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Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India.

ABSTRACT: The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. The CARE rheumatology clinic at Kerala, India, caters to average 170 (range: 140-240) patients per day. Patients with prefixed appointments had two-level screening for eligibility for teleconsultation. Those eligible were given the option for teleconsultation on the widely available WhatsApp app. Of those who completed teleconsultations, 100 were chosen at random to provide feedback. In the first 7 days, out of 1469 appointments, 975 were found eligible for teleconsultation. Of these, 723 (74%) opted for it. The average footfall in the clinic was reduced to 67 (range 29-117). The proportion of patients accepting teleconsultations increased with time. Amongst the 100 respondents, median satisfaction was 9 (IQR 8-10) and recommendation for continuing was 9.5 (IQR 8-10) on a 0-10 scale. Multivariate analysis showed the recommendation score was dependent on beliefs about social distancing, perceptions about clinical examination, and the satisfaction score of the first teleconsultation. Age, sex, availability of personal video conferencing app or of vehicles did not independently influence this score. Without teleconsultation facilities, three-fourths of the respondents would have stopped drugs or self-medicated. The switch was feasible and accepted by patients. It enabled quick reduction in the number of persons travelling to the centre. Not making the switch could have deprived approximately three-quarters of these patients of proper medical care. Key Points • Patient to rheumatologist ratios in India is heavily skewed and awareness about telemedicine is limited. • Switch to telemedicine was feasible and allowed a decrease in the number of people attending the clinic. • Not switching could have lead to disruption of care or self-medication in a majority of patients.

SUBMITTER: Shenoy P

PROVIDER: S-EPMC7260460 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India.

Shenoy Padmanabha P Ahmed Sakir S Paul Aby A Skaria Teny Grace TG Joby Joel J Alias Bazil B

Clinical rheumatology 20200530 9

The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. The CARE rheumatology clinic at Kerala, India, caters to average 170 (range: 140-240) patients per day. Patients with prefixed appointments had two-level screening for eligibility for teleconsultation. Those eligibl ...[more]

PMID: 32474883

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Project description:ObjectiveThe COVID-19 pandemic necessitated the use of telemedicine to maintain continuity of care for patients with cardiovascular diseases (CVDs). This study aimed to demonstrate the feasibility of implementing a nurse-led teleconsultation strategy for CVD management during the COVID-19 pandemic in India and evaluated the impact of nurse-led teleconsultations on patient treatment satisfaction.Design, setting and participantsWe developed a two-stage teleconsultation strategy and tested the feasibility of implementing a nurse-led teleconsultation strategy to manage CVD in a northern state (Punjab) in India. A multidisciplinary team of experts developed the treatment protocol used for teleconsultations to manage CVD. Nurses were trained to provide teleconsultation, triaging of patients and referrals to the physicians. Patients with CVD who had an outpatient visit or hospitalisation between September 2019 and March 2020 at the Dayanand Medical College Hospital, Ludhiana, India, were contacted by phone and offered teleconsultations. Telemedicine strategy comprised: stage 1 nurse-led teleconsultations and stage 2 physician-led teleconsultations. Descriptive analysis was performed to report the proportion of patients triaged by the two-stage telemedicine strategy, and patient's clinical characteristics, and treatment satisfaction between the nurse-led versus physician-led teleconsultations.ResultsOverall, nurse-led stage 1 teleconsultations were provided to 12 042 patients with CVD. The mean (SD) age of the participants was 58.9 years (12.8), and men were 65.4%. A relatively small proportion of patients (6.3%) were referred for the stage-2 physician-led teleconsultations and of these only 8.4% required hospitalisations. During stage 1 nurse-led teleconsultations, patients were referred to the physicians due to uncontrolled diabetes (24.9%), uncontrolled hypertension (18.7%) and congestive heart failure (16.2%). The patient's treatment satisfaction was similar between the nurse-led versus physician-led teleconsultations (p=0.07).ConclusionThis study showed that a nurse-led telemedicine strategy is feasible to implement in a resource-constraint setting for triaging patients with CVD and reduces physician's burden.

Project description:IntroductionThe ongoing COVID-19 pandemic and the lockdown measures employed by the government have forced neurologists across the world to look upon telemedicine as the only feasible and practical option to continue providing health care towards children with epilepsy in home isolation. Children with epilepsy are challenging for teleconsultation as direct information from the patient is missing, regarding seizures and adverse effects, especially behavioral and psychological side effects.MethodsClinical and epilepsy-related details of telephonic consultations for children 1 month-18 years, performed between 26th March and 17th May 2020 in a tertiary care teaching hospital in Uttarakhand (a state of India known for hilly terrains with low per capita income) were recorded. Suitable changes in the dose/commercial brand of antiepileptic drug (AED) regimen were performed, along with the addition of new AED and referral to local practitioners for immediate hospitalization, when urgent health care issues were detected. Voice call, text message, picture/video message, and all other possible measures were employed to accumulate maximum clinical information in real-time.ResultsA total of 153 children(95 males [62 %], 9.45 ± 3.24 years, 140 lower/middle socioeconomic status) were enrolled after screening 237 children with various neurological disorders, whose caregivers contacted for teleconsultation. A total of 278 telephone consultations performed for these 153 children (1-5 telephone calls per patient). Hundred-thirteen children were identified to have a total of 152 significant clinical events (breakthrough seizure/uncontrolled epilepsy (108), AED related (13), and unrelated systemic adverse effects (24), worsening of associated co-morbidities (7). In rest of the patients, the query of the caregiver included unavailability of AED/prescribed commercial brand in the locality, query related to the dose of drugs, proxy for a scheduled routine visit (no active issues), and concern regarding COVID-19 related symptoms and effect of COVID-19 and lockdown in children with epilepsy. Ninety-three (60 %) patients required hiking up of AED dose, whereas 29 (17 %) patients required the addition of a new AED/commercial brand. Five children were advised immediate admission to a nearby hospital. Overall, 147 (96 %) caregivers were satisfied with the quality of medical advice.ConclusionTeleconsultation is one of the few feasible options with good effectiveness for providing medical advice to children with epilepsy during pandemic times.

Project description:BackgroundDuring the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings.ObjectiveThis study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events.DesignImplementation study.SettingA tertiary care university hospital in Germany from April 2020 to October 2020.PatientsOne hundred and eleven patients scheduled for elective surgery.InterventionPatients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey.Main outcome measuresPrimary endpoints were medical and technical feasibility, user satisfaction and time savings.ResultsFor 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery.ConclusionTelepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic.Trial registrationNCT04518514, ClinicalTrials.gov.

Project description:BackgroundThe global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship.ObjectiveThe aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures.MethodsThis was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model.ResultsWe report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001).ConclusionsPatients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic.

Project description:BackgroundOntario stroke prevention clinics primarily held in-person visits before the COVID-19 pandemic and then had to shift to a home-based teleconsultation delivery model using telephone or video to provide services during the pandemic. This change may have affected service quality and patient experiences.ObjectiveThis study seeks to understand patient satisfaction with Ontario stroke prevention clinics' rapid shift to a home-based teleconsultation delivery model used during the COVID-19 pandemic. The research question explores explanatory factors affecting patient satisfaction.MethodsUsing a cross-sectional service performance model, we surveyed patients who received telephone or video consultations at 2 Ontario stroke prevention clinics in 2021. This survey included closed- and open-ended questions. We used logistic regression and qualitative content analysis to understand factors affecting patient satisfaction with the quality of home-based teleconsultation services.ResultsThe overall response rate to the web survey was 37.2% (128/344). The quantitative analysis was based on 110 responses, whereas the qualitative analysis included 97 responses. Logistic regression results revealed that responsiveness (adjusted odds ratio [AOR] 0.034, 95% CI 0.006-0.188; P<.001) and empathy (AOR 0.116, 95% CI 0.017-0.800; P=.03) were significant factors negatively associated with low satisfaction (scores of 1, 2, or 3 out of 5). The only characteristic positively associated with low satisfaction was when survey consent was provided by the substitute decision maker (AOR 6.592, 95% CI 1.452-29.927; P=.02). In the qualitative content analysis, patients with both low and high global satisfaction scores shared the same factors of service dissatisfaction (assurance, reliability, and empathy). The main subcategories associated with dissatisfaction were missing clinical activities, inadequate communication, administrative process issues, and absence of personal connection. Conversely, the high-satisfaction group offered more positive feedback on assurance, reliability, and empathy, as well as on having a competent clinician, appropriate patient selection, and excellent communication and empathy skills.ConclusionsThe insights gained from this study can be considered when designing home-based teleconsultation services to enhance patient experiences in stroke prevention care.

Project description:The urgency to curtail the devastating effects of the ongoing COVID-19 Pandemic has led to the implementation of several measures to limit its spread, including movement restrictions and social distancing. As most developing countries rely solely on hospital visitations for their medical needs, this impediment to assessing healthcare services compounded by low uptake of telehealth services could result in dire consequences. This is a cross-sectional study among Healthcare providers (HCP) and Healthcare consumers (HCC) in Nigeria. We administered a pre-validated self-administered online questionnaire comprising questions to assess the knowledge, use, perceptions, and benefits of telemedicine among study participants. Descriptive statistics were used to examine participants’ perceptions on telemedicine use and to summarize participants’ characteristics. A total of 158 healthcare providers and 1381 healthcare consumers completed the online survey. Ninety percent of HCP reported that they used some form of telemedicine to deliver health care, and 63% of HCC had received healthcare through telemedicine. A significant proportion of HCP (62%) and HCC (69%) agreed that telemedicine would improve healthcare consultation experience and satisfaction. However, fewer (21%) HCP agreed that they liked that there would be no physical contact with patients using telemedicine. In contrast, 52% of HCC agreed that they liked that there would be no physical contact with healthcare providers while using telemedicine. The majority of the participants believed that benefits of telemedicine would include: being a safe way for healthcare delivery during pandemics (HCP = 62%, HCC = 83%), affordability (HCP = 62%, HCC = 82%), and time-saving (HCP = 54%, HCC = 82%,). Teleconsultation services have been shown to aptly complement face-to-face hospital visits in ensuring effective triaging in hospitals and providing adequate healthcare delivery to patients regardless of geographical and physical barriers. These results support telemedicine use for the provision of healthcare services during the COVID-19 pandemic.

Dataset Information

Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India.

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Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India.

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