Evaluation of telemedicine-based training for rural primary healthcare providers in China: A randomized controlled trial

Last registered on October 31, 2022

Pre-Trial

General Information

Title

RCT ID

AEARCTR-0010327

Initial registration date

October 29, 2022

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published

October 31, 2022, 4:37 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Country

China

Region

Shaanxi Province

Primary Investigator

Name

Qiufeng Gao

Affiliation

Center for Experimental Economics in Education at Shaanxi Normal University

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Yaojiang Shi

PI Affiliation

Center for Experimental Economics in Education at Shaanxi Normal University

Contact Investigator

Additional Trial Information

Status

On going

Start date

2021-01-01

End date

2023-12-31

Keywords

Health

Additional Keywords

Telemedicine, Primary health care

JEL code(s)

Secondary IDs

Prior work

This trial does not extend or rely on any prior RCTs.

Abstract

Background and aims
Digital technologies have the potential to address some challenges in providing high-quality and equitable health care services. In particular, telemedicine service can overcome geographical barriers and provide health service/training to residents/healthcare workers in remote and undeveloped areas. Previous studies have documented poor quality of primary health care in rural areas of China. This study aims to assess whether a telemedicine-based training program could improve the quality of care delivered by primary healthcare providers in rural areas and what influences rural primary healthcare providers’ engagement in the program.

Who can participate?
First, we identified rural primary healthcare providers who were practicing Western medicine in the 40 sample townships. In each township, we randomly selected 3 doctors in the township health center and included all of the doctors from 3 randomly selected villages. These doctors were included in our trial and are hereafter referred to as “sample primary healthcare providers”.

In addition, for each selected village, we randomly selected 5 households. Residents aged 18 or older in these households (hereafter, “sample rural residents”) were surveyed. Thus, a total of 15 households was selected in each township for investigation.

What does the study involve?
Following a baseline survey, 40 townships in our trial were randomly assigned to either the intervention group or the control group. In the intervention group, sample primary healthcare providers were offered the opportunity to participate in a telemedicine-based training program for 7 months (see descriptions in the Intervention section below). Sample primary healthcare providers in the control group did not receive any intervention. Within three months after the training program ended, sample primary healthcare providers were followed up to assess their clinical knowledge and practices, and sample rural residents were followed up to assess patient satisfaction, utilization of primary medical services, their own health behavior and knowledge, as well as health services provided by doctors in their village clinic and township health center.

What are the possible benefits and risks of participating?
This study is expected to benefit rural primary healthcare providers and residents in the townships randomly assigned to the intervention group. Potential benefits to primary healthcare providers include improved clinical knowledge. Rural residents served by primary healthcare providers in the intervention group may benefit from improved care. There are no risks involved in participating in this study.

External Link(s)

Registration Citation

Citation

Gao, Qiufeng and Yaojiang Shi. 2022. "Evaluation of telemedicine-based training for rural primary healthcare providers in China: A randomized controlled trial." AEA RCT Registry. October 31. https://doi.org/10.1257/rct.10327-1.0

Sponsors & Partners

Experimental Details

Interventions

Intervention(s)

Sample primary healthcare providers in the intervention group were invited to participate in a telemedicine-based training program for 7 months. During this program, online training and teleconsultation services were provided by experts in an urban comprehensive tertiary hospital who were qualified at least as attending physicians. The voluntary online training consisted of 31 sessions covering a series of common diseases in rural areas. Teleconsultation creates a hands-on approach to learning: sample primary healthcare providers could contact experts via teleconsultation when they needed help with patient cases, which served as another form of training and allowed for learning by doing. Sample primary healthcare providers were allowed to use the teleconsultation services for free during business hours.

Sample primary healthcare providers in the control group did not receive any intervention.

Intervention Start Date

2021-03-01

Intervention End Date

2021-09-30

Primary Outcomes

Primary Outcomes (end points)

1. Clinical knowledge of primary healthcare providers (Vignettes Method and Structural Questionnaire Test)
1) Each primary healthcare provider in the sample was administered Vignettes presenting three disease cases: asthma, unstable angina, and child diarrhea. The analysis will focus on process quality, correctness of diagnoses, and appropriateness of treatment, which will all be evaluated by experts.
2) A series of ten test items related with common diseases were adopted in a structural questionnaire. The test scores will be calculated based on the number of correctly answered test items, which will also be evaluated by experts.
2. Clinical practice of primary healthcare providers (Standardized Patients Method)
Unannounced standardized patients (hereafter, “SPs”) were used to assess clinical practice of primary healthcare providers. We chose three cases presented by Standardized Patients: asthma, unstable angina, and child diarrhea. In principle, each primary healthcare provider received 0 to 2 cases of SP visits based on predetermined rules. The analysis will focus on process quality, correctness of diagnoses, appropriateness of treatment, and consulation length, which will all be evaluated by experts.

Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)

1. Patient satisfaction reported by SPs and sample rural residents
2. Utilization of primary medical services collected from sample rural residents as well as patient load reported by sample primary healthcare providers
3. Services offered by sample primary healthcare providers for chronic disease management, as reported by sample rural residents
4. Sample rural residents’ health behavior (including medication adherence and monitoring of chronic diseases) and health knowledge about chronic diseases

Secondary Outcomes (explanation)

Experimental Design

Interventional cluster randomized controlled trial

Experimental Design Details

Randomization Method

Clusters (township level) were randomly assigned to the intervention and control groups using a computerized random number generator. Within each cluster, sample primary healthcare providers and sample rural residents were randomly selected by computer software.

Randomization Unit

Townships

Was the treatment clustered?

Yes

Experiment Characteristics

Sample size: planned number of clusters

We aimed to include 40 townships. Each township is estimated to have at least 6 primary healthcare providers from 4 primary health facilities (i.e., 3 doctors randomly selected from the township health center and all doctors from 3 randomly selected village clinics) and 15 households (i.e., 5 households randomly selected from the same 3 randomly selected villages).

Sample size: planned number of observations

We expected to enroll at least 240 primary healthcare providers and roughly 600 households in the study.

Sample size (or number of clusters) by treatment arms

We combined stratified randomization at the county level with clustered randomization at the township level. Specifically, wthin each county, we planned to randomly assign half townships to the intervention group and the other half to the control group. Since the number of townships in the sample counties was unevenly distributed, we ultimately assigned 19 townships to the intervention group and 21 townships to the control group by computer software.

Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Supporting Documents and Materials

IRB