Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India
Switching to teleconsultation for rheumatology in the wake of the COVID-19 pandemic: feasibility and patient response in India
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DOI：
10.1007/s10067-020-05200-6
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发表时间：
2020-05-30
影响因子：
3.4
通讯作者：
Alias, Bazil
中科院分区：
文献类型：
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作者：
Shenoy, Padmanabha;Ahmed, Sakir;Alias, Bazil
新冠肺炎疫情的紧急爆发要求我们紧急转向远程会诊。印度的患者与风湿病医生的比例很高，患者对远程医疗的概念有限。因此，我们试图找到切换到远程会诊的患者的可行性和接受。在印度喀拉拉邦的援外社风湿病诊所平均每天接待170名（范围：140-240名）病人。预先预约的患者进行了两级筛选，以确定是否有资格接受远程会诊。符合条件的人可以选择在广泛使用的WhatsApp应用程序上进行远程咨询。在完成远程咨询的人中，随机选择100人提供反馈。在头7天，在1469个预约中，有975个符合远程咨询的条件。其中，723人（74%）选择了它，诊所的平均客流量减少到67人（范围29-117）。接受远程会诊的患者比例随着时间的推移而增加。在100名受访者中，满意度中位数为9（IQR 8-10），在0-10量表上，建议继续进行的评分为9.5（IQR 8-10）。多变量分析显示，推荐分数取决于社会距离的信念，对临床检查的看法，以及第一次远程会诊的满意度评分。年龄，性别，个人视频会议应用程序或车辆的可用性并没有独立影响这个分数。如果没有远程咨询设施，四分之三的受访者会停止药物或自我治疗。转换是可行的，并为患者所接受。这使得前往该中心的人数迅速减少。如果不进行这种转变，可能会剥夺大约四分之三的患者获得适当医疗护理的机会。
The emergent COVID-19 pandemic dictates an urgent switch to teleconsultation. India has high patient to rheumatologist ratio, and patients have limited concepts about telemedicine. Thus, we attempted to find the feasibility and acceptance of patients in switching to teleconsultation. The CARE rheumatology clinic at Kerala, India, caters to average 170 (range: 140-240) patients per day. Patients with prefixed appointments had two-level screening for eligibility for teleconsultation. Those eligible were given the option for teleconsultation on the widely available WhatsApp app. Of those who completed teleconsultations, 100 were chosen at random to provide feedback. In the first 7 days, out of 1469 appointments, 975 were found eligible for teleconsultation. Of these, 723 (74%) opted for it. The average footfall in the clinic was reduced to 67 (range 29-117). The proportion of patients accepting teleconsultations increased with time. Amongst the 100 respondents, median satisfaction was 9 (IQR 8-10) and recommendation for continuing was 9.5 (IQR 8-10) on a 0-10 scale. Multivariate analysis showed the recommendation score was dependent on beliefs about social distancing, perceptions about clinical examination, and the satisfaction score of the first teleconsultation. Age, sex, availability of personal video conferencing app or of vehicles did not independently influence this score. Without teleconsultation facilities, three-fourths of the respondents would have stopped drugs or self-medicated. The switch was feasible and accepted by patients. It enabled quick reduction in the number of persons travelling to the centre. Not making the switch could have deprived approximately three-quarters of these patients of proper medical care.