Abstract
Dear Editors:
We read with great interest the recent publication in this journal by Mulgrew et al., 1 “Comparison of Parent Satisfaction with Care for Childhood Obesity Delivered Face-to-Face and by Telemedicine.” The authors concluded “that there was no significant difference in parent satisfaction between consultations for childhood obesity delivered face to face and by telemedicine.” 1
We have read additional articles about patient satisfaction from telemedicine care. Marcin et al. 2 found that in their study, overall, patient satisfaction from telemedicine care was very high. All the parent/guardians rated satisfaction with telemedicine care as either excellent or very good, and all but two of the rural providers surveyed reported satisfaction with telemedicine as excellent or very good. Also, Liu et al. 3 declared that patients were satisfied with the telemedicine conclusion but that doctors were dissatisfied with it and felt hampered by the communication barriers.
These articles are consistent with the results of Mulgrew et al., 1 but we have a series of concerns regarding their study. First, patients included in the study of Mulgrew et al. 1 resided in rural and remote areas of California and faced disparities with respect to healthcare access and socioeconomic status; therefore, it is possible that results may not be generalizable to telemedicine weight management programs in urban or more affluent populations. Second, in this study, the sampling frame is not exact. Mulgrew et al. 1 stated “During the study time period, 54 parents/guardians of children who received childhood weight management consultations completed the questionnaires. Of those, 25 responses were included. Twenty-nine responses were excluded because the patients were 12 years of age or older.” It was better that the first samples were precisely determined when the questionnaires were distributed based on specific criteria in order to avoid wasting time and money. On the other hand, in order to eliminate any possible bias it was more that the two groups were comparable based on criteria such as sex, race, weight, and stature. 4
In spite of these limitations, the study of Mulgrew et al. 1 makes important contributions to application of the the existing literature in obesity and pediatrics. Patients who previously had to travel to tertiary-care facilities from rural or remote locations could be reassured about the ability of telemedicine weight management consultations to contribute to patient care plans. 5
References
Response to Fayaz-Bakhsh and Yusefi
Kirk Mulgrew, MD
Children's Hospital of Orange County, Orange, California.
Dear Editors:
We appreciate the interest in our article and the comments by Fayaz-Bakhsh and Yusefi.
Regarding the first concern: We agree that our results may not be applicable to telemedicine weight management programs in urban or more affluent populations. This was not a goal of our study. In order to address this question, we would need to obtain a much larger sample size that includes patients in a larger number of geographic areas and socioeconomic backgrounds. One of the main goals of our telemedicine program is to increase access to quality care for those in remote areas of California.
The second concern discusses the sampling frame. Fayaz-Bakhsh and Yusefi are correct in that determination of specific inclusion criteria prior to questionnaire distribution would have eliminated the unnecessary collection of questionnaires and prevented the exclusion of such a large number of participants. This was a pilot study conducted, in part, to determine the feasibility of questionnaire distribution and data collection. We planned to increase our sample size, use more specific inclusion criteria prior to questionnaire distribution, and include more outcome data (such as body mass index) in future studies.