LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 348-349
Is telemedicine a feasible tool? – Experiences and challenges faced by the team during COVID-19 home care program
G Rakesh Maiya, Timsi Jain, G Shiny Chrism Queen Nesan, P Preeti, Yogesh Mohan, G Dinesh Kumar
Department of Community Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
|Date of Submission||12-Aug-2020|
|Date of Acceptance||29-Jan-2021|
|Date of Web Publication||29-May-2021|
Dr. G Shiny Chrism Queen Nesan
Department of Community Medicine, Saveetha Medical College and Hospital, Thandalam, Chennai - 602 105, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maiya G R, Jain T, Chrism Queen Nesan G S, Preeti P, Mohan Y, Kumar G D. Is telemedicine a feasible tool? – Experiences and challenges faced by the team during COVID-19 home care program. Indian J Community Med 2021;46:348-9
|How to cite this URL:|
Maiya G R, Jain T, Chrism Queen Nesan G S, Preeti P, Mohan Y, Kumar G D. Is telemedicine a feasible tool? – Experiences and challenges faced by the team during COVID-19 home care program. Indian J Community Med [serial online] 2021 [cited 2021 Jun 17];46:348-9. Available from: https://www.ijcm.org.in/text.asp?2021/46/2/348/317088
Currently, India ranks third in the number of COVID-19 cases, with 2,702,742 cases, of which 343,945 cases are from Tamil Nadu. Majority (80%) of cases are asymptomatic or mild symptomatic which do not require hospital admission and can be managed through home isolation. Saveetha Medical College and Hospital introduced a model that monitors the patients and their caregivers in home isolation through regular teleconsultation to improve their access to medical services [Figure 1]. This ongoing model expresses the challenges faced by the team and to evaluate the feasibility of Telemedicine as a tool to be advised for future management. COVID-19 Home Care Program, was launched on 15, June 2020 for asymptomatic and mild symptomatic patients residing in Chennai and neighboring districts as per Ministry of Health & Family Welfare, Government of India guidelines.
The resources include (a) workforce which consisted of faculties, postgraduates, interns and field workers, (b) Home Care Kit containing Masks, Pulse oximeter, Thermometer, Sanitizer, Vitamin C, Zinc supplements, and COVID home care instruction booklet which was available in English and Tamil with complete information on symptoms, mode of transmission, respiratory etiquette, hand hygiene, the Do's and Don'ts of COVID-19 home care for both the patient and the caregiver and a model diet plan. Landline number exclusive for COVID home care inquiries and a room for the team to function and maintain records on a daily basis was provided.
No physical examination was done and only a discharge summary stating that the patient was registered under the program, was monitored daily and was discharged from the program after satisfying the discharge criteria was given. .
A total of 316 patients were registered till August 18, 2020. The mean age of the patients was 35.71 ± 12.8 years. 65% were males and only 31.3% had downloaded Arogya Setu App. The presence of symptoms was the reason for testing in 56% followed by contact of history 42.8% of patients.
The positive aspects of the model were that it was able to function with less complicated logistics and preexisting human and material resources, the tireless involvement of the team members and the management for the proper functioning of the program, the sense of gratitude and satisfaction of the patients toward the program and their support by referring it to other eligible COVID-19 patients. Thus, the telemedicine used for home care was indeed a feasible and useful tool which can be adopted by every other institution, especially medical colleges in future for the well-being of the patients. The most important experience gained was proper utilization of video calls to comprehend with the complaints of the patients. For instance, a patient's complaint of generalized swelling of the body was perceived as anasarca by the intern, which was ruled out and patient was re-assured. The usage of devices in the kit was also explained through video calls. With the enrolment of pediatric age group patients, a separate pediatric kit was made where Zinc and Vitamin C tablets were replaced with syrup; dose of syrup was adjusted after pediatrician's opinion. Running the model gave the team an experience of administration at difficult situations and feeling of confidence and satisfaction involved in it. Difficult challenges faced were timely transfer of photocopy of patients' prescription of drugs for their complaints through WhatsApp, prompt replacement of defective devices in the field, handling overanxious patients over phone, prompt consultation of the specialists from other departments such as General Medicine, Psychiatry, Ophthalmology, Obstetrics, and Gynecology costed our efforts and prescription for non-COVID symptoms were outside the ambit of the program; however, we did it as a good-will gesture.
The Medical Council of India in partnership with NITI Aayog has suggested that the health systems should invest in telemedicine. Our experience suggests that teleconsultation is very feasible in Medical college setup thanks to the workforce, logistics, and expertise of various departments. This is an effective strategy to combat COVID-19 pandemic by reducing overburdening of the health system and reducing exposure of infection to health-care workers as well as ensuring that those in need receive care without needing to go out. It is also cost-effective and can be reached out to the remote areas.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Telemedicine Practice Guidelines Enabling Registered Medical Practitioners to Provide Healthcare Using Telemedicine. Ministry of Health and Family Welfare; 2020. Available from: https://www.mohfw.gov.in/pdf/Telemedicine.pdf
. [Last accessed on 2020 Aug 03].