Diagnostic concordance of telemedicine as compared to face-to-face care in primary health care clinics in rural India: a randomized crossover trial (Preprint)

BACKGROUND Due to the COVID-19 pandemic, a growing number of provider-to-provider telemedicine programs have emerged that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. An important question for patients, health providers, and policymakers is whether provider-to-provider telemedicine-based care is comparable to in-person care and whether it is a safe and acceptable alternative when in-person care is not accessible. OBJECTIVE To compare the diagnosis and treatment decisions from teleconsultations to those of face-to-face care in teleclinics in rural Gujarat. METHODS We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at ten telemedicine primary care clinics. Patients received an in-person consultation followed by a teleconsultation or vice versa. The in-person doctor's diagnosis and treatment plan were considered the gold standard. In addition, we surveyed the patients reporting to the teleclinic to understand their acceptability towards telemedicine and its impact on health access. RESULTS We observed a 74% diagnostic concordance and an 80% concordance in the treatment plan between the in-person and remote doctor. The highest diagnostic concordance was seen in the management of hypertension (95%), diabetes (93%), and obstetrics (80%). The lowest was seen in cardiology (33%) and patients with non-specific issues (30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. CONCLUSIONS We found that telemedicine is a safe and effective alternative in rural primary health care delivery in India when in-person care cannot be provided.