Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India
Can telemedicine initiative be an effective intervention strategy for improving treatment compliance for pediatric HIV patients: Evidences on costs and improvement in treatment compliance from Maharashtra, India
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DOI：
10.1371/journal.pone.0223303
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发表时间：
2019-10-08
期刊：
影响因子：
3.7
通讯作者：
Manglani, Mamta, V
中科院分区：
文献类型：
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作者：
Rout, Sarit Kumar;Gabhale, Yashwant R.;Manglani, Mamta, V
背景印度最近推出了远程医疗举措，以提高儿科艾滋病毒患者以低成本获得专业护理的机会，由于疾病负担不断增加，卫生系统应对疾病的准备有限，他们面临着多重挑战。这项研究是在位于该国西部地区的马哈拉施特拉邦进行的，目的是为有关该方案有效性的政策提供信息。其目的是估计儿童艾滋病患者ART服务的单位成本，并检查与常规ART服务相比，儿童艾滋病远程医疗举措导致的资源使用效率和治疗依从性。（3个来自与儿科HIV卓越中心（PCoE）相关的链接中心，3个来自非链接中心）随机从三个高，中、低水平ART中心，根据每个分支的病例量进行分类。采用自下而上的成本计算方法来了解服务的单位成本。损失的后续行动和访问的及时性进行了比较，两个武器之间，并与costs.ResultsThe平均成本每次访问是在链接的中心和非链接的中心INR 1803为3412。与非链接中心相比，链接中心的失访率改善了5个百分点，而每名儿科患者的成本降低了557 INR。的链接导致在链接的中心相比，非链接centers.Discussion和conclusionThe远程医疗链接的访问的及时性增加导致的情况下，负载量的增加，从而降低成本。这项研究所提出的关于资源使用效率和治疗依从性改善的证据可用于扩大这一举措。
BackgroundIndia has recently introduced telemedicine initiatives to enhance access to specialized care at a low cost for the pediatric HIV patients, who face multiple challenges due to growing disease burden and limited preparedness of the health system to address it. There are limited evidences on the cost-effectiveness of these interventions. This study was undertaken in Maharashtra, a province, located in the western region of the country, to inform policy regarding the effectiveness of this programme. The objective was to estimate the unit cost of ART services for pediatric HIV patients and examine the efficiency in the use of resource and treatment compliance resulting from telemedicine initiatives in pediatric HIV compared to usual ART services.MethodsWe selected 6 ART centers (3 from linked centers linked to Pediatric HIV Centre of Excellence (PCoE) and 3 from non-linked centers) randomly from three high, middle and low ART centers, categorized on the basis of case load in each arm. A bottom up costing methodology was adopted to understand the unit cost of services. Loss to follow up and timeliness of the visits were compared between the two arms and were linked to the cost.ResultsThe average cost per-visit was INR 1803 in the linked centers and that for the non-linked centers was INR 3412. There has been 5 percentage point improvement in lost to follow-up in the linked centers compared to non-linked centers against a back-drop of a reduction in per-pediatric patient cost of INR 557. The linkage has resulted in increase in timeliness of the visits in linked centers compared to non-linked centers.Discussion and conclusionThe telemedicine linkage led to an increase in the case load leading to a decrease in cost. The evidence on efficiency in the use of resource and improvement in treatment compliance as suggested by this study could be used to scale up this initiative.