{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T06:35:48Z","timestamp":1777876548311,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Telemedicine and e-Health"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Telemedicine allows patients to connect with healthcare providers remotely. It has recently expanded to evaluate low-acuity illnesses such as pharyngitis by using patients' personal communication devices. The purpose of our study was to compare the telemedicine-facilitated physical examination with an in-person examination in emergency department (ED) patients with sore throat.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">This was a prospective, observational, blinded diagnostic concordance study of patients being seen for sore throat in a 60,000-visit Midwestern academic ED. A telemedicine and a face-to-face examination were performed independently by two advanced practice providers (APP), blinded to the results of the other evaluator. The primary outcome was agreement on pharyngeal redness between the evaluators, with secondary outcomes of agreement and inter-rater reliability on 14 other aspects of the pharyngeal physical examination. We also conducted a survey of patients and providers to evaluate perceptions and preferences for sore throat evaluation using telemedicine.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Sixty-two patients were enrolled, with a median tonsil size of 1.0. Inter-rater agreement (kappa) for tonsil size was 0.394, which was worse than our predetermined concordance threshold. Other kappa values ranged from 0 to 0.434, and telemedicine was best for detecting abnormal coloration of the palate and tender superficial cervical lymph nodes (anterior structures), but poor for detecting abnormal submandibular lymph nodes or asymmetry of the posterior pharynx (posterior structures). In survey responses, telemedicine was judged easier to use and more comfortable for providers than patients; however, neither patients nor providers preferred in-person to telemedicine evaluation.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Telemedicine exhibited poor agreement with the in-person physical examination on the primary outcome of tonsil size, but exhibited moderate agreement on coloration of the palate and cervical lymphadenopathy. Future work should better characterize the importance of the physical examination in treatment decisions for patients with sore throat and the use of telemedicine in avoiding in-person healthcare visits.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/tmj.2017.0240","type":"journal-article","created":{"date-parts":[[2018,2,22]],"date-time":"2018-02-22T15:38:12Z","timestamp":1519313892000},"page":"790-796","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":38,"title":["Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study"],"prefix":"10.1177","volume":"24","author":[{"given":"Moneeb","family":"Akhtar","sequence":"first","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul G.","family":"Van Heukelom","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azeemuddin","family":"Ahmed","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel D.","family":"Tranter","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erinn","family":"White","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathaniel","family":"Shekem","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Walz","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Fairfield","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Priyanka","family":"Vakkalanka","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"},{"name":"University of Iowa College of Public Health"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas M.","family":"Mohr","sequence":"additional","affiliation":[{"name":"University of Iowa Carver College of Medicine"},{"name":"University of Iowa College of Public Health"},{"name":"University of Iowa Carver College of Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,10,12]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200101183440308"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(05)70267-X"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.18.2315"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2007-0484"},{"key":"e_1_3_3_6_2","volume-title":"Reasons for emergency room use among U.S. children: National Health Interview Survey, 2012","author":"Gindi RM","year":"2014","unstructured":"Gindi RM, , Jones LI. Reasons for emergency room use among U.S. children: National Health Interview Survey, 2012. Hyattsville, MD: National Center for Health Statistics, 2014."},{"key":"e_1_3_3_7_2","first-page":"1","article-title":"Reasons for Emergency Room Use Among U.S. Adults Aged 18\u201364: National Health Interview Survey, 2013 and 2014","volume":"90","author":"Gindi RM","year":"2016","unstructured":"Gindi RM, , Black LI, , Cohen RA. Reasons for Emergency Room Use Among U.S. Adults Aged 18\u201364: National Health Interview Survey, 2013 and 2014. Natl Health Stat Rep, 2016; 90:1\u201316.","journal-title":"Natl Health Stat Rep"},{"key":"e_1_3_3_8_2","unstructured":"Rui P Kang K Albert M. National Hospital Ambulatory Medical Care Survey: 2013 Emergency Department Summary Tables. Available at www.cdc.gov\/nchs\/data\/ahcd\/nhamcs_emergency\/2013_ed_web_tables.pdf (last accessed August28 2017)."},{"key":"e_1_3_3_9_2","volume-title":"Wait time for treatment in hospital emergency departments: 2009","author":"Hing E","year":"2012","unstructured":"Hing E, , Bhuiya FA. Wait time for treatment in hospital emergency departments: 2009. Hyattsville, MD: National Center for Health Statistics, 2012."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1089\/153056201750279584"},{"key":"e_1_3_3_11_2","unstructured":"Beck M. How Telemedicine Is Transforming Health Care. 2016. Available at www.wsj.com\/articles\/how-telemedicine-is-transforming-health-care-1466993402 (last accessed August28 2017)."},{"key":"e_1_3_3_12_2","unstructured":"Kirkner RM. Telehealth: Some Thumbs Up Some Down On Quality of Care. 2017. Available at www.managedcaremag.com\/archives\/2017\/4\/telehealth-some-thumbs-some-down-quality-care (last accessed August28 2017)."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000102043.70312.E9"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h5527"},{"key":"e_1_3_3_15_2","unstructured":"Hall SD. Rapid growth projected for global telemedicine market. 2015. Available at www.fiercehealthcare.com\/it\/rapid-growth-projected-for-global-telemedicine-market (last accessed August30 2017)."},{"key":"e_1_3_3_16_2","unstructured":"DocuTAP. Urgent Care Trends to Watch in 2016. 2016. Available at https:\/\/docutap.com\/blog\/trends-to-watch-in-urgent-care-in-2016 (last accessed August30 2017)."},{"key":"e_1_3_3_17_2","unstructured":"Dougherty C. Am I sick? Google Has a Doctor Waiting on Video. 2014. Available at https:\/\/bits.blogs.nytimes.com\/2014\/10\/13\/am-i-sick-google-has-a-doctor-waiting-on-video\/ (last accessed August28 2017)."},{"key":"e_1_3_3_18_2","unstructured":"American Hospital Association. Telehealth: Helping Hospitals Deliver Cost-Effective Care. Issue Brief 2016. Available at www.aha.org\/content\/16\/16telehealthissuebrief.pdf (last accessed August30 2017)."},{"key":"e_1_3_3_19_2","unstructured":"State Policy Resource Center American Telemedicine Association. States with Parity Laws for Private Insurance Coverage of Telemedicine (2017). Available at www.americantelemed.org\/main\/policy-page\/state-policy-resource-center#.VsspsRh4zsY (last accessed August30 2017)."},{"key":"e_1_3_3_20_2","unstructured":"Wicklund E. Mass. Health Systems Lobby for Telehealth Parity State Support. 2017. Available at https:\/\/mhealthintelligence.com\/news\/mass.-health-systems-lobby-for-telehealth-parity-state-support (last accessed August30 2017)."},{"key":"e_1_3_3_21_2","unstructured":"Schmidt S. 10 Companies to Watch in the Field of Telemedicine. 2016. Available at http:\/\/blog.marketresearch.com\/10-companies-to-watch-in-the-field-of-telemedicine (last accessed August30 2017)."},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2015.2024"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1089\/tmj.2015.0079"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ambp.2006.03.002"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2007.09.015"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2017.04.045"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1258\/jtt.2008.080512"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7248.1517"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/1357633X010070S130"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e31829e7d6a"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2005.04.008"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1996.03540190061030"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp068013"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2011.01121.x"}],"container-title":["Telemedicine and e-Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/tmj.2017.0240","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/tmj.2017.0240","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/tmj.2017.0240","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:26:11Z","timestamp":1777587971000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/tmj.2017.0240"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10]]},"references-count":33,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1089\/tmj.2017.0240"],"URL":"https:\/\/doi.org\/10.1089\/tmj.2017.0240","relation":{},"ISSN":["1530-5627","1556-3669"],"issn-type":[{"value":"1530-5627","type":"print"},{"value":"1556-3669","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10]]}}}