Feasibility, Diagnostic Accuracy, and Satisfaction of an Acute Pediatric Video Interconsultation Model in Rural Primary Care in Catalonia: Prospective Observational Study

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Background: In Catalonia, Spain, pediatric primary care is undergoing restructuring, including greater integration of information and communication technologies. The adoption of digital health solutions has increased notably since the COVID-19 pandemic. In areas with limited availability of health care professionals, digital tools are a key strategy for facilitating access to services and ensuring continuity of care. Objective: This study aimed to evaluate the feasibility, diagnostic agreement, and satisfaction of users and professionals of an acute pediatric video consultation model, referred to as video interconsultation, that includes a synchronous remote physical examination and takes place between health care professionals. Methods: This was a 20-month prospective within-patient diagnostic accuracy study including 200 children (aged 0-14 y) with acute conditions in rural primary care in Catalonia. A secure, closed, real-time, web-based, clinician-assisted video consultation platform enabled remote pediatric assessment-visual examination, audio auscultation via a digital stethoscope, and caregiver-reported symptoms-with a pediatrician remotely guiding a nurse physically present with the child. The intervention was compared, in all cases, with a standard in-person pediatric assessment as the reference standard. Outcomes were feasibility, diagnostic accuracy, and user and professional satisfaction. The platform was developed based on telemedicine usability and clinical safety principles. Results: Of the 200 children enrolled, remote video consultations were successfully completed in 64.5% (129/200) of cases. Diagnostic agreement with in-person assessment was 78.2% (129/165). Overall mean diagnostic accuracy across all diagnoses was 0.99 (95% CI 0.98-1.00), with a mean specificity of 0.99 (95% CI 0.98-1.00) and a mean sensitivity of 0.90 (95% CI 0.84-0.95), varying by condition, with lower performance for pathologies requiring detailed physical examination. Overall, 95% (190/200) of users and 74% (148/200) of professionals reported a positive experience. Conclusions: The proposed pediatric video consultation model was feasible, accurate, and well accepted for managing a substantial proportion of acute pediatric conditions in primary care. Its implementation could improve access to medical care in rural areas and help reduce health care disparities. Further research is needed to support scalability and implementation in routine clinical practice.

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