Transplant Trial Watch

Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic.

Damery, S., et al.

Journal of Medical Internet Research 2021; 23(9): e19232.


Aims
This study aimed to compare real-time remote consultations versus standard face-to-face consultations between clinically stable liver transplant patients and secondary care physicians for routine patient follow-up.

Interventions
Participants were randomised to either the real-time remote consultations (intervention) group or the standard face-to-face appointments (usual care) group.

Participants
54 clinically stable adult liver transplant patients (aged ≥18 years).

Outcomes
The primary endpoint was combined patient satisfaction score for three domains of the Visit-Specific Satisfaction Instrument (VSQ-9).The secondary outcomes were rate of recruitment, retention and crossover; rate of questionnaire completion and return format; system performance; use of health service; feasibility of collecting data on patient costs; feasibility of obtaining clinical tests locally, clinical contacts, health-related quality of life (HRQoL) and satisfaction in the other six VSQ-9 domains.

Follow-up
12 months

CET Conclusions
The randomised controlled trial compared real-time remote consultations with standard face-to-face consultations in clinically stable liver transplant recipients for routine follow up. The initial power calculation showed that 180 patients were needed based on the primary outcome patient reported satisfaction regarding convenience of location, getting through to the office by phone, and length of time waiting. Due to poor recruitment, the protocol was changed from a definitive trial to a feasibility study. Fifty-six patients were randomised according to an online randomisation tool. The statistician who analysed the primary outcome was blinded to group allocation. Only 64% of postappointment questionnaires were returned. The underpowered analysis showed that satisfaction was similar between groups at the 1-year follow-up. Seventeen percent of the patients in the intervention group received all appointments over video as planned. Other patients in the intervention group received a mix of video and telephone appointments or telephone appointments only due to technical issues. A qualitative evaluation using semi-structured interviews explored patient (n=8) and staff experiences of remote consultations. All patients were satisfied with the received care and reported saving time and money. Some patients reported that the patient-physician interaction was affected by the remote consultation and the interviews revealed issues with obtaining test results locally in half of the patients interviewed. Generally, patients and staff were positive towards including remote consultations in routine follow up care.

Jadad score
2

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
ISRCTN Registry - 14093266

Funding source
Non-industry funded