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

Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

Status: Active, not recruiting

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

Treatments: Behavioral: Telemedicine Brief Behavioural Lifestyle Intervention; Behavioral: Face to face Brief Behavioural Lifestyle Intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT07299201

23/282-P

Details and patient eligibility

About

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.

Full description

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.

Enrollment: 120 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

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.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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120 participants in 2 patient groups

Arm 1: Proactive Telemedicine (PTM)

Active Comparator group

Description:

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.

Treatment:

Behavioral: Telemedicine Brief Behavioural Lifestyle Intervention

Arm 2: Face-to-Face Consultation

Active Comparator group

Description:

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

Treatment:

Behavioral: Face to face Brief Behavioural Lifestyle Intervention