Centre for Arthritis and Rheumatism Excellence (CARE), Nettoor, Cochin, India.
Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, 751024, India.
Clin Rheumatol. 2020 Sep;39(9):2757-2762. doi: 10.1007/s10067-020-05200-6. Epub 2020 May 30.
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. Key Points • Patient to rheumatologist ratios in India is heavily skewed and awareness about telemedicine is limited. • Switch to telemedicine was feasible and allowed a decrease in the number of people attending the clinic. • Not switching could have lead to disruption of care or self-medication in a majority of patients.
突发的 COVID-19 大流行促使我们紧急转向远程问诊。印度的医患比例悬殊，且患者对远程医疗的概念有限。因此，我们试图了解患者转向远程问诊的可行性和接受程度。印度喀拉拉邦的 CARE 风湿病诊所每天接待约 170 名（范围：140-240 名）患者。有预约的患者需要进行两级筛查，以确定是否符合远程问诊的条件。符合条件的患者可以选择使用广泛使用的 WhatsApp 应用程序进行远程问诊。在完成远程问诊的患者中，随机选择了 100 名患者提供反馈。在最初的 7 天内，在 1469 次预约中，有 975 次符合远程问诊条件。其中 723 人（74%）选择了远程问诊。诊所的平均客流量减少到 67 人（范围 29-117 人）。随着时间的推移，接受远程问诊的患者比例有所增加。在 100 名受访者中，中位数满意度为 9（IQR8-10），继续推荐的比例为 9.5（IQR8-10），满分 10 分。多变量分析表明，推荐评分取决于对社交距离的信念、对临床检查的看法以及第一次远程问诊的满意度。年龄、性别、个人视频会议应用程序或车辆的可用性均不会独立影响此评分。如果没有远程问诊设施，四分之三的受访者将停止服药或自行用药。该转变是可行的，并且被患者接受。这使得前往中心的人数迅速减少。如果不进行转变，大约四分之三的患者可能会无法获得适当的医疗护理。关键点 • 印度的医患比例严重失衡，对远程医疗的认识有限。 • 转向远程医疗是可行的，可以减少到诊所就诊的人数。 • 如果不进行转变，可能会导致大多数患者的护理中断或自行用药。
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