Comparing remote and in-person mental health consultations at Maputo Military Hospital

INTERVENTION: Synchronous telemedicine consultation Usual in person consultation CONDITION: ; Mental and Behavioural Disorders Mental and Behavioural Disorders PRIMARY OUTCOME: Consultation attendance within 14 days of randomisation. Binary variable, measured from the administrative appointment record with attendance confirmation. Where the consultation does not take place, the reason is classified into eight pre‐specified categories, including appointment capacity constraint. SECONDARY OUTCOME: Adverse events, safety incidents and privacy incidents. Complete clinical decision‐making. Binary variable assessed using an auditable five‐item checklist, requiring at least four of five items with the risk assessment item mandatory. Independent double coding of a random 20% subsample, with agreement quantified by Cohen's kappa. Feasibility outcomes: recruitment rate per month; consent rate among eligible patients; completeness of the primary outcome and of the checklist; inter‐rater agreement; fidelity to the standard operating procedure; proportion of remote consultations with a technical incident; proportion not completed for technical reasons; proportion of safety escalations to in‐person care. Patient experience and usability of the remote channel, by short questionnaire covering clarity, ease of use, confidence and perceived privacy. Time to consultation, in days from randomisation to attendance, for attended consultations. INCLUSION CRITERIA: Aged 18 years or over Scheduled mental health appointment or active referral at the hospital Written informed consent Available to attend the consultation within 14 days of randomisation Active telephone contact, or the possibility of assisted remote consultation in an institutional room