Background: A feasibility trial was conducted to determine the potential for telemedicine to replace alternate diabetes review appointments in the care of those with gestational diabetes (GDM). One of the aims of this study was to access concordance of clinical decision making between diabetes clinic visits and telemedicine review sessions.
Methods: 50 women with GDM were randomised to usual care (n=26) or usual care plus telemedicine (n=24). Telemedicine entailed weekly blood pressure and weight measurements and transmission of this data, along with blood glucose readings, for review by the health care team.
The management decisions made for the intervention group at each clinic and telemedicine review were recorded under one of 6 categories. Recall bias was minimised by conducting the telemedicine review 2 days before the clinic review.
It was not possible to ensure the same clinician performed both the telemedicine and corresponding clinic review making it necessary to measure inter-rater (between clinician) and intra-rater (within the same clinician) agreement. 20 vignettes, short clinical scenarios, were developed based on information which would be available at telemedicine or clinic review. Each clinician was asked to record a management decision for these vignettes (measuring inter-rater agreement) and to repeat this after a number of weeks (measuring intra-rater agreement).
Cohens kappa was used to quantify the proportion of agreement in excess of the amount of agreement that would be expected by chance.
Results: Cohens kappa was 0.54 for telemedicine and face-to-face review, indicating moderate or fair to good agreement in terms of the management decisions made. This compared to 0.65 (substantial or fair to good agreement) for inter-rater agreement and 0.44, (indicating moderate or fair to good agreement) to 0.77 (indicating substantial or excellent agreement) for intra-rater agreement.
Conclusion: Telemedicine allows clinicians to make comparable management decisions as diabetes clinic review.
30 Nov - 01 Dec 2016
World Congress on Clinical Trials in Diabetes