Comparing care for low-acuity patients in different healthcare settings

The Right Care, for the Right Patient, at the Right Time, by the Right Provider: A Value-based Comparison of the Management of Ambulatory Patients With Acute Health Concerns in walk-in Clinics, Primary Care Physician Practices and Emergency Departments

This study is testing how well low-acuity patients with common health issues are cared for in emergency rooms, walk-in clinics, and primary care offices, comparing in-person visits to telemedicine.

Quick facts

• Study type: Observational
• Enrollment: 4000 (estimated)
• Ages: 18 Years and up
• Sex: All
• Sponsor: CHU de Quebec-Universite Laval (Academic / other)
• Locations: 7 sites (Kingston, Ontario and 6 other locations)
• Trial ID: NCT05892666 on ClinicalTrials.gov

What this trial studies

This observational study aims to evaluate the value of care received by ambulatory patients with acute health concerns in emergency departments, walk-in clinics, and primary care practices. It will compare in-person visits and telemedicine consultations, focusing on various common complaints such as sore throat, cough, and urinary issues. Patients will be recruited through a random sampling schedule, with follow-up phone calls to assess their experiences and outcomes. The study seeks to provide insights into the cost-effectiveness and quality of care across different healthcare settings.

Who should consider this trial

Good fit: Ideal candidates include ambulatory patients aged 18 and over presenting with specific acute health complaints in emergency departments, walk-in clinics, or primary care practices.

Not a fit: Patients who are transported by ambulance or those not covered by provincial health insurance may not benefit from this study.

Why it matters

Potential benefit: If successful, this study could help optimize healthcare delivery for low-acuity patients, potentially reducing unnecessary emergency department visits.

How similar studies have performed: Other studies have shown varying success in comparing care models for low-acuity patients, but this specific approach focusing on telemedicine during the COVID-19 pandemic is relatively novel.

Eligibility criteria

We shall include patients:

1. aged 18 years and over;
2. seen in person or via telemedicine in an ED, a walk-in clinic, or the primary care practice where they are registered;
3. ambulatory during the entire visit or consultation;
4. with one of the following presenting complaints:

   1. acute diarrheas, defined as at least one day (24h) reported with three or more loose or liquid stools in the last seven days;
   2. Sore throat;
   3. Nasal congestion;
   4. Increased or purulent nasal discharge;
   5. Earache or ear discharge;
   6. Shortness of breath;
   7. Cough;
   8. Increased or purulent sputum;
   9. Muscle aches;
   10. Anosmia;
   11. Dysgeusia;
   12. Burning urine;
   13. Urinary frequency and urgency;
   14. Dysuria;
   15. Limb traumatic injury;
   16. Cervical, thoracic or lumbar back pain;
   17. Fever.

We shall exclude patients:

1. transported by ambulance;
2. not covered by the provincial health insurance plan;
3. having consulted for a similar problem in the previous 30 days since patients with refractory disease represent a population with different care needs.;
4. living in a long-term healthcare facility or incarcerated;
5. with cognitive impairment that prevents reliable answers to the research questions;
6. receiving palliative care.

Where this trial is running

Kingston, Ontario and 6 other locations

• Kingston Health Sciences Centre — Kingston, Ontario, Canada (Not_yet_recruiting)
• Queen's Family Health Team — Kingston, Ontario, Canada (Not_yet_recruiting)
• Ottawa Hospital — Ottawa, Ontario, Canada (Not_yet_recruiting)
• CISSS de Lanaudière — Joliette, Quebec, Canada (Not_yet_recruiting)
• CIUSSS-Nord de Montréal — Montreal, Quebec, Canada (Not_yet_recruiting)
• CIUSSS de la Capitale-Nationale — Québec, Canada (Not_yet_recruiting)
• Centre de recherche CHU de Québec - Université Laval — Québec, Canada (Recruiting)

Study contacts

• Principal investigator: Simon Berthelot, MD MSc FRCPC CCMF(MU) — CHU de Québec-Université Laval
• Study coordinator: Simon Berthelot, MD MSc FRCPC

Conditions Ambulatory Care; Emergency Services, Hospital; Quality of Care; Costs