Hello,
I was thoroughly confused by this website https://www.gov.uk/guidance/case-control-study-comparative-studies which describes a paper (details below) where they call cases post-operative bariatric surgery patients who have telemedicine technology and controls post-operative bariatric surgery patiints who do not and then looks at how well they attend for follow up.
I had thought that case/control status had to be an outcome, and that aim of a case control study was to examine the exposure. In this study it seems to me that the case/control status is an exposure and they are examining an outcome. I would describe this as an observational cohort study. What do others think?
Thank you
Judith
Example: Can telemedicine help with post-bariatric surgery care? A case-control design
In 2019, Wang and colleagues published a paper entitled Exploring the Effects of Telemedicine on Bariatric Surgery Follow-up: a Matched Case Control Study.
The study showed that people who go through bariatric surgery have better outcomes if they attend their follow-up appointments after surgery in comparison to those who do not. However, attending appointments can be challenging for people who live in remote areas. In Ontario, Canada, telemedicine suites were set up to enable healthcare provider-patient videoconferencing.
The researchers used a matched case-control study to investigate if telemedicine videoconferencing can support post-surgery appointment attendance rates in people who live further away from the hospital sites. They used the existing data from the bariatric surgery hospital programme to identify eligible patients.
All patients attending the bariatric surgery were offered telemedicine services. The cases were the participants who used telemedicine services; they were compared to those who did not (the controls).
Cases and controls were matched on various characteristics, specifically:
- gender
- age
- time since bariatric surgery
- body mass index (BMI)
- travel distance from the hospital site
Researchers measured:
- the percentage of appointments attended
- rates of dropout
- pre-and post-surgery weight and BMI
- various physical and psychological outcomes
They also calculated rurality index to classify patients into urban, non-urban and rural areas. These variables were used to compare cases (those who used telemedicine) and controls (those who did not).
During the study period, they identified that 487 patients of 1,262 who received bariatric surgery used telemedicine services. Of those, 192 agreed to participate in the study.
They found that patients who used telemedicine did as well as patients who attended in person, both in terms of appointment attendance rates and in terms of physical and psychological outcomes.
Moreover, the researchers found that the cases (telemedicine users) came from more rural areas than the controls. The authors argued that this demonstrated that telemedicine can help overcome the known challenges for patients in more rural areas to attend appointments.
Randomising patients to telemedicine or withdrawing the telemedicine would be difficult, undesirable and possibly unethical. Case-control was a good alternative to assess the potential impact on patient outcomes in a service that is already up and running.