Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis

Huang, Garry; Pawape, Gibson; Taune, M.; Hiasihri, Stenard; Ustero, Pilar; O’Brien, D. P.; Cros, Philipp du; Graham, Stephen M.; Wootton, Richard; Majumdar, S. S.

doi:10.3389/fpubh.2019.00222

Cited by 14 publications

(11 citation statements)

References 17 publications

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“…An inventory study in Pakistan highlighted that 78% child TB cases were diagnosed by the non-NTP private providers, which may not be surprising when distance is long to public child TB care; childhood TB under-reporting was highest in these provinces [ 23 ]. We think telemedicine could be used remotely to link PHC to child TB sites for timely diagnoses and management of serious child TB cases and this could address some of the challenges posed by lack of physical health care infrastructure [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Geographic accessibility to childhood tuberculosis care in Pakistan

Yaqoob

Alvi²,

Fatima³

et al. 2022

Global Health Action

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Background Tuberculosis (TB) in children is difficult to detect and often needs specialists to diagnose; the health system is supposed to refer to higher level of health care when diagnosis is not settled in a sick child. In Pakistan, the primary health care level can usually not diagnose childhood TB and will refer to a paediatricians working at a secondary or tertiary care hospital. We aimed to determine the health services access to child TB services in Pakistan. Objective We aimed to determine the geographical access to child TB services in Pakistan. Method We used geospatial analysis to calculate the distance from the nearest public health facility to settlements, using qGIS, as well as population living within the World Health Organization’s (WHO) recommended 5-km distance. Result At primary health care level, 14.1% of facilities report child TB cases to national tuberculosis program and 74% of the population had geographical access to general primary health care within 5-km radius. To secondary- and tertiary-level health care, 33.5% of the population had geographical access within 5-km radius. The average distance from a facility for diagnosis of childhood TB was 26.3 km from all settlement to the nearest child TB sites. The population of one province (Balochistan) had longer distances to health care services. Conclusion With fairly good coverage of primary health care but lower coverage of specialist care for childhood TB, the health system depends heavily on a good referral system from the communities.

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Section: Discussionmentioning

confidence: 99%

Geographic accessibility to childhood tuberculosis care in Pakistan

Yaqoob

Alvi²,

Fatima³

et al. 2022

Global Health Action

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“… 26–29 In Papua New Guinea, a web-based ‘store and forward’ telemedicine service was used to optimize the treatment of multidrug-resistance TB. 30 In a study of patients with active pulmonary TB, videophone technology was used for directly observed therapy (DOT) of 304 treatment doses. It revealed 95% treatment adherence in a cost-effective manner.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and usefulness of tele-follow-up in the patients with tuberculous meningitis

Kalita

Pandey

Shukla

et al. 2021

Transactions of the Royal Society of Tropical Medicine and Hygiene

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Background Tuberculous meningitis (TBM) is the most severe form of tuberculosis and these patients need close follow-up because of a high frequency of complications. The coronavirus disease 2019 pandemic and lockdown resulted in an interruption in physical follow-up. In this situation, tele-follow-up may be helpful. We report the feasibility and usefulness of a telephonic follow-up in patients with TBM. Methods Patients with TBM managed by us from January 2017 to March 2020 were included from the TBM registry. Their presenting symptoms, and clinical and investigation findings were noted. We contacted these patients telephonically and their clinical status was obtained using a questionnaire. Based on the telephonic information, outcomes were categorized as death, poor or good. Patients with the new medical problems were advised as to relevant investigations and the reports were obtained through WhatsApp for prescribing treatment. Results The telephone numbers of 103 of 144 (71.5%) patients were viable. Twenty-seven (26.2%) patients died, 15 (19.7%) had a poor outcome and 61 (80.2%) had a good outcome. Twenty-five (32.9%) patients had new medical problems: 18 TBM related and 7 TBM unrelated. The medical problems of 23 patients could be managed telephonically and only 3 (4%) patients needed a physical visit. Sixty-five (85.5%) patients happily answered the questionnaire and willing responders needed a treatment modification more frequently than the reluctant responders (p=0.008). Patients on active antitubercular treatment needed treatment modification more frequently (80% vs 21.3%). Conclusions Tele-follow-up is feasible in 96% of TBM patients and is beneficial, cost effective and overcomes the barrier of distance.

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“…Referral-preparation times were examined in the Collegium Telemedicus system, which at the time of the study comprised 33 clinical networks and 6 educational networks. A clinical case corresponded to a patient, and an educational case corresponded to a case report or a case-management discussion (5). The epoch examined was 8 September 2018 to 1 March 2019, a total of 25 weeks.…”

Section: Methodsmentioning

confidence: 99%

Time Required to Create a Referral in Various Store-and-Forward Telemedicine Networks

Wootton

O'Kane²

2019

Front. Public Health

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Store and forward telemedicine is used routinely in health care, but there is little published information about how such telemedicine systems are used. For example, an important aspect of the system's usability is the length of time it takes to submit a referral. Referral-submission times were measured in networks based on the Collegium Telemedicus system. In a 25-week period in 2018/2019, eight Collegium networks received a total of 1,649 clinical or educational cases submitted via the web interface. The time to prepare a referral was measured in 669 of these cases, in two different ways. An indirect measurement of the referral-preparation time was calculated as the interval between the user logging in, and the referral being submitted. A direct measurement of the referral-preparation time was calculated as the interval between the user opening the referral page and the referral being submitted to the server. The difference between the two measurements represents time spent by the user on other activities after logging in, before beginning the referral. The median referral-preparation time, measured directly, was 888 s (IQR 512-1765). The median of the differences between the two preparation times was 27s (IQR 8-146). The referral-preparation times in the eight networks were broadly similar, despite the differences in the nature of their operation (clinical or educational), and the types of case handled (single specialty or multi-specialty). Quantitative information about aspects of the user interface, such as the referral-preparation time, is important not only in the initial system design, but also in its subsequent development.

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Telemedicine in Resource-Limited Settings to Optimize Care for Multidrug-Resistant Tuberculosis

Cited by 14 publications

References 17 publications

Geographic accessibility to childhood tuberculosis care in Pakistan

Geographic accessibility to childhood tuberculosis care in Pakistan

Feasibility and usefulness of tele-follow-up in the patients with tuberculous meningitis

Time Required to Create a Referral in Various Store-and-Forward Telemedicine Networks

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