Using telemedicine to improve the care delivered to sexually abused children in rural, underserved hospitals

Kristen J. MacLeod, James P Marcin, Cathy Boyle, Sheridan Miyamoto, Robert J. Dimand, Kristen K. Rogers

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

OBJECTIVE. We used live telemedicine consultations to assist remote providers in the examination of sexually assaulted children presenting to rural, underserved hospitals. We hypothesized that telemedicine would increase the ability of the rural provider to perform a complete and accurate sexual assault examination. PATIENTS AND METHODS. Child abuse experts from a university children's hospital provided 24/7 live telemedicine consultations to clinicians at 2 rural, underserved hospitals. Consultations consisted of videoconferencing to assist in the examination and interpretation of findings during live examinations. Consecutive female patients <18 years of age presenting to the 2 participating hospitals were included. We developed and used an instrument to assess the quality of care and the interventions provided via telemedicine as it related to patient history, physical examination, colposcopic and manual manipulation techniques, interpretation of findings, and treatment plans for victims of child sexual abuse. RESULTS. Data from 42 live telemedicine consultations were analyzed. The mean duration of the consultations was 71 minutes (range: 25-210 minutes). The consultations resulted in changes in interview methods (47%), the use of the multimethod examination technique (86%), and the use of adjunct techniques (40%). There were 9 acute sexual assault telemedicine consults that resulted in changes to the collection of forensic evidence (89%). Rankings of practitioners' skills and the telemedicine consult effectiveness were high, with the majority of cases scoring ≥5 on a 7-point Likert scale. CONCLUSIONS. The use of telemedicine to assist in the examination of sexually assaulted children presenting to underserved, rural communities results in significant changes in the methods of examination and evidence collection. It is possible that this model of care results in increased quality of care and appropriate forensic evidence collection.

Original languageEnglish (US)
Pages (from-to)223-228
Number of pages6
JournalPediatrics
Volume123
Issue number1
DOIs
StatePublished - Jan 2009

Fingerprint

Rural Hospitals
Telemedicine
Referral and Consultation
Quality of Health Care
Videoconferencing
Sexual Child Abuse
Child Abuse
Rural Population
Physical Examination
Interviews

Keywords

  • Child sexual abuse
  • Nonaccidental trauma
  • Quality of care
  • Telehealth
  • Telemedicine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Using telemedicine to improve the care delivered to sexually abused children in rural, underserved hospitals. / MacLeod, Kristen J.; Marcin, James P; Boyle, Cathy; Miyamoto, Sheridan; Dimand, Robert J.; Rogers, Kristen K.

In: Pediatrics, Vol. 123, No. 1, 01.2009, p. 223-228.

Research output: Contribution to journalArticle

MacLeod, Kristen J. ; Marcin, James P ; Boyle, Cathy ; Miyamoto, Sheridan ; Dimand, Robert J. ; Rogers, Kristen K. / Using telemedicine to improve the care delivered to sexually abused children in rural, underserved hospitals. In: Pediatrics. 2009 ; Vol. 123, No. 1. pp. 223-228.
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abstract = "OBJECTIVE. We used live telemedicine consultations to assist remote providers in the examination of sexually assaulted children presenting to rural, underserved hospitals. We hypothesized that telemedicine would increase the ability of the rural provider to perform a complete and accurate sexual assault examination. PATIENTS AND METHODS. Child abuse experts from a university children's hospital provided 24/7 live telemedicine consultations to clinicians at 2 rural, underserved hospitals. Consultations consisted of videoconferencing to assist in the examination and interpretation of findings during live examinations. Consecutive female patients <18 years of age presenting to the 2 participating hospitals were included. We developed and used an instrument to assess the quality of care and the interventions provided via telemedicine as it related to patient history, physical examination, colposcopic and manual manipulation techniques, interpretation of findings, and treatment plans for victims of child sexual abuse. RESULTS. Data from 42 live telemedicine consultations were analyzed. The mean duration of the consultations was 71 minutes (range: 25-210 minutes). The consultations resulted in changes in interview methods (47{\%}), the use of the multimethod examination technique (86{\%}), and the use of adjunct techniques (40{\%}). There were 9 acute sexual assault telemedicine consults that resulted in changes to the collection of forensic evidence (89{\%}). Rankings of practitioners' skills and the telemedicine consult effectiveness were high, with the majority of cases scoring ≥5 on a 7-point Likert scale. CONCLUSIONS. The use of telemedicine to assist in the examination of sexually assaulted children presenting to underserved, rural communities results in significant changes in the methods of examination and evidence collection. It is possible that this model of care results in increased quality of care and appropriate forensic evidence collection.",
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AB - OBJECTIVE. We used live telemedicine consultations to assist remote providers in the examination of sexually assaulted children presenting to rural, underserved hospitals. We hypothesized that telemedicine would increase the ability of the rural provider to perform a complete and accurate sexual assault examination. PATIENTS AND METHODS. Child abuse experts from a university children's hospital provided 24/7 live telemedicine consultations to clinicians at 2 rural, underserved hospitals. Consultations consisted of videoconferencing to assist in the examination and interpretation of findings during live examinations. Consecutive female patients <18 years of age presenting to the 2 participating hospitals were included. We developed and used an instrument to assess the quality of care and the interventions provided via telemedicine as it related to patient history, physical examination, colposcopic and manual manipulation techniques, interpretation of findings, and treatment plans for victims of child sexual abuse. RESULTS. Data from 42 live telemedicine consultations were analyzed. The mean duration of the consultations was 71 minutes (range: 25-210 minutes). The consultations resulted in changes in interview methods (47%), the use of the multimethod examination technique (86%), and the use of adjunct techniques (40%). There were 9 acute sexual assault telemedicine consults that resulted in changes to the collection of forensic evidence (89%). Rankings of practitioners' skills and the telemedicine consult effectiveness were high, with the majority of cases scoring ≥5 on a 7-point Likert scale. CONCLUSIONS. The use of telemedicine to assist in the examination of sexually assaulted children presenting to underserved, rural communities results in significant changes in the methods of examination and evidence collection. It is possible that this model of care results in increased quality of care and appropriate forensic evidence collection.

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