ABSTRACT
COVID-19, the novel coronavirus, has posed a major threat to low- and middle-income countries (LMICs) due to inadequate health infrastructure and human resources. Ethiopia, a low-income country with the second largest population in Africa, has coordinated a strategic response, leveraging existing infrastructure and health systems and mobilizing public health professionals and specialist expert physicians for a multifaceted, unified government approach and adaptive response. Resource limitations, particularly in critical care, have still posed challenges, but the public health and clinical interventions thus far have prevented the catastrophic toll that many predicted. As the pandemic continues, Ethiopia expects to use a triple care model integrated at all levels, consisting of COVID-19 care, isolation care for suspected cases, and essential health services, and urges intensified non-pharmaceutical interventions alongside equitable global vaccine distribution as the ultimate answers to pandemic control. This paper draws on existing data, national planning and guidelines, and expertise from health leadership to describe this response in hopes of providing an example of how future large-scale health challenges might be faced in LMICs, using Ethiopia's successes and challenges in facing the pandemic.
COVID-19, le nouveau coronavirus, a représenté une menace majeure pour les pays à revenu faible et intermédiaire (LMIC) en raison de l'insuffisance des infrastructures de santé et des ressources humaines. L'Éthiopie, un pays à faible revenu dont la population est la deuxième plus importante d'Afrique, a coordonné une réponse stratégique, en tirant parti des infrastructures et des systèmes de santé existants et en mobilisant des professionnels de la santé publique et des médecins experts spécialisés pour une approche gouvernementale unifiée à multiples facettes et une réponse adaptative. Les ressources limitées, notamment en matière de soins intensifs, ont encore posé des problèmes, mais les interventions cliniques et de santé publique menées jusqu'à présent ont permis d'éviter le bilan catastrophique que beaucoup prédisaient. Alors que la pandémie se poursuit, l'Éthiopie prévoit d'utiliser un modèle de soins triple intégré à tous les niveaux, composé de soins COVID-19, de soins d'isolement pour les cas suspects et de services de santé essentiels, et préconise l'intensification des interventions non pharmaceutiques parallèlement à une distribution équitable des vaccins à l'échelle mondiale comme réponses ultimes au contrôle de la pandémie. Cet article s'appuie sur les données existantes, la planification et les directives nationales, et l'expertise des responsables de la santé pour décrire cette réponse dans l'espoir de fournir un exemple de la manière dont les futurs défis sanitaires à grande échelle pourraient être relevés dans les LMIC, en utilisant les succès et les défis de l'Éthiopie face à la pandémie.
ABSTRACT
Purpose: Telemedicine is an essential part of healthcare delivery and has grown exponentially during the COVID-19 pandemic. Data on optimal utilization and implementation of telemedicine in SOT care remain limited. We aimed to evaluate patient, provider and clinic staff perspectives on telemedicine use and potential barriers in SOT clinics. Method(s): We prospectively enrolled adults seen via telemedicine (video or telephone) in SOT clinics at a single academic transplant center between 9-10/2021. Patients completed a survey administered either online or phone following their visit. Providers and clinic staff involved in telemedicine completed online surveys. Surveys were tailored to patient, provider and clinic staff to assess specific concerns, barriers and satisfaction with telemedicine. Result(s): Survey response rate was 21% (175/853) for patients, 57% (70/122) for providers and 31% (20/64) for clinic staff. 95% of visits were video and seen in liver (39%), kidney (40%), lung (16%) and heart transplant (5%) clinics. Patients were male (51%) with a median age of 62, English-speaking (95%) and had some college experience (84%). Patient and provider descriptions of telemedicine use are shown in Figure 1. Patients were not concerned with privacy (86%), lack of physical exam (76%), audio/video difficulties (89% and 93%) or help with setup (82%). Most were satisfied with the ease of video visit (85%) and quality of care (80%). Compared to in-person visits, patients felt their telemedicine visit was similar (66%) if not better (16%). Among providers, most were satisfied with ease of video visits (74%) and quality of care (60%), but 48% were dissatisfied with telephone visits. Providers spent time assisting patients (72%) or required help from staff to aid patients (7%) with visits;90% noted functioning of software/hardware before visits as crucial to improving telemedicine use. Among clinic staff, 50% reported additional time spent aiding patients with initial visit setup due to needing to instruct how to use telemedicine software (60%) and providing additional instructions to caregiver(s) (20%). Conclusion(s): Telemedicine via video is an effective and convenient method of healthcare delivery across the continuum of SOT care according to patients, providers and clinic staff. However, concerns about time assisting with setup were noted by providers and staff. Additional resources and support are needed to improve navigation of telemedicine for patients and to improve efficiency with telemedicine for providers and staff. (Figure Presented).
ABSTRACT
BACKGROUND: Telemedicine is an essential part of healthcare delivery and has grown exponentially as a result of the COVID-19 pandemic. However, data on optimal utilization and implementation of telemedicine in solid organ transplant care remains limited. We aimed to evaluate patient, provider, and clinic staff perspectives on telemedicine use and potential barriers in solid organ transplant clinics. METHODS: We prospectively enrolled adults seen via telemedicine (video or telephone) in solid organ transplant clinics at a single academic transplant center between 9-10/2021. Patients completed a survey administered either online or via phone following their visit. Providers and clinic staff involved in telemedicine completed online surveys. Surveys were customized to patient, provider, and clinic staff to assess specific concerns, barriers, and satisfaction with telemedicine. RESULTS: Survey response rate was 21% for patients (175 of 853), 57% for providers (70 of 122) and 31% for clinic staff (20 of 64). 95% of telemedicine visits were video and were from liver (39%), kidney (40%), lung (16%) and heart transplant (5%) clinics. The majority of patients were male (51%) with a median age of 62, English-speaking (95%), and had some college experience (84%). Descriptions of telemedicine use among patients and providers are shown in Figure 1. Most patients were not concerned about privacy (86%), lack of physical exam (76%), audio/video difficulties (89% and 93%), or assistance with setup (82%). The majority were satisfied with the ease of video visit (85%) and quality of care (80%). Compared to traditional in-person visits, most patients felt their telemedicine visit was similar (66%) if not better (16%). Among providers, the majority were satisfied with ease of video visits (74%), quality of care (60%), and overall use of video visits (64%), but 48% were dissatisfied with telephone visits. Most providers reported spending time assisting patients (72%) with 7% requiring assistance from clinic staff to aid patients with video visits. 90% of providers identified appropriate software/hardware functioning prior to visits as a key feature to improve telemedicine use. Among clinic staff, 50% reported spending additional time assisting patients with setting up their initial visit due to needing to instruct how to use telemedicine software (60%) and providing additional instructions to caregiver(s) (20%). CONCLUSION: Telemedicine via video is an effective and convenient method of healthcare delivery across the continuum of solid organ transplant care according to patients, providers and clinic staff. However, concerns about time assisting with setup were highlighted by providers and clinic staff. Additional resources and support are needed to improve navigation of telemedicine for patients and to improve efficiency with telemedicine for providers and clinic staff. (Figure Presented)