Neurological Teleconsultations in General Practice: A Stepped-Wedge Cluster Randomized Clinical Trial
Abstract
Importance: Incorporating teleneurology into primary care aimed to improve access to neurological care in a rural region in Germany. A telemedicine network connecting neurologists, general practitioners (GPs), and patients was established.
Objective: To determine whether teleneurology services in rural primary care increased the proportion of patients with neurological symptoms managed solely in general practice.
Design, setting, and participants: The NeTKoH study (Neurological Teleconsultation With General Practitioners to Strengthen Specialist Care in Western Pomerania, Germany) was a stepped-wedge cluster randomized clinical trial conducted from January 1, 2021, through July 31, 2025, to compare teleconsultations vs standard care. Patients were continuously approached and eligible if they were aged 18 years or older and presented at one of 41 participating GP practices in northeast Germany with symptoms for which a neurological consultation was deemed necessary. The duration of patient follow-up was 3 months. Data analysis was conducted from January to July 2025.
Intervention: Practices were equipped with a telemedicine system to enable a video conference between the GP and patient on 1 side and a neurologist on the other side to obtain immediate neurological assessment and guide further care decisions.
Main outcomes and measures: The primary outcome was the proportion of patients who continued to be managed solely within general practice.
Results: Between October 15,…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 983 participants or records.
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