The implementation of neurologic teleconsultations in rural primary care in Northeastern Germany (NeTKoH): an evaluation guided by the RE-AIM framework

Background Neurologic diseases represent a major public health burden both globally and nationally, straining the health care systems especially in rural areas with a scarcity of neurologists, and endangering patients’ proximal access to care. The NeTKoH project (Neurologic Teleconsultation with General Practitioners to strengthen specialist care in Western Pomerania) addressed this by providing teleconsultations with neurologic experts from a university hospital for patients presenting with neurologic symptoms in primary care practices in rural areas of Western Pomerania in Northeast Germany. Objective A comprehensive evaluation of such teleneurologic interventions under real-world conditions, focusing on their generalizability (both internal and external validity), is essential to advise decision-makers. We applied the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to systematically assess NeTKoH’s implementation and to inform its translation from research to practice. Methods Each RE-AIM dimension was operationalized: ​ Reach comprised the proportions of patients enrolled out of those approached by their physicians and of patients in the intervention who received a teleconsultation; Effectiveness measured the proportions of patients triaged to general practitioner care, of patients with improved QoL at follow-up, of same-day teleconsultations, and of positive patient responses regarding satisfaction; Adoption assessed the proportions of participating and of continuously participating physicians; Implementation focused on installed devices, preparatory visits with device training, device use by physicians, and teleconsultations performed; Maintenance measured patients’ and physicians’ self-reported intention to continue using teleconsultations. Results NeTKoH demonstrated high scores for Reach (98.8%), Adoption (83.0%), Implementation (99.2%), and Maintenance (85.0%), while Effectiveness was “generally positive” (66.0%). The representativeness of patient and physician populations in the study was limited, but both were broadly comparable to the regional target populations. Discussion/Conclusion Our findings suggest that teleconsultations for patients with neurologic conditions in primary care settings are feasible, acceptable, and improve access to specialist care. The RE-AIM framework provided relevant insights that can guide a dissemination trial for a potential scale-up. Trial registration German Clinical Trials Register (DRKS00024492), registered on September 28, 2021.