Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform

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Abstract

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.

Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.

Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7–21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26–3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.

Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

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Quality of patient record keeping: an indicator of the quality of care?

Esther C de Jong, Cordula Wagner, Peter Spreeuwenberg … (2011)

Patient record review of hospitalised patients is by far the most applied method to assess adverse events (AEs) in hospitals. The diligence with which information is recorded may influence the visibility of AEs. On the other hand, poor quality of the information in patient records may be a cause or a consequence of poor quality of care and may thus be associated with higher rates of AEs. The objective of this study was to assess the relation between the quality of patient records and the occurrence of AEs. In this study, 7926 hospital admissions of 21 Dutch hospitals were analysed with a structured record review method. The occurrence of AEs, the presence of patient information and the quality of the present information (completeness, readability and adequacy) were assessed. Their association was analysed using multilevel logistic regression analyses. The absence of record components was associated with lower rates of AEs, suggesting that missing record components lead to an underassessment of AEs in record-review studies. In contrast, poor quality of the information present in patient records was associated with higher rates of AEs, implying that the quality of the present patient information is a predictor of the quality of care. Evidence-based standards and a (electronic) format for record keeping are necessary for standardisation of recording patient information. This will improve the completeness, readability, accessibility, accuracy and exchange of patient information between healthcare providers and institutions. Better registration of patient information will benefit the quality of the healthcare process and will reduce the risk of AEs.

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Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review

Richard Wootton, Kambiz Bahaadinbeigy, David Hailey (2011)

Background A major benefit offered by telemedicine is the avoidance of travel, by patients, their carers and health care professionals. Unfortunately, there is very little published information about the extent of avoided travel. We propose to undertake a systematic review of literature which reports credible data on the reductions in travel associated with the use of telemedicine. Method The conventional approach to quantitative synthesis of the results from multiple studies is to conduct a meta analysis. However, too much heterogeneity exists between available studies to allow a meaningful meta analysis of the avoided travel when telemedicine is used across all possible settings. We propose instead to consider all credible evidence on avoided travel through telemedicine by fitting a linear model which takes into account the relevant factors in the circumstances of the studies performed. We propose the use of stepwise multiple regression to identify which factors are significant. Discussion Our proposed approach is illustrated by the example of teledermatology. In a preliminary review of the literature we found 20 studies in which the percentage of avoided travel through telemedicine could be inferred (a total of 5199 patients). The mean percentage avoided travel reported in the 12 store-and-forward studies was 43%. In the 7 real-time studies and in a single study with a hybrid technique, 70% of the patients avoided travel. A simplified model based on the modality of telemedicine employed (i.e. real-time or store and forward) explained 29% of the variance. The use of store and forward teledermatology alone was associated with 43% of avoided travel. The increase in the proportion of patients who avoided travel (25%) when real-time telemedicine was employed was significant (P = 0.014). Service planners can use this information to weigh up the costs and benefits of the two approaches.

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Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output

Richard Wootton, Antoine Geissbuhler, Kamal Jethwani … (2012)

OBJECTIVE: To summarize the experience, performance and scientific output of long-running telemedicine networks delivering humanitarian services. METHODS: Nine long-running networks -those operating for five years or more -were identified and seven provided detailed information about their activities, including performance and scientific output. Information was extracted from peer-reviewed papers describing the networks' study design, effectiveness, quality, economics, provision of access to care and sustainability. The strength of the evidence was scored as none, poor, average or good. FINDINGS: The seven networks had been operating for a median of 11 years (range: 5-15). All networks provided clinical tele-consultations for humanitarian purposes using store-and-forward methods and five were also involved in some form of education. The smallest network had 15 experts and the largest had more than 500. The clinical caseload was 50 to 500 cases a year. A total of 59 papers had been published by the networks, and 44 were listed in Medline. Based on study design, the strength of the evidence was generally poor by conventional standards (e.g. 29 papers described non-controlled clinical series). Over half of the papers provided evidence of sustainability and improved access to care. Uncertain funding was a common risk factor. CONCLUSION: Improved collaboration between networks could help attenuate the lack of resources reported by some networks and improve sustainability. Although the evidence base is weak, the networks appear to offer sustainable and clinically useful services. These findings may interest decision-makers in developing countries considering starting, supporting or joining similar telemedicine networks.

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Author and article information

Contributors

Sophie Delaigue: URI : http://frontiersin.org/people/u/173253

Jean-Jacques Morand: URI : http://frontiersin.org/people/u/192219

Richard Wootton: URI : http://frontiersin.org/people/u/124834

Laurent Bonnardot: URI : http://frontiersin.org/people/u/128796

Journal

Journal ID (nlm-ta): Front Public Health

Journal ID (iso-abbrev): Front Public Health

Journal ID (publisher-id): Front. Public Health

Title: Frontiers in Public Health

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2296-2565

Publication date (Electronic): 14 November 2014

Publication date Collection: 2014

Volume: 2

Electronic Location Identifier: 233

Affiliations

[1] ¹Dermatology Department, Hopital Nord , Marseille, France

[2] ²Department of Dermatology, Sainte Anne Military Hospital , Toulon, France

[3] ³Médecins Sans Frontières , New York, NY, USA

[4] ⁴Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø, Norway

[5] ⁵Faculty of Health Sciences, University of Tromsø , Tromsø, Norway

[6] ⁶Fondation Médecins Sans Frontières , Paris, France

[7] ⁷Department of Medical Ethics and Legal Medicine (EA 4569), Paris Descartes University , Paris, France

Author notes

Edited by: Michal Grivna, United Arab Emirates University, United Arab Emirates

Reviewed by: Ricardo J. Wray, University of Pennsylvania, USA; Xiaoguang Ma, University of South Carolina, USA; Maria Zolfo, Institute of Tropical Medicine, Belgium

*Correspondence: Sophie Delaigue, Chemin des Bourrely, 13015 Marseille, France e-mail: delaiguesophie@ 123456yahoo.fr

This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health.

Article

DOI: 10.3389/fpubh.2014.00233

PMC ID: 4231841

PubMed ID: 25453029

SO-VID: 30346b1f-aa69-4bc8-96ed-5801388eb130

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 05 August 2014

Date accepted : 27 October 2014

Page count

Figures: 9, Tables: 3, Equations: 0, References: 23, Pages: 9, Words: 4667

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Most cited references 18

Quality of patient record keeping: an indicator of the quality of care?

Estimating travel reduction associated with the use of telemedicine by patients and healthcare professionals: proposal for quantitative synthesis in a systematic review

Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output

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