Objective. To evaluate a scalable pediatric telemedicine and medication delivery service (TMDS) that extends early healthcare access at households to avert emergencies. Study design. A TMDS in Haiti was configured for scalability by triaging severe cases to hospital-level care, non-severe cases with higher clinical uncertainty to in-person exams at households with medication delivery, and non-severe cases with low clinical uncertainty to medication delivery alone. This design was evaluated in a prospective cohort study conducted among pediatric patients (≤10 years). Clinical and operational metrics were compared to a formative reference study in which all non-severe patients received an in-person exam. The primary outcomes were reported rates of clinical improvement/recovery and in-person care seeking at 10-days. Results: 1043 cases (41 severe; 1002 non-severe) were enrolled in the scalable TMDS mode and 19% (190) of the non-severe cases received an in-person exam. 382 cases (24 severe, 358 non-severe) were enrolled in the reference study and 94% (338) of the non-severe cases received an in-person exam. At 10-days, rates of improvement were similar for the scalable (97%, 897) and reference (95%, 329) modes. Rates of participants who sought follow-up care were 15% (138) in the scalable mode and 24% (82) in the reference mode. Conclusion: In the context of a five-fold reduction of in-person exams, participants in the scalable TMDS mode had non-inferior rates of improvement at 10-days. These findings highlight an innovative and now scalable solution to improve early access to healthcare at households without compromising safety.

The authors have declared no competing interest.

This work was financially supported at the University of Florida by the Children's Miracle Network (EJN), private donations made to the University of Florida Foundation, and a National Institutes of Health grant (EJN).

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The University of Florida Institutional Review Board gave ethical approval for this work (IRB202002693; IRB201802920. Additionally the Comité National de Bioéthique in Port-au-Prince Haiti gave ethical approval for this work (Ref2021-11; Ref1819-51).

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De-identified data from this study are available from the corresponding author (EJN) upon request.