Sanjeev Gulati and Amrita Sengar
Introduction:
Telemedicine is the delivery of health care and/or health information in nephrology using electronic systems. There is no previous experience in Telenephrology from developing countries with limited resources like India.
Aim:
This single centre prospective study to assess the feasibility, acceptability and effectiveness of Telenephrology services for regular follow up as well as for triaging patients for admission in setting of a countrywide lockdown.
Methods:
The study period was the lockdown period in the country from 23rd March to 31st May. The patients were informed about the availability of Telenephrology services through text messages sent form our patients data base as well through Social Media like Facebook and whatsapp. The patient data was stored in Electronic Medical records (EMR) using the Healthplix platform. A combination of Whatsapp and EMR database was used to provide telemedicine services during the lockdown period. On receiving the request, a formatted message was sent requesting for information seeking current concerns by the patient , weight, vital signs including blood pressure records as well as current and previous investigations. The data was entered in EMR and electronic prescription generated. This was emailed or whatsapped as per patient preference. At the end of the econsult the patient was asked to rate his experience on a scale of 0 to 10.
Results:
During the study period a total of 477 econsults were given. The study group comprised of 277 patients and there were 184 males and 93 females . The mean age of the patients in was 41.74 years years ( range 0.17 – 94 yrs ). There were 61 children and 216 adults. Of the 477 econsults that were advised, 476 (99.8%) opted in. In only 1 econsult, the patient opted out and decided to come for clinic visit as he was not comfortable with either whatsapp or email prescription and did not have any family support for the same. Of these 277 patients that were provided teleconsultation, 256 were follow-up patients previously being followed up in our clinics and rest 20 were new consultations being evaluated for the first time. Of the 476 econsults given, 459 (96.4%) were advised follow up econsults, 17 (10.2%) were advised admission and 1 patient advised to come for clinic opd evaluation . Of the 459 econsults that were advised followup , only 1 patient who was advised followup econsult , opted to come for admission and observation. Rest of the 458 econsults were managed by telemedicine followup. The patient satisfaction score for econsults was 8.7.
Conclusion:
So based on this pilot study, we conclude that Telenephrology offered a viable modality for delivery of Nephrology services during lockdown period when access to healthcare was restricted. It also provides a model which can be replicated by physicians as well as organizations to expand and improve the practice of Telenephrology
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