Telemedizin in der Pädiatrie – Akzeptanz und Zufriedenheit aus Elternperspektive

Abstract

Background

The telemedical networking of children’s clinics of varying sizes and specializations can support healthcare close to home, especially in rural regions with structural limitations. A Regional Tele-Paediatric Network was implemented in Mecklenburg-Western Pomerania and North Brandenburg (innovation fund project RTP-Net). This study examines the question of how participating parents accepted and evaluated this form of care.

Method

Parents of paediatric patients at a participating clinic were invited to take part in the study during the observation period 02.2021 to 03.2023 study. A mixed-methods approach was used that comprised a standardized questionnaire. The interviews were transcribed, categorized according to Kuckartz and subjected to descriptive evaluation. Between 12.2023 to 02.2024, telephone interviews were conducted with parents who had agreed to be recontacted.

Results

A total of 507 cases (403 patients) were included in the RTP-Net. Data from 138 questionnaires were analyzed. 74.5% of parents found that the use of telemedicine was helpful for the treatment of their child; 88.1% could imagine that telemedicine could supplement paediatric healthcare in the future. Parents interviewed over the telephone (n=11) rated telemedicine services positively. The main advantages mentioned were saving in time and distance, availability of specialist expertise and avoidance of long waiting times. There were concerns about the lack of physical contact between telemedicine doctor and patient.

Conclusion

Parents show a high level of acceptance of telemedicine and trust in the provision of telemedical services. Telemedicine can help parents to avoid the burden of long journeys and waiting times and improve access to specialist medical expertise. In order to improve the acceptance and satisfaction of parents, it is important to inform them about the results if the telemedical advice was based on a doctor-to-doctor consultation.

Zusammenfassung

Hintergrund

Die telemedizinische Vernetzung von Kinder-Kliniken unterschiedlicher Größen und Spezialisierungen kann insbesondere in ländlichen Regionen mit strukturellen Einschränkungen eine wohnortnahe Versorgung unterstützen. In Mecklenburg-Vorpommern und Nord-Brandenburg wurde ein Regionales Telepädiatrisches Netzwerk (Innovationsfondsprojekt RTP-Net) implementiert. In dieser Publikation wird der Frage nachgegangen, wie teilnehmende Eltern diese Versorgungsform akzeptierten und bewerteten.

Methodik

Der Mixed-Methods-Ansatz umfasste einen deskriptiv ausgewerteten standardisierten Fragebogen für Eltern, die ihr Kind im Beobachtungszeitraum 02.2021 bis 03.2023 in einer teilnehmenden Klinik vorstellten und an der Studie teilnahmen. Zwischen 12.2023 und 02.2024 wurden telefonische Interviews mit Eltern geführt, die einer Wiederkontaktierung zugestimmt hatten. Die Interviews wurden transkribiert und inhaltlich strukturierend nach Kuckartz kategorisiert und ausgewertet.

Ergebnisse

Es wurden 507 Fälle (403 Patienten) in das RTP-Net eingeschlossen. Daten aus 138 Elternfragebögen wurden analysiert. 74,5% der befragten Eltern fanden, dass die Nutzung der Telemedizin hilfreich für die Behandlung ihres Kindes war. 88,1% von ihnen können sich vorstellen, dass Telemedizin die pädiatrische Versorgung zukünftig ergänzt. Es wurden elf Telefoninterviews geführt. Diese Eltern schätzten telemedizinische Angebote positiv ein. Als Vorteile galten v. a. die Weg- und Zeitersparnis, die Verfügbarkeit spezialfachärztlicher Expertise und die Vermeidung langer Wartezeiten. Bedenken bestanden in Bezug auf den fehlenden physischen Kontakt zwischen Telemedizinarzt und Patient. Um die Akzeptanz und Zufriedenheit der Eltern zu verbessern, ist es wichtig, diese über das Resultat zu informieren, wenn die telemedizinische Maßnahme als Arzt-zu-Arzt-Konsultation erfolgte.

Schlussfolgerung

Auf Seiten der Eltern ist eine hohe Akzeptanz telemedizinischer Angebote und Vertrauen in die telemedizinische Leistungserbringung gegeben. Durch Telemedizin können Belastungen der Eltern durch lange Anfahrtswege und Wartezeiten vermieden werden und der Zugang zu spezialfachärztlicher Expertise verbessert werden.

Keywords

paediatrics - network - telemedicine - parents - acceptance - regional healthcare

Schlüsselwörter

Pädiatrie - Netzwerk - Telemedizin - Eltern - Akzeptanz - regionale Versorgung

Introduction

The economization of healthcare and the shortage of skilled professionals have been key factors for the final or temporary closure of paediatric departments and emergency services in recent years [1] [2] [3]. At the same time, the number of treated children and adolescents, as well as the number of chronically ill children, has increased [4]. This has particularly affected rural areas, where access to specialized care has been impacted. The geographically uneven distribution of medical resources leads to significant burdens for families in rural regions, who often face long journeys to access necessary medical care.

Telemedicine, defined as the provision of medical services via telecommunication technologies, has the potential to improve the accessibility and quality of healthcare. The integration of telemedicine applications into care (e. g., teleconsultations, telemonitoring, or video consultations) allows for timely and flexible paediatric care regardless of geographical barriers. Paediatric telemedicine has been a topic of discussion in Germany in recent years [5] [6] [7], and internationally, it has been considered a complementary option for paediatric care for decades [8] [9] [10] [11].

In Germany, the COVID-19 pandemic significantly increased the acceptance and use of telemedicine, which has in turn heightened the focus on its long-term integration into medical practice. However, the perspective of parents on this issue has been little studied yet. To the best of our knowledge, three studies have reported findings on the acceptance and satisfaction with telemedicine from the parents' viewpoint in Germany [12] [13] [14].

Between 2020 and 2024, as part of an innovation fund project (RTP-Net), a tele-paediatric network was developed and implemented in 13 hospitals in the northeast of Germany (Mecklenburg-Western Pomerania and Brandenburg). The network offered the following functionalities:

• Telemedicine triage: Standardized assessment of the urgency of treatment for children visiting an emergency department without an available paediatrician.

• Telemedicine consultation (specialist video consultation): A consultation between two doctors on specialist issues and interpretation of, for example, imaging results when a subspecialist is not available on site.

• Ensuring specialist standards via virtual background services: The role of a specialist background service and teleconsultation by a tele-paediatrician. During the project period, this function did not replace the specialist background service on site.

After the start of the field phase, the function “video consultation with patients at home” was added at the request of participating doctors. The project was based on a web-based document exchange und documentation platform (eHealth platform). Video consultations were conducted using a video consultation solution certified for healthcare use [15]. In the observational and implementation study, the perspective of parents was also solicited. The results are presented in the following analysis.

Methodology

The implementation was carried out as part of a prospective, non-controlled study under real-world conditions. The study included patients under the age of 18 from the participating paediatric departments. Parents were informed about the study and subsequently asked to provide their written informed consent for any potential telemedicine interventions. The study did not include newborns in the initial treatment or children and adolescents who required resuscitation.

To assess parents' acceptance and perceptions regarding telemedicine, a mixed-methods approach was chosen, consisting of a written survey (quantitative) and semi-structured parent interviews (qualitative). Parents who agreed to be recontacted were asked to provide their email address and phone number.

Survey

The semi-standardized questionnaire (see online supplement) was adapted from a previous study [12], modified, and tested. It consisted of 18 questions across four areas: general information, distance to the hospital, paediatric care, and socio-economic data. The survey included ten closed-ended and eight open-ended questions. For the questions concerning satisfaction with care during the telemedicine contact and the feasibility of telemedicine as a future complementary care option, 6-point Likert scales were used.

The data collection phase spanned the entire field phase (04.2021 to 02.2024). Parents received the paper-based questionnaire at the hospital. The completed questionnaires were transferred by the project team to the eHealth platform. At the end of the field phase, the data were extracted from the platform and prepared for analysis. Descriptive statistics were performed using SPSS, and data visualization was done with Microsoft Excel.

Parent Interviews

At the end of the field phase, semi-structured interviews were conducted. Parents who had agreed to be recontacted during study enrolment were interviewed. They received a personalized invitation letter via email, followed by a reminder letter approximately two weeks later. Upon a positive response, an interview appointment was scheduled. The audio recordings of the phone interviews were transcribed verbatim and analysed thematically using MAXQDA 2024 (VERBI Software) according to Kuckartz [16]. In an iterative and discursive process, a category system was developed with deductively derived main categories, which were then supplemented with inductively derived subcategories. Using a coding guideline, two researchers independently assigned text segments to the categories. The text segments were paraphrased, and the findings for each category were summarized in conclusions.

Ethical Approval

The project has received a positive vote from the Ethics Committee of the University Medicine Greifswald and is registered in the German Clinical Trials Register (DRKS00024002).

Results

Survey

A total of 403 patients (507 cases) were included in the study. There were 141 completed parent questionnaires, three of which were excluded (patients aged>18 years). In total, 138 questionnaires (31.4% of the patients) were included in the analysis. [Table 1] provides an overview of the demographic characteristics of the sample.

Table 1 Description of demographic parameter.

	n (%)
relationship to the child (n=137)**
mother	117 (85.4)
father	18 (13.1)
legal guardian	0 (0.0)
other	2 (1.5)
sex of the parent (n=131)**
female	110 (84.0)
male	21 (16.0)
other	0 (0.0)
age group of the parent (n=133)**
up to 20 years	8 (6.0)
21 to 30 years	20 (15.0)
31 to 40 years	65 (48.9)
41 to 50 years	31 (23.3)
51 bis 60 years	7 (5.3)
over 60 years	2 (1.5)
age group of the child (n=138)*
up to 2 years	49 (35.5)
3 to 6 years	25 (18.1)
7 to 13 years	45 (32.6)
14 to 17 years	19 (13.8)

Data sources: * eHealth platform; ** parents questionnaire

[Table 2] provides an overview of the care-related items of the sample. 41% of the respondents visited the clinic as self-admission, and the majority of parents reported a travel time of approximately 15–30 minutes to the hospital. 64.2% of the caregivers travelled to the hospital by car.

Table 2 Description of healthcare-related parameter.

	n (%)
Hospital on-site (n=138)*
hospital 1	56 (40.6)
hospital 2	42 (30.4)
hospital 3	14 (10.1)
hospital 4	10 (7.2)
hospital 5	8 (5.8)
hospital 6	4 (2.9)
hospital 7	3 (2.2)
hospital 8	1 (0.7)
“How did you get to the hospital?” (n=134)**
referral by general practitioner paediatrician	54 (40.3)
self-referral	55 (41.0)
by emergency medical services	25 (18.7)
“How did you arrive at the hospital?” (n=137)**
private car	88 (64.2)
ride in a car of a friend or relative	12 (8.8)
public local transport	3 (2.2)
on foot	9 (6.6)
emergency medical services	23 (16.8)
other	2 (1.5)
“How many minutes did it take you to reach this hospital?” (n=121)**
up to 15 minutes	42 (34.7)
15 up to 30 minutes	44 (36.2)
30 up to 45 minutes	22 (18.2)
45 up to 60 minutes	5 (4.1)
over 60 minutes	8 (6.6)

Data sources: * eHealth platform; ** parents questionnaire

Approximately 40% of the respondents (n=51/128) identified problems with local paediatric care, with 46 individuals naming specific issues (multiple responses possible). [Fig. 1] shows the most frequent responses. Under “Other” (n=5/66, 8%), statements such as “uncoordinated vacation policies in paediatric practices,” “dissatisfaction with medical treatment,” “admission freeze at practices,” and “insufficient nursing staff” were grouped together.

Fig. 1 Perceived problems in regional paediatric care from the parents' perspective.

Of the parents who participated in the survey, 47.1% of children (n=65) had a telemedicine consultation. 36% (n=50) used the virtual background functionality, followed by video consultations with patients at home (n=10; 7.3%) and telemedicine triage (n=2; 1.5%). In 11 patients, no telemedicine functionality was documented in the eHealth platform. In 18.8% of telemedicine contacts, the patient was present (n=26).

[Table 3] illustrates that 74.8% of the respondents (n=77/102) found telemedicine helpful for the treatment of their child. On average, parents rated the question with 1.76 on the 6-point Likert scale (n=85, 95%; CI 1.49–2.04). In cases with negative evaluations (ratings of 4, 5, or 6), data from the eHealth platform revealed that in two cases no video connection was established, and in three cases the patient or the caregiver was present during the telemedicine contact. 88.1% of the parents (n=111/126) could imagine telemedicine as a future supplement to paediatric care. On average, parents rated this question with 1.84 on the 6-point Likert scale (n=117, 95%; CI 1.67–2.01).

Table 3 Acceptance and satisfaction of telemedicine from the parents’ perspective.

“Did you find the use of telemedicine (videoconferences) helpful for the treatment of your child?” (n=102)
Rating*	1	2	3	4	5	6	Don’t know
answers (n; %)	49 (47.6)	26 (25.5)	1 (1.0)	3 (2.9)	2 (1.9)	4 (3.9)	17 (16.5)
patient/ parent present (n; %)	16 (61.5)	7 (26.9)	0	0	0	2 (7.7)	–
Telemedicine triage (n, %)	1 (50.0)	0	0	0	0	0	–
Telemedicine video consultation (n; %)	20 (30.8)	9 (13.8)	9 (13.8)	2 (3.1)	0	3 (4.6)	–
Virtual background service (n; %)	19 (38.0)	9 (18.0)	1 (2.0)	1 (2.0)	2 (4.0)	1 (2.0)	–
Video consultation with patients at home (n; %)	4 (40.0)	6 (60.0)	0	0	0	0	–
"I can imagine that telemedicine consultations (videoconferences) could be established as an additional healthcare infrastructure for rural areas." (n=126)
Rating	1	2	3	4	5	6	Donʼt know
answers (n; %)	48 (37.8)	51 (40.5)	12 (9.4)	5 (3.9)	1 (0.8)	1 (0.8)	8 (6.3)
Patient/ parent present (n; %)	13 (50.0)	8 (30.8)	4 (15.4)	0	0	0	–
Telemedicine triage (n, %)	1 (50.0)	1 (50.0)	0	0	0	0	–
Telemedicine video consultation (n; %)	16 (24.6)	23 (35.4)	10 (15.4)	2 (3.1)	0	1 (1.5)	–
Virtual background service (n; %)	20 (40.0)	19 (38.0)	1 (2.0)	3 (6.0)	1 (2.0)	0	–
Video consultation with patients at home (n; %)	5 (50.0)	4 (40.0)	1 (10.0)	0	0	0	–

* 6-point Likert scale: 1=“Strongly agree”, 2=Agree, 3=“Somewhat agree”, 4=“Somewhat disagree”, 5=“disagree”, 6=“Strongly disagree”

Parent Interviews

Of the 72 parents contacted via email, seven responded positively to the initial invitation and four responded positively to the reminder. A total of eleven study participants were scheduled for interviews. Four of the interviewees had used the “virtual background service” functionality, three had used the “specialist video consultation,” and three others had not used any telemedicine functionality during their child's treatment. In one case, the interviewee was present during the telemedicine service. Ten out of the eleven interviewees were female. The average interview duration was ten minutes. A total of 150 interview excerpts were coded.

Overall, parents expressed a positive attitude toward telemedicine. They particularly valued the reduction or avoidance of travel distances and the associated time savings, the exchange of information among doctors and obtaining expert opinions, the quick and easy access to specialists, and the reduction of waiting times for specialist consultations.

“Principally, I think it's a good idea. We are in a vast rural area, and I notice time and again that you have to travel to Stralsund or Greifswald for even the smallest issue just to have the children properly examined.” (Interview 5, 0:01:53.2–0:02:27.2)

Concerns were raised regarding the lack of physical contact and the sometimes-insufficient technical infrastructure. Two respondents mentioned data protection issues but evaluated the benefits of telemedicine as outweighing their concerns in this regard.

“Of course, there’s always the common question about data protection, etc. But personally, I am one of those who say, we also need to take advantage of progress.” (Interview 3, 0:05:23.4–0:05:59.4)

Eight participants indicated that they had no prior experience with telemedicine in the treatment of their children. One person had professional experience with telemedicine.

The care and treatment of the sick children as part of the project were perceived positively by eight respondents. Two individuals felt that the care was insufficient. Most participants could not provide any insights into their experiences with telemedicine during the project, as in seven cases, the telemedicine measure took place from doctor to doctor, and in three cases, no telemedicine intervention occurred. Only one case involved the parents directly in the telemedicine measure.

“Basically, I didn’t really experience anything with telemedicine. We were asked if it was fine, the examinations were done, and then I only spoke with the doctor on-site.” (Interview 8, 0:04:46.0–0:05:47.1)

In eight cases, the parents did not wish for further involvement in telemedicine measures. However, they wanted to be informed about the outcome of the telemedicine intervention (diagnosis and/or treatment method) in a follow-up discussion, with the contact with the doctor on-site being considered sufficient. Only two people desired further involvement.

“…for me, it wouldn’t be so interesting with whom the doctor is talking… whom he consults and whom he calls and which clinic, that would only be of secondary interest, I think, when it’s about the health of the child, and then he says, ‘this is what we decided or found out, I spoke with a colleague,’… then that would be enough for me. I don’t need to be more involved.” (Interview 9, 0:05:42.4–0:06:36.2)

The parents interviewed were willing to use telemedicine in the future, as they viewed it as an essential part of future healthcare and a regional necessity.

“Yes, we simply need it in rural areas. We don’t have any other options. So if it works, I’m still convinced of the benefits, really.” (Interview 4, 0:10:04.4–0:10:33.9)

However, two individuals viewed telemedicine solely as an additional service, as they believed that complete reliance on telemedicine, without any physical contact, was not feasible.

[Table 4] provides an overview of the five main categories.

Table 4 Top five categories with coding frequencies.

main category	subcategory	expression	number of code segments	number of interviews
attitude towards telemedicine	general	positive	13	8
	distance/time savings		11	7
	expert opinion		5	5
	accessibility of specialists		5	5
	waiting time for specialists’ appointments		3	3
	lack of physical contact	negative	8	6
	data protection		2	2
	technical equipment		1	1
		total	48	11
previous experience with telemedicine	–	present	8	8
	–	absent	1	1
		total	9	9
care/ provision in the project	–	positive	14	8
	–	negative	4	2
		total	18	10
involvement in telemedicine	–	sufficient	9	8
	–	insufficient	4	2
		total	13	10
willingness to use in the future	–	present	14	11
	–	absent	0	0
		total	14	11

Discussion

The possibility of supplementing paediatric care with telemedicine was viewed positively by the parents in our study. Satisfaction with the care and treatment of their children within the framework of the project was also high. Parents showed strong willingness to continue using telemedicine in the future. The results of other studies regarding parental acceptance align with our findings. While these studies cover various telemedicine use cases – such as a study conducted in the same region between 2015 and 2019 on telemedicine triage in paediatric emergency care [12] or other studies on video consultations for parents of paediatric diabetes patients [13] and children with obesity [17] – the attitude of parents toward telemedicine services and the experiences they had within these studies seem to be overwhelmingly positive, regardless of the specific setting.

Based on the existing evidence, it can be concluded that parents of paediatric patients accept the support of paediatric care through telemedicine and are in favour of expanding telemedicine offerings. This represents an important driving factor for the further development and establishment of tele-paediatric services. However, it is expected that various factors influencing the acceptance and satisfaction of parents will vary depending on the field of use, as well as the type and purpose of the telemedicine application. Additionally, whether telemedicine is used in acute or emergency situations versus non-urgent circumstances may also influence acceptance [18]. Furthermore, parents' attitudes should not be considered fixed; they can change over time due to personal experiences with telemedicine, life circumstances, and evolving needs. It is therefore important, on the one hand, to continue integrating and considering the parental perspective in the development and establishment of telemedicine services in the future. Our study found that parental satisfaction with the telemedicine intervention was closely tied to being informed by the treating physician about the results of the intervention. However, further involvement in the telemedicine process was generally not seen as necessary. On the other hand, further research is needed to investigate which factors influence parental acceptance and satisfaction, and how the currently positive acceptance and satisfaction, as indicated by existing studies, can be maintained and fostered. It is also important to identify which specific telemedicine applications are seen by parents as needed and how these can be meaningfully integrated into the healthcare system – whether in direct interactions between doctor and patient, in the treatment of chronic diseases, or in emergency situations. Continuous research and evaluation of paediatric telemedicine services, with the involvement of all stakeholders, is essential to further improve acceptance.

The primary advantage of telemedicine services, as observed in this analysis from the parents' perspective, lies in enhanced and easier access to specialized paediatric care, reducing waiting times, travel, and time spent. This finding is supported by Lakshin et al. [14]. Disadvantages mentioned by parents, such as the lack of physical contact with the doctor [14] or technical difficulties [13], have also been noted in other studies, though they seem to strongly depend on the setting.

When evaluating the results of our study, it must be noted that not all hospitals in the region actively participated in the parental survey, so a comprehensive picture for the entire region within the project cannot be provided. Additionally, some parents were not actively involved in the telemedicine intervention, which made it difficult to answer the question “Did you find the use of telemedicine helpful for the treatment of your child?” in some cases. A further limitation was that some of the parents interviewed had only agreed to participate in the project, but no telemedicine services were provided to them, meaning that no statements regarding the experience with telemedicine in the project could be made in part of the interviews. Furthermore, interviews were conducted at the end of the project period, which meant the time gap between the hospital stay and the interview varied greatly, and in some cases, parents had difficulty remembering all the details of their child's treatment.

Additionally, the findings must be interpreted considering other methodological limitations. Since the data collection relied on self-reports from parents, response biases may have influenced the results. Furthermore, selection bias or selective non-response from less satisfied parents may have occurred. Due to the lack of a control group, the collected data cannot be placed in a comparative context.

Fundref Information

GBA Innovationsfonds — RTP-Net 01VSF19057

Funding

This study was conducted as part of the project “Implementation of a Regional Tele-Paediatric Network in Mecklenburg-Western Pomerania and Brandenburg” (RTP-Net, VSF19057), which was funded through the Innovation Fund.

Conflict of Interest

The authors declare that they have no conflict of interest.

Acknowledgements

We would like to express our sincere thanks to the participating doctors in our partner hospitals as well as to all the parents for their willingness to participate.

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Publication History

Received: 30 August 2024

Accepted: 13 December 2024

Article published online:
19 May 2025