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Huda RK, Chowhan RS, Arora S, Seervi D, Verma S, Singh J, Kalra S, Choudhary A, Sangwan RK, Khetan M, Babu BV. Perceptions of healthcare workers and patients on the implementation of telemedicine in hard-to-reach areas: A qualitative study from rajasthan, India. Digit Health 2025; 11:20552076251331874. [PMID: 40297354 PMCID: PMC12034945 DOI: 10.1177/20552076251331874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 03/17/2025] [Indexed: 04/30/2025] Open
Abstract
Objective To explore the perceptions of healthcare providers and patients regarding the implementation of telemedicine in hard-to-reach areas of Rajasthan, India, and identify factors influencing its adoption and effectiveness. Methods A qualitative study was conducted using 24 in-depth interviews with healthcare providers from primary health centres and a district hospital, as well as patients from remote areas in Balotra district of Rajasthan. Thematic analysis was used to identify key themes related to the acceptance, benefits, challenges, and recommendations for telemedicine adoption. Results The acceptance of telemedicine increased, driven by cultural norms, trust, and familiarity with technology. It improved efficiency, reduced travel costs, and enhanced disease management. However, poor internet connectivity, inadequate training, and low digital literacy posed challenges. Participants emphasized the need for user-friendly systems, better infrastructure, and continuous training to improve adoption in remote areas. Conclusion Telemedicine can potentially transform healthcare access in remote regions of India, reducing healthcare inequities and improving health outcomes. However, addressing technical, infrastructural, and literacy challenges is essential for its successful implementation.
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Affiliation(s)
- Ramesh K Huda
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Rahul S Chowhan
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Simran Arora
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Dileep Seervi
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Sakshi Verma
- Indian Institute of Public Health Gandhinagar, Gandhinagar, India
| | - Jayvardhan Singh
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Sumit Kalra
- Indian Institutes of Technology, Jodhpur, Rajasthan, India
| | | | - Ramesh K Sangwan
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Mukti Khetan
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
| | - Bontha V Babu
- National Institute for Implementation Research on Non-Communicable Diseases, Jodhpur, Rajasthan, India
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Shetty Y, Kamat S, Tripathi R, Parmar U, Jhaj R, Banerjee A, Balakrishnan S, Trivedi N, Chauhan J, Chugh PK, Tripathi CD, Badyal DK, Solomon L, Kaushal S, Gupta K, Jayanthi M, Jeevitha G, Chatterjee S, Samanta K, Desai C, Shah S, Medhi B, Joshi R, Prakash A, Gupta P, Roy A, Chandy S, Ranjalkar J, Bright HR, Dikshit H, Mishra H, Roy SS, Kshirsagar N. Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences. Indian J Med Res 2024; 159:130-141. [PMID: 38528817 PMCID: PMC11050754 DOI: 10.4103/ijmr.ijmr_2309_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND OBJECTIVES Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians. METHODS It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as 'prescriptions having deviations'. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an 'unacceptable deviation'. RESULTS Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108). INTERPRETATION CONCLUSIONS The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.
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Affiliation(s)
- Yashashri Shetty
- Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India
| | - Sandhya Kamat
- Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India
| | - Raakhi Tripathi
- Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India
| | - Urwashi Parmar
- Department of Pharmacology & Therapeutics, Seth GSMC & KEM Hospital, Mumbai, Maharashtra, India
| | - Ratinder Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Aditya Banerjee
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Niyati Trivedi
- Department of Pharmacology, Medical College, Medical College, Baroda, Gujarat, India
| | - Janki Chauhan
- RUM Centre, Medical College, Medical College, Baroda, Gujarat, India
| | - Preeta Kaur Chugh
- Department of Pharmacology, VMMC & Safdarjung Hospital, New Delhi, India
| | - C. D. Tripathi
- Department of Pharamocology, The Government Institute of Medical Sciences, Greater Noida, Uttar Pradesh, India
| | - Dinesh Kumar Badyal
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - Lydia Solomon
- Department of Pharmacology, Christian Medical College, Ludhiana, Punjab, India
| | - Sandeep Kaushal
- Department of General Medicine, Christian Medical College, Ludhiana, Punjab, India
| | - Kanchan Gupta
- Department of General Medicine, Christian Medical College, Ludhiana, Punjab, India
| | - M. Jayanthi
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - G. Jeevitha
- Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Suparna Chatterjee
- Department of Pharmacology, Institute of Post Graduate Medical Education & Research, Kolkata, West Bengal, India
| | - Kalyan Samanta
- Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India
| | - Chetna Desai
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Samidh Shah
- Department of Pharmacology, B. J. Medical College, Ahmedabad, Gujarat, India
| | - Bikash Medhi
- Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Rupa Joshi
- Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Ajay Prakash
- Department of Pharmacology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Pooja Gupta
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Atanu Roy
- RUM Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sujith Chandy
- Departments of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jaya Ranjalkar
- Departments of Pharmacology & Clinical Pharmacology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Heber Rew Bright
- Departments of Pharmacy, Christian Medical College, Vellore, Tamil Nadu, India
| | - Harihar Dikshit
- Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Hitesh Mishra
- Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Sukalyan Saha Roy
- Department of Pharmacology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
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Grover A, Bhargava B, Srivastava S, Sharma LK, Cherian JJ, Tandon N, Chandershekhar S, Ofrin RH, Bekedam H, Pandhi D, Mukherjee A, Dhaliwal RS, Singh M, Rajshekhar K, Roy S, Rasaily R, Saraf D, Kumar D, Parmar N, Kabra SK, Chaudhry D, Deorari A, Tandon R, Singh R, Khaitan B, Agrawala S, Gupta S, Goel SC, Bhansali A, Dutta U, Seth T, Singh N, Awasthi S, Seth A, Pandian J, Jha V, Dwivedi SK, Tripathi R, Thakar A, Jindal S, Gangadhar BN, Bajaj A, Kant M, Chatterjee A. Developing Standard Treatment Workflows-way to universal healthcare in India. Front Public Health 2023; 11:1178160. [PMID: 37663866 PMCID: PMC10472454 DOI: 10.3389/fpubh.2023.1178160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/22/2023] [Indexed: 09/05/2023] Open
Abstract
Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.
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Affiliation(s)
- Ashoo Grover
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | - Balram Bhargava
- Department of Cardio Neuro Centre, Indian Council of Medical Research, New Delhi, India
| | - Saumya Srivastava
- Division of NCD, Indian Council of Medical Research, New Delhi, India
| | | | | | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Deepika Pandhi
- Department of Dermatology, University College of Medical Sciences, New Delhi, India
| | - Aparna Mukherjee
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Manjula Singh
- Division of ECD, Indian Council of Medical Research, New Delhi, India
| | | | - Sudipto Roy
- Indian Council of Medical Research, New Delhi, India
| | - Reeta Rasaily
- Division of NCD, Indian Council of Medical Research, New Delhi, India
- Division of BMI, Indian Council of Medical Research, New Delhi, India
| | - Deepika Saraf
- Department of Paediatrics, AIIMS, New Delhi, India
- Department of Pulmonology, PGIMER, Chandigarh, India
| | - Dhiraj Kumar
- Indian Council of Medical Research, New Delhi, India
| | - Neeraj Parmar
- Indian Council of Medical Research, New Delhi, India
| | | | - Dhruva Chaudhry
- Pandit Bhagwat Dayal Sharma PG Institute of Medical Sciences, Rohtak, India
| | - Ashok Deorari
- Himalayan Institute of Medical Sciences, Baksar Wala, Dehradun, India
| | - Radhika Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Binod Khaitan
- All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | - Anil Bhansali
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Haematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | - Neeta Singh
- All India Institute of Medical Sciences, New Delhi, India
| | - Shally Awasthi
- Department of Paediatrics, King George's Medical University, Lucknow, India
- Department of Urology, King George's Medical University, Lucknow, India
- Department of Neurology, King George's Medical University, Lucknow, India
- Department of Nephrology, King George's Medical University, Lucknow, India
- Department of Cardiology, King George's Medical University, Lucknow, India
- Department of Obstetrics and Gynecology, King George's Medical University, Lucknow, India
- Department of ENT, King George's Medical University, Lucknow, India
- Department of Pulmonology, King George's Medical University, Lucknow, India
- Department of Psychiatry, King George's Medical University, Lucknow, India
- Department of Gastroenterology, King George's Medical University, Lucknow, India
| | - Amlesh Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Vivekanand Jha
- The George Institute for Global Health, New Delhi, India
| | | | | | - Alok Thakar
- All India Institute of Medical Sciences, New Delhi, India
| | - Surinder Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Anjali Bajaj
- Government of Himachal Pradesh, Himachal Pradesh, India
| | - Mohan Kant
- Department of Paediatrics, Indian Council of Medical Research, New Delhi, India
- Department of Opthalmology, Indian Council of Medical Research, New Delhi, India
- Department of General Surgery, Indian Council of Medical Research, New Delhi, India
- Dermatology, Indian Council of Medical Research, New Delhi, India
- Paediatric Surgery, Indian Council of Medical Research, New Delhi, India
- Oncology, Indian Council of Medical Research, New Delhi, India
- Orthopaedics, Indian Council of Medical Research, New Delhi, India
- Endocrinology, Indian Council of Medical Research, New Delhi, India
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Lahariya C, Sharma S, Agnani M, de Graeve H, Srivastava JN, Bekedam H. Attributes of Standard Treatment Guidelines in Clinical Settings and Public Health Facilities in India. Indian J Community Med 2022; 47:336-342. [PMID: 36438529 PMCID: PMC9693950 DOI: 10.4103/ijcm.ijcm_665_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 03/09/2022] [Indexed: 12/26/2022] Open
Abstract
Background Standard Treatment Guidelines (STGs) are time-tested tool to improve healthcare quality and patient safety. This study was done to review the available guidelines and assess their essential attributes using AGREE reporting checklist 2016. Methods Publications from PubMed, World Health Organization, Global Health Regional Libraries, Index Medicus, Google, Google Scholar, and insurers, state/central government portals were searched. Results In total, 241 STGs met the inclusion criteria. A range of developers with a varying focus and priorities developed these guidelines (government mostly under national programs 134 (56%); professional associations 67 (28%), academic/research institutions 36 (15%); international agencies 4 [2%]). The government-led guidelines focused on program operations (mainly infections, maternal, and childcare), whereas insurers focused on surgical procedures for protection against fraudulent intentions for claims. The available STGs varied largely in terms of development process rigor, end-user involvement, updation, applicability, etc.; 12% guidelines developed documented GRADE criteria for evidence. Most guidelines focused on the primary care, and only 27 and 7% included treatment at tertiary and secondary levels, respectively, focused on general practitioners. Conclusion There is a need for coordinated, and collaborative efforts to generate evidence-based guidelines, facilitate periodic revisions, standardized development process, and the standards for monitoring embedded in the guidelines. A single designated authority for the standard treatment guidelines development and a central web-based repository with free access for clinicians/users will ensure wide access to quality guidelines enhancing acceptance and stewardship.
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Affiliation(s)
- Chandrakant Lahariya
- World Health Organization (WHO) Country Office for India, New Delhi, India,Address for correspondence: Dr. Chandrakant Lahariya, National Professional Officer, World Health Organization Country Office for India, Fifth Floor, Nirman Bhawan, New Delhi - 110 011, India. E-mail:
| | - Sangeeta Sharma
- Institute of Human Behaviour and Allied Sciences (IHBAS) and Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi, India
| | - Manohar Agnani
- National Health Mission, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Hilde de Graeve
- World Health Organization (WHO) Country Office for India, New Delhi, India
| | | | - Henk Bekedam
- World Health Organization (WHO) Country Office for India, New Delhi, India
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