• To demonstrate the extent of change in patient management through the availability of digital X-ray with teleradiology consultation.
SECONDARY OBJECTIVES OF STUDY
• To demonstrate the extent of change in patient diagnosis through the availability of digital X-ray with teleradiology consultation.
• To demonstrate the extent of change in patient diagnosis and management in the subgroup of patients with chest pathologies through the availability of digital X-ray with teleradiology consultation.
• To estimate if the extent of change in diagnosis and management is different in patients < 5 years of age versus ≥5 years of age.
Formation virtuelle comme catalyseur d’amelioration des soins neonataux au CSREF de Douentza / Mali
BACKGROUND
Improving treatment success rates among multi drug-resistant tuberculosis (MDR-TB) patients is critical to reducing its incidence and mortality, but adherence poses an important challenge. Video-based direct observed therapy (vDOT) may provide adherence benefits, while addressing the time and cost burden associated with community treatment supporter (CTS)-DOT. This study explored experiences of patients, family members and healthcare workers with different DOT modalities for adherence support in Eswatini.
METHODS
Between April 2021 and May 2022, thirteen men and five women with MDR-TB, ten healthcare workers, and nine caregivers were purposively sampled to include a range of characteristics and experiences with DOT modalities. Data were generated through individual in-depth interviews and a smartphone messaging application (WhatsApp). Data coding was undertaken iteratively, and thematic analysis undertaken, supported by Nvivo.
RESULTS
Four themes emerged that reflected participants’ experiences with different DOT modalities, including stigma, efficiency, perceived risks of TB acquisition, and patient autonomy. vDOT was appreciated by patients for providing them with privacy and shielding them from stigmatisation associated with being seen in TB clinics or with community treatment supporters. vDOT was also seen as more efficient than CTS-DOT. Health workers acknowledged that it saved time, allowing them to attend to more patients, while many patients found vDOT more convenient and less expensive by removing the need to travel for in-person consultations. Health workers also appreciated vDOT because it reduced risks of TB acquisition by minimising exposure through virtual patient monitoring. Although many patients appreciated greater autonomy in managing their illness through vDOT, others preferred human contact or struggled with making video recordings. Most family members appreciated vDOT, although some resented feeling removed from the process of supporting loved ones.
CONCLUSIONS
vDOT was generally appreciated by MDR-TB patients, their family members and health workers as it addressed barriers to adherence which could contribute to improved treatment completion rates and reduced workplace exposure. However, patients should be offered an alternative to vDOT such as CTS-DOT if this modality does not suit their circumstances or preferences.
In December 2019, following a request from MSF’s intersectional working group for mental health and psychosocial services, MSF’s telemedicine (TM) services team implemented a full-time psychiatrist based in Amman, Jordan. This was in the context of a global shortage of mental health (MH) clinicians, and rapidly increasing demand for MSF to provide MH care. This specialist’s main responsibility was to deliver psychiatric training and supervision using WHO’s MH global action plan intervention guide (mhGAP-IG). Prior to implementation, psychiatric training was delivered face-to-face by national and international psychiatrists in the field, or if this was not operationally possible, patients with MH conditions went untreated or were managed with advice provided by distance. We hoped that intervention would improve MSF clinician capacity, therefore increasing access to quality care for patients with MH conditions across all projects and in particular those settings where it had not previously been feasible.
METHODS
Intervention impact was assessed by analysing the total number of countries and projects where support was provided, the number of clinicians trained, and the number of supervision sessions provided. Analysis was supplemented through analysis of 15 structured interviews with stakeholders, including clinicians (8), activity managers (4), section mental health advisors (4) and the TM psychiatrist.
ETHICS
This work met the requirements for exemption from MSF Ethics Review Board review, and was conducted with permission from Clair Mills, former Medical Director, Operational Centre Paris, MSF, and Sebastien Spenser, former Medical Director, Operational Centre Brussels, MSF.
RESULTS
A total of 13 MSF projects across eight countries received TM support in 2020. mhGAP-IG training was provided online to 39 clinicians, followed by 123 supervision sessions. Structured interviews demonstrated delivery of mhGAP-IG training online in MSF projects, with adherence to MSF guidelines. Improved capacity building was reported, with clinicians observed to have greater clinical confidence and being considered more likely to provide MH assessment and care. Impact in terms of increased volume of patient care was difficult to analyse, partly related to restrictions and activity alterations occurring during the COVID-19 pandemic.
CONCLUSION
Ongoing challenges requiring future consideration include ensuring adequate information technology infrastructure (internet connection, access to adequate communication equipment, broader use of secure platforms such as Siilo) and standardised approaches to supervision. Future analyses could consider impact on quality of care, for example by measuring secondary outcomes such as MH activity and default rates. This project continues; we propose it comprises an innovative way to improve access to patient care and to provide clinician learning and development.
CONFLICTS OF INTEREST
None declared.