Proactive Telemedicine to Improve Healthcare Access and Prevention in Rural Primary Care (PTM)

NCT ID: NCT07299201

Last Updated: 2025-12-23

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

ACTIVE_NOT_RECRUITING

Clinical Phase

NA

Total Enrollment

120 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-06-25

Study Completion Date

2026-03-16

Brief Summary

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The study evaluates whether Proactive Telemedicine (PTM) can improve healthcare access for individuals who have not contacted their primary care team for at least one year, compared with face-to-face visits. PTM consists of brief, remote behavioral interventions addressing modifiable risk factors such as tobacco use, alcohol consumption (AUDIT-C: Alcohol Use Disorders Identification Test - Consumption), physical activity (IPAQ: International Physical Activity Questionnaire), and Mediterranean diet adherence (PREDIMED: Prevención con Dieta Mediterránea). PTM follows national preventive protocols including PAPPS (Programa de Actividades Preventivas y de Promoción de la Salud) and uses validated tools such as EuroQol-5D-5L (EQ-5D-5L) to measure healthcare accessibility and quality-of-life outcomes. This randomized non-inferiority trial aims to determine whether PTM is as effective and safe as traditional in-person consultations.

Detailed Description

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Healthcare systems, particularly in rural and aging populations, face persistent challenges in ensuring equitable and universal access. Many individuals do not regularly engage with primary care services due to geographical, socioeconomic, organizational, or personal barriers. Digital health initiatives, including the World Health Organization's Global Strategy on Digital Health 2020-2025, highlight telemedicine as a key tool to improve accessibility and support preventive care.

Proactive Telemedicine (PTM) is a model in which primary care professionals initiate remote contact with individuals who have not interacted with their healthcare team for at least one year. The intervention uses synchronous (telephone) and asynchronous (secure messaging) communication to deliver brief behavioral counseling based on cognitive-behavioral and motivational interviewing principles. These interventions target modifiable lifestyle factors such as smoking, alcohol consumption, physical inactivity, and dietary patterns, and are aligned with national preventive care recommendations.

This randomized non-inferiority trial evaluates whether PTM provides accessibility, preventive impact, and user experience comparable to face-to-face consultations. The study examines whether proactively delivered telemedicine can serve as a scalable and acceptable strategy to increase engagement with primary care services in underserved rural areas. The information obtained will help determine the feasibility, effectiveness, and future implementation potential of PTM within broader healthcare systems.

Conditions

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Primary Health Care Telemedicine Face to Face Consultation Health Care Access Prevention Quality of Life Adverse Effects Cardiovascular (CV) Risk Behavior Change Interventions Brief Intervention

Keywords

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telemedicine primary care access non-inferiority trial health behavior change rural healthcare preventive medicine quality of life proactive intervention

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The study uses a two-arm parallel assignment model in which participants are randomly allocated to either the proactive telemedicine intervention or standard face-to-face care. Each participant remains in their assigned arm for the duration of the study, with no crossover.
Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

NONE

Study Groups

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Arm 1: Proactive Telemedicine (PTM)

Participants receive proactive remote contact by telephone or secure electronic messaging. A standardized brief behavioral intervention is delivered at baseline, four months, and eight months, focusing on smoking status, alcohol consumption, Mediterranean diet adherence, and physical activity. The stage of behavioral change is assessed to tailor motivational strategies. Participants then enter an observational phase to monitor natural healthcare utilization.

Group Type ACTIVE_COMPARATOR

Telemedicine Brief Behavioural Lifestyle Intervention

Intervention Type BEHAVIORAL

Participants received proactive digital contact via phone or e-consultation. They underwent a brief behavioural intervention addressing modifiable lifestyle factors such as smoking, alcohol consumption, physical activity, and diet. Additionally, access to the rural primary healthcare system will also be measured.

Arm 2: Face-to-Face Consultation

Participants attend in-person appointments at the health center at baseline, four months, and eight months. Each visit includes the same standardized behavioral intervention used in the PTM arm. Participants then enter an observational phase.

Intervention: Face-to-Face Brief Behavioral Lifestyle Intervention

Group Type ACTIVE_COMPARATOR

Face to face Brief Behavioural Lifestyle Intervention

Intervention Type BEHAVIORAL

Participants attend in-person visits where they undergo a brief behavioural intervention addressing modifiable lifestyle factors (smoking, alcohol, physical activity, diet). Additionally, access to the rural primary healthcare system is also measured.

Interventions

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Telemedicine Brief Behavioural Lifestyle Intervention

Participants received proactive digital contact via phone or e-consultation. They underwent a brief behavioural intervention addressing modifiable lifestyle factors such as smoking, alcohol consumption, physical activity, and diet. Additionally, access to the rural primary healthcare system will also be measured.

Intervention Type BEHAVIORAL

Face to face Brief Behavioural Lifestyle Intervention

Participants attend in-person visits where they undergo a brief behavioural intervention addressing modifiable lifestyle factors (smoking, alcohol, physical activity, diet). Additionally, access to the rural primary healthcare system is also measured.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Registered patients of EAP Anoia Rural
* Age ≥18 years
* No contact with the primary care team within the previous 12 months
* Able to provide informed consent (electronic or paper)

Exclusion Criteria

* Proxy care (consulted by caregivers without patient present).
* Inability to communicate.
* Severe cognitive or psychiatric impairment.
* Advanced or palliative chronic conditions (MACA: Modelo de Atención Crónica Avanzada - Advanced Chronic Care Model).
* Outdated contact information.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Institut Catala de Salut

OTHER_GOV

Sponsor Role collaborator

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

OTHER

Sponsor Role lead

Responsible Party

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Robert Panades Zafra

MD, Primary Care Physician, EAP Anoia Rural, Catalonia, Spain

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Josep Vidal Alaball, PhD

Role: STUDY_DIRECTOR

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Robert Panadés Zafra, MD

Role: PRINCIPAL_INVESTIGATOR

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Locations

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EAP Anoia rural. Gerència d'Atenció Primària i a la comunitària Penedès. Institut Català de la Salut. Departament de Salut. Generalitat de Catalunya

Igualada, Barcelona, Spain

Site Status

Countries

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Spain

References

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Related Links

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https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services

Background resource on access to health services as a social determinant of health, from Healthy People 2030.

Other Identifiers

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23/282-P

Identifier Type: -

Identifier Source: org_study_id