Evaluation of a Scalable Design for a Pediatric Telemedicine and Medication Delivery Service: A Prospective Cohort Study in Haiti

Objective. To evaluate a scalable pediatric telemedicine and medication delivery service (TMDS) that extends early healthcare access at households to avert emergencies. Study design. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, non-severe cases with higher clinical uncertainty to in-person exams at households with medication delivery, and non-severe cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients (≤10 years). Clinical and operational metrics were compared to a formative reference study in which all non-severe patients received an in-person exam. The primary outcomes were reported rates of clinical improvement/recovery and in-person care seeking at 10-days. Results: 1043 cases (41 severe; 1002 non-severe) were enrolled in the scalable TMDS mode and 19% (190) of the non-severe cases received an in-person exam. 382 cases (24 severe, 358 non-severe) were enrolled in the reference study and 94% (338) of the non-severe cases received an in-person exam. At 10-days, rates of improvement were similar for the scalable (97%, 897) and reference (95%, 329) modes. Rates of participants who sought follow-up care were 15% (138) in the scalable mode and 24% (82) in the reference mode. Conclusion: In the context of a five-fold reduction of in-person exams, participants in the scalable TMDS mode had non-inferior rates of improvement at 10-days. These findings highlight an innovative and now scalable solution to improve early access to healthcare at households without compromising safety.