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Ncube B, Mars M, Scott RE. Recommendations for Developing a Telemedicine Strategy for Botswana: A Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6718. [PMID: 37754578 PMCID: PMC10530668 DOI: 10.3390/ijerph20186718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023]
Abstract
Botswana is developing its eHealth capacity using a National eHealth Strategy. However, that strategy overlooks telemedicine, a potential solution for many healthcare challenges. For telemedicine to benefit Botswana, a telemedicine-specific strategy is required. While establishing a national strategy is a sovereign responsibility, guidance and recommendations can be provided. Using published resources specific to Botswana, key health-related issues were identified. These issues were matched with suitable telemedicine activities and delivery approaches. Recommendations were then derived from these for use in an effective telemedicine-specific strategy for Botswana. From 28 health-related issues, 6 were prioritised. Three telemedicine activities were identified (clinical services, education, and behaviour change), and one delivery approach was chosen (store-and-forward) because they align well with current needs, infrastructure, and mobile phone user capabilities. Since telemedicine has been proven to be effective, efficient, and cost-effective when implemented correctly, this knowledge and experience, plus a recognised strategy development framework, has led to evidence-based recommendations. Specific telemedicine options were identified as examples. As confidence grows, telemedicine options can be expanded to address additional clinical needs and explore alternative activities and delivery options. The recommendations can help the government develop a telemedicine-specific strategy that aligns with the National eHealth Strategy while actively promoting and supporting the adoption and system integration of straightforward telemedicine interventions. This foundation will facilitate the future expansion of telemedicine initiatives for the benefit of all Batswana.
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Affiliation(s)
- Benson Ncube
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
| | - Richard E. Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa; (M.M.); (R.E.S.)
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
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Mena R, Mendoza E, Mangano FT, Henrickson M, Scott M, DeFoor WR, Little KJ, Ruschman J, Prada CE. International Pediatric Multidisciplinary Management Using Telemedicine to Promote Equitable Care. Telemed J E Health 2022; 29:674-685. [PMID: 36112346 DOI: 10.1089/tmj.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the use of telemedicine as a collaboration tool between a pediatrician and subspecialists looking to address challenges, such as the lack of health care specialists, which are present in the Dominican Republic. Study design: During this 6-year study, 65 patients were evaluated by a medical team consisting of a local pediatrician and 17 subspecialists from a leading academic medical center in the Unites States. Patient's age ranged from 2 months to 16 years of age (mean 8 years old). The most common reasons for referral were masses or malignancies, vascular malformations, urogenital anomalies, stuttering, and cochlear implant programming. Results: A total of 39 out of 65 cases (60%) carried an initial diagnosis. Of the 65 cases, a change in medical management occurred in 92.31% of cases (60 cases). There was no change in medical diagnosis or treatment in 5 of 65 cases (8%). Conclusion: This protocol exhibited high patient satisfaction with the technology and platform and direct patient savings from transportation costs. It also demonstrated the importance of thorough diagnosis in providing appropriate treatment and solutions. Telemedicine use in comparable practices should be studied further to aid in the development of policies for the diagnosis and management of chronic illnesses that require referrals to subspecialists.
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Affiliation(s)
- Rafael Mena
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro de Obstetricia y Ginecologia, Santo Domingo, Dominican Republic
- Department of Pediatrics, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Esperanza Mendoza
- Department of Pediatrics, Neonatal Intensive Care Unit, Centro de Obstetricia y Ginecologia, Santo Domingo, Dominican Republic
| | - Francesco T. Mangano
- Department of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Michael Henrickson
- Department of Pediatrics, Divisions of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Michael Scott
- Department of Pediatrics, Divisions of Audiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - William R. DeFoor
- Department of Pediatrics, Divisions of Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kevin J. Little
- Department of Pediatrics, Pediatric Hand and Upper Extremity Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Ruschman
- Department of Pediatrics, Center for Teleheath, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carlos E. Prada
- Division of Human Genetics, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Department of Pediatrics, Division of Genetics, Birth Defects & Metabolism, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Feinberg School of Medicine of Northwestern University, Chicago, Illinois, USA
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Abstract
Pediatric practice increasingly involves providing care for children with medical complexity. Telehealth offers a strategy for providers and health care systems to improve care for these patients and their families. However, lack of awareness related to the unintended negative consequences of telehealth on vulnerable populations--coupled with failure to intentional design best practices for telehealth initiatives--implies that these novel technologies may worsen health disparities in the long run. This article reviews the positive and negative implications of telehealth. In addition, to achieve optimal implementation of telehealth, it discusses 10 considerations to promote optimal care of children using these technologies.
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Affiliation(s)
- Eli M Cahan
- Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA 94305, USA; NYU School of Medicine, New York, NY 10010, USA.
| | | | - Nirav R Shah
- Clinical Excellence Research Center, Stanford School of Medicine, Stanford, CA 94305, USA
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Holmes AN, Chansky PB, Simpson CL. Teledermatology Consultation Can Optimize Treatment of Cutaneous Disease by Nondermatologists in Under-Resourced Clinics. Telemed J E Health 2019; 26:1284-1290. [PMID: 31800369 DOI: 10.1089/tmj.2019.0217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Access to dermatologists is limited for disadvantaged patients, who may receive suboptimal dermatologic care from nonspecialists. We assessed if teledermatology could improve primary care provider (PCP)-delivered care for cutaneous disease at a clinic serving uninsured patients. Materials and Methods: Utilizing the American Academy of Dermatology's free AccessDerm program, we offered store-and-forward teledermatology to PCPs, who initiated consultations at will during clinical care independent of the study. We retrospectively analyzed all consultations from 2013 to 2017 and collected patient age/sex, teledermatologist diagnosis, time to teledermatologist reply, time to next dermatology appointment, as well as PCP- and teledermatologist-proposed care plans. Results: Retrospective analysis of 131 consults revealed a 37-h mean teledermatology response-time versus a 14-day appointment wait (p < 0.00001). Teledermatologists provided a definitive care plan without in-person evaluation for 82 (65%) of completed consults and recommended interim treatments while awaiting appointments in 15 cases, thus accelerating care plan delivery in 97 cases (76%). The triage decision rate differed among diagnostic categories; deferral to in-person evaluation was more frequent for neoplasms (p < 0.0001). When PCPs specified preconsult treatment plans, 82% differed from teledermatologist-advised management. Following teledermatologist recommendations would have changed the clinical course in 70% of cases, potentially avoiding suboptimal care, including inappropriate corticosteroids, antimicrobials, and emergency room referrals. Conclusions: We found teledermatology can effectively guide PCPs in resource-limited settings by accelerating delivery of dermatologist-recommended care plans for uninsured patients. Expanding teledermatology for PCPs in under-resourced clinics has the potential to improve treatment of cutaneous disease by nonspecialists and to mitigate suboptimal care for disadvantaged patients.
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Affiliation(s)
- Alexis N Holmes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter B Chansky
- Department of Dermatology, New York University, New York, New York, USA
| | - Cory L Simpson
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ford AR, Gibbons CM, Torres J, Kornmehl HA, Singh S, Young PM, Chambers CJ, Maverakis E, Dunnick CA, Armstrong AW. Access to Dermatological Care with an Innovative Online Model for Psoriasis Management: Results from a Randomized Controlled Trial. Telemed J E Health 2019; 25:619-627. [PMID: 30222518 PMCID: PMC6417973 DOI: 10.1089/tmj.2018.0160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background:Many patients with chronic skin diseases lack regular access to dermatologists in the United States and suffer poor clinical outcomes.Introduction:We performed a 12-month randomized controlled trial to evaluate the impact of an online, collaborative connected health (CCH) model for psoriasis management on access to specialty care.Materials and Methods:The 300 enrolled patients were randomized to online or in-person care. We compared distance traveled as well as transportation and in-office waiting time between the two groups and obtained patient and provider perspectives on CCH.Results:At baseline, no differences existed between the groups in difficulties obtaining specialty care. Over 12 months, the mean (standard deviation [SD]) distance traveled to and from appointments was 174.8 (±577.4) km/person for the in-person group and 2.2 (±14.2) km/person for the online group (p = 0.0003). The mean (SD) time spent on transportation and in-office waiting for in-person appointments was 4.0 (±4.5) h/person for the in-person group and 0.1 (±0.4) h/person for the online group (p = 0.0001). Patients found CCH to be safe, accessible, equitable, efficient, effective, and patient-centered. Providers found CCH to be useful for providing psoriasis care.Discussion:The CCH model resulted in significantly less distance traveled as well as transportation and in-office waiting time compared to in-person care. Both patients and providers were highly satisfied with CCH.Conclusions:The CCH model resulted in increased access to specialty care and enabled patient-centered, safe, and effective management of psoriasis patients.
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Affiliation(s)
- Adam R. Ford
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Caitlin M. Gibbons
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Josefina Torres
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Heather A. Kornmehl
- Department of Dermatology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Sanminder Singh
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Paulina M. Young
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
| | - Cindy J. Chambers
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Emanual Maverakis
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Cory A. Dunnick
- Department of Dermatology, University of Colorado Schoolof Medicine, University of Colorado Denver, Aurora, Colorado
| | - April W. Armstrong
- Department of Dermatology, Keck School of Medicineof the University of Southern California, Los Angeles, California
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Peracca SB, Jackson GL, Weinstock MA, Oh DH. Implementation of Teledermatology: Theory and Practice. CURRENT DERMATOLOGY REPORTS 2019. [DOI: 10.1007/s13671-019-0252-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Delaigue S, Bonnardot L, Steichen O, Garcia DM, Venugopal R, Saint-Sauveur JF, Wootton R. Seven years of telemedicine in Médecins Sans Frontières demonstrate that offering direct specialist expertise in the frontline brings clinical and educational value. J Glob Health 2019; 8:020414. [PMID: 30574293 PMCID: PMC6292825 DOI: 10.7189/jogh.08.020414] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Médecins Sans Frontières (MSF), a medical humanitarian organization, began using store-and-forward telemedicine in 2010. The aim of the present study was to describe the experience of developing a telemedicine service in low-resource settings. Methods We studied the MSF telemedicine service during the period from 1st July 2010 until 30th June 2017. There were three consecutive phases in the development of the service, which we compared. We also examined the results of a quality assurance program which began in 2013. Results During the study period, a total of 5646 telemedicine cases were submitted. The workload increased steadily, and the median referral rate rose from 2 to 18 cases per week. The number of hospitals submitting cases and the number of cases per hospital also increased, as did the case complexity. Despite the increased workload, the allocation time reduced from 0.9 to 0.2 hours, and the median time to answer a case decreased from 20 to 5 hours. The quality assurance scores were stable. User feedback was generally positive and more than 90% of referrers who provided a progress report about their case stated that it had been sent to an appropriate specialist, that the response was sufficiently quick and that the teleconsultation provided an educational benefit. Referrers noted a positive impact of the system on patient outcome in 39% of cases. Conclusions The quality of the telemedicine service was maintained despite rising caseloads. The study showed that offering direct specialist expertise in low-resource settings improved the management of patients and provided additional educational value to the field physicians, thus bringing further benefits to other patients.
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Affiliation(s)
| | - Laurent Bonnardot
- Department of Medical Ethics and Legal Medicine, Paris Descartes University, Paris, France.,Fondation Médecins Sans Frontières, Paris, France
| | - Olivier Steichen
- Department of Internal Medicine AP-HP, Hôpital Tenon, Paris, France.,Faculty of Medicine Sorbonne Universités, UPMC University Paris, Paris, France
| | | | | | | | - Richard Wootton
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
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Ismail A, Stoff BK, McMichael JR. Store-and-forward teledermatology service for primary care providers in Afghanistan. Int J Dermatol 2018; 57:e145-e147. [PMID: 30070355 DOI: 10.1111/ijd.14165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/17/2018] [Accepted: 07/04/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Aimen Ismail
- Department of Dermatology, Emory University, Atlanta, GA, USA
| | - Benjamin K Stoff
- Department of Dermatology, Department of Pathology and Laboratory Medicine, Emory Center for Ethics, Emory University, Atlanta, GA, USA
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