NEWS There are lessons from the pandemic that can be applied usefully to how health care can be delivered.

CONTEXT In the wake of novel coronavirus pandemic and fear of transmission, health-care providers have been reassigned from other specialties to COVID-19, restricting high quality care for other conditions.

DISRUPTIONS IN ESSENTIAL SERVICES

• A survey by the World Health Organization (WHO) in 105 countries (July 2020) pointed essential services were disrupted in the majority of countries, with immunization, antenatal and childcare services among the most widely affected.
• About 45% of low-income countries incurred at least partial disruption of over 75% of services, relative to only 4% of high-income countries. Almost 60% of services were at least partially disrupted in South East Asian countries.
• In India, detection of tuberculosis cases was down by 50% in April-December of 2020 relative to the same period in 2019, and antenatal care visits were down by 56% in the first half of 2020.
• The blood sugar control for diabetics was at risk, increasing the chances of adverse events requiring hospitalization, including worse outcomes in the case of COVID-19 infection.
• Cancer care has been badly affected in many countries, as well as diagnosis and treatment of other non-communicable diseases.
• The pandemic has exacerbated inequalities in health care; people living in rural and remote areas were further disadvantaged by not being able to travel to cities to seek specialist care.
• The pre-existing shortage of specialists in many rural areas led to care being delayed or not happening at all.

ENHANCE TECHNOLOGY USE

• The acceleration in the use of digital technologies has mitigated the impact of COVID-19 to some extent.
• Virtual consultations avoid the risk of COVID-19 transmission and are helping to bridge this socio-economic divide. One such initiative by the government is the e-Sanjeevani platform.
• Also the private providers and non-governmental organizations (NGO) have expanded virtual access to underserved populations.
• Yet, given the scale of unmet demand, there is an urgent need to increase the efficiency and effectiveness of every minute spent in virtual care interactions. 

LESSONS FROM PANDEMIC

There are lessons we can learn from the pandemic that can be applied usefully to how we deliver health care.

• Remote-shared medical appointments in which multiple patients with similar medical needs meet with a clinician at once, remotely, and where each receives individual attention, can greatly increase telehealth capacity by eliminating repetition of common advice.
• Remote shared medical appointments essentially virtualise in-person shared medical appointments (SMAs) which have been offered successfully in the United States for over 20 years. SMAs also enable peer support and peer-to-peer learning.
• Providers who have offered SMAs have found them to improve both productivity and outcomes for many conditions, notably diabetes. SMAs could help tackle India’s widespread “sugar” problem.

• Providers can offer virtual group information sessions accessible via smartphone in which a health-care worker explains the benefits of COVID-19 testing and vaccination and answers questions, reaching potentially quite large audiences.
• Engaging in real time with a care provider in an interactive format will likely encourage safe behaviours to a greater extent than without interaction.
• Adoption of in-person shared medical appointments has been slow. Training platforms such as ECHO, which train primary-care providers in many States through an online platform — can accelerate adoption and should also guide implementers on how to gather data that can be used to scientifically validate this care model.
• Patients who choose to attend an in-person SMA often like the experience and return for more. This is likely for virtual SMAs too. Trialling and acceptance of this model could amplify the impact of health systems both during the pandemic and beyond.

PLATFORMS FOR TELEHEALTH CARE

The e-Sanjeevani and other telehealth platforms could consider offering virtual shared medical appointments. Patients in different villages, with similar conditions can be seen at once remotely by a generalist or specialist, during the pandemic.

Once transmission risk subsides, seeing patient groups within each village centre will help build supportive bonds, enable sharing of local knowledge, and likely attract supplementary providers.

INDIA WITH ADVANTAGE

Relative to other nations, India is well poised to ramp up tele-health, as data plans are cheaper in India than anywhere.

WHO’ s Global Strategy on Digital Health, adopted by the World Health Assembly, is a call to action providing a road map for nations to rapidly expand digital health services. With innovation in systems thinking, learning and adaptation, new digital tools bring an opportunity to leapfrog into a reality of ‘Health for All’.

Reference:

1. https://www.thehindu.com/opinion/op-ed/in-telehealth-scaling-up-the-indian-advantage/article33854619.ece