Cabo Verde Telemedicine Program: An Update Report and Analysis of 2,442 Teleconsultations.

Introduction: The Cabo Verde Telemedicine program (CVTP) was established by the International Virtual e-Hospital Foundation using the Initiate-Build-Operate-Transfer strategy to improve access to specialty care for the population in the archipelago of Cabo Verde in 2012. Since its inception, the CVTP has proven a great success story of telemedicine in Africa. Our first report on the initial results of a nationwide CVTP was published in 2014. The aim of this article is to analyze the follow-up data and analyze the activity of CVTP. Methods: All telemedicine consultations of the CVTP from 2014 to 2018 were analyzed. Patient demographics, clinical discipline, and transfer status were analyzed. Categorical variables were compared with a chi-squared test. Results: There were 2,442 telemedicine consultations in 24 clinical programs performed during the study period. The most common clinical disciplines with >100 consultations were neurology, cardiology, orthopedic surgery, general surgery, endocrinology, otolaryngology, urology, and dermatology. Overall, the transfer rate was 34.3%. Conclusion: The nationwide CVTP continues to increase access to specialized care, prevent unnecessary and costly transfers, and has become a great success story of telemedicine in Africa. Moreover, this program should serve as a model for establishing island-nations telemedicine programs worldwide.

Telemedicine Consultation as an Indicator of Local Telemedicine Champions' Contributions, Health Care System Needs or Both: Tales from Two Continents.

Background: Telemedicine systems increase access to care, particularly in remote and developing countries. Nationwide telemedicine programs in Cabo Verde and Albania have been built by the International Virtual e-Hospital Foundation (IVeH) and based on the effective Initiate-Build-Operate-Transfer (IBOT) strategy. The aim of this study was to compare the clinical results between the two programs and examine the relationship between the clinical teleconsultations as an indicator of health care system needs and the contribution of local telemedicine champions. Methods: Data were prospectively collected between 2014 and 2018 from Albania and Cabo Verde. Telemedicine champions were defined as programs, physicians, or hospitals who have contributed at least 100 telemedicine consultations during the study periods. Chi-squared test was utilized to analyze the data. Results: There were 2,442 teleconsultations in Cabo Verde and 2,724 teleconsultations in Albania during the study periods. Using the 100-consultation benchmark as the indicator of telemedicine champion, we identified radiology (n = 1,061), neurotrauma (n = 742), and general neurology or stroke (n = 489) as champion clinical disciplines in Albania. With the same method of 100 consultations, we identified eight champion clinical disciplines in Cabo Verde, including neurology (n = 720), cardiology (n = 313), orthopedics (n = 190), surgery (143), endocrinology (141), otolaryngology (n = 139), urology (n = 139), and dermatology (126). The patient transfer/nontransfer ratio was 0.5 in Cabo Verde and 0.3 in Albania (p < 0.001). Three hospitals in Albania and eight community hospitals/health care centers in Cabo Verde requested the majority of teleconsultations. Two main hospitals in Cabo Verde and Albania responded to the consultations. Conclusion: The successful implementation of a telemedicine program depends on many factors. However, physician champions, who eventually create clinical discipline champions, and represent the hospital champions, are the backbone of the sustainability and progress of any telemedicine program. The number of consultations reflects the lack of local specialty expertise to provide health care service and thus can be used for future planning and investment.