teleconsultations.

Inclusion Criteria:

Patients in rural Appalachian areas of eastern Kentucky using the Kentucky TeleCare telemedicine network.

Exclusion Criteria:

None specifically mentioned.

Description of Study Protocol:

Recruitment

  • Recruitment methods for patients not described
  • All patients lived in rural Appalachian areas of eastern Kentucky.

Design

Before-and-after study.

Intervention

  • Kentucky TeleCare telemedicine network
  • Consultant specialties included psychiatry (41), dermatology (24), clinical nutrition (20), anaesthesia (3), infectious diseases (3), rheumatology (2), internal medicine (1), neurology (1) and pediatric pulmonology (1).

Statistical Analysis

  • Using SPSS PC+ statistical software, frequencies and means were calculated for the responses to each of the questions
  • Statistical analyses included multiple regression.
Data Collection Summary:

Timing of Measurements

  • The first interactive teleconsultation took place in December 1995. During the subsequent 10 months, 96 teleconsultations in nine different specialties were carried out.
  • Patient completed the questionnaire after the teleconsultation.

Dependent Variables

Patient comfort and satisfaction was measured with 13 questions on a seven-point Likert scale with "1" indicating strong disagreement and "7" strong agreement.

Independent Variables

Kentucky TeleCare teleconsultations.

Description of Actual Data Sample:
  • Initial N: 96 patients
  • Attrition (final N): 96 patients, all participated in the survey; 52 females, 39 males. In five cases, the sex was not recorded where patients were signing for a child.
  • Age: Mean, 36 years; range, one to 88 years
  • Ethnicity: Not described
  • Other relevant demographics: Not described
  • Anthropometrics: Not described
  • Location: Kentucky.
Summary of Results:

Key Findings

  • The results indicated a high level of patient satisfaction, with a mean score of 6.8 (on a seven-point Likert scale) for the question, "Overall, I was very satisfied with today's consultation."
  • The results indicated that the majority of patients were satisfied with the telemedicine encounter, although a minority (16%) would have preferred to see the specialist in person
  • Specialties caring for the 15 patients stating a preference for a traditional consultation
    • Psychiatry: Nine patients
    • Dermatology: Two patients
    • Nutritional counseling: Two patients
    • Rheumatology: One patient
    • Pediatric pulmonology: One patient.
  • Results of a step-wise regression revealed three significant variables relating to satisfaction:
    • Question Four (Consultant knew what he/she was doing)
    • Question 12 (Care received was as good as in person)
    • Question Five (Consultant was able to address problem).
  • The results indicated that the more patients perceived the consultant to be competent, caring and able to address their problems, the more satisfied they were with the telemedicine consultation.

Patient Satisfaction Results

Question

Mean±SD
I think I will be satisfied with today's telemedicine consultation (N=74)
5.4±1.6

I felt I could talk about anything with the consultant (N=90)

6.6±0.8
The consultant cared about me as a person (N=91)
6.6±0.8
The consultant knew what he/she was doing (N=94)
6.8±0.6
The consultant was able to address what was bothering me today (N=93)
6.5±0.8
My medical problem was quite urgent today (N=89)
5.0±1.9
During the consultation, I was nervous about using the telemedicine equipment (N=93)
3.5±2.2
I was embarrassed or self-conscious when the examination was performed (N=93)
2.7±2.0
I had difficulty hearing what the consultant said because of the video system (N=94)
2.1±2.0
I had no trouble seeing the consultant over the video system (N=93)
5.8±2.2
Telemedicine makes it easier to get medical care (N=94)
6.6±0.9
The care I received from this telemedicine consultation was as good as a regular in-person visit (N=94)
6.5±0.9
Overall, I was very satisfied with today's consultation (N=94)
6.8±0.5

 

Author Conclusion:
  • The study showed that patients in rural eastern Kentucky were very satisfied with telemedicine as a means of health-care delivery
  • Further research is needed to document cost-effectiveness and quality of patient care
  • The present study shows that if patients perceive the specialist to be competent, feel that the specialist can address their problems and think that a teleconsultation is as good as a traditional one, then patients will be satisfied with interactive telemedicine.
Funding Source:
Government: Kentucky TeleCare partnership
University/Hospital: University of Kentucky
Reviewer Comments:
  • Inclusion and exclusion criteria and recruitment methods for patients receiving teleconsultations were not described
  • Questionnaire was not shown to be valid and reliable.
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
 
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? ???
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? No
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) No
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? Yes
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? N/A
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? ???
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? Yes
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? ???
  7.5. Was the measurement of effect at an appropriate level of precision? ???
  7.6. Were other factors accounted for (measured) that could affect outcomes? ???
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? ???
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? ???
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? ???