Telemedicine as a healthcare delivery model for crisis response during the COVID-19 pandemic in Nepal.

OBJECTIVES

Evaluation of the role of telemedicine, and factors associated with patient adherence to telemedicine-based recommendations during the COVID-19 pandemic.

STUDY

DESIGN

Retrospective study.

METHODS

Patients who received telemedicine consultations from January 2, 2021 to October 9, 2021 were evaluated. Adherence to advice was assessed at three months by reviewing prescribed lab reports, medications used, and available health facility visit records. Patients' satisfaction and their willingness to take similar services in the future was assessed by using a closed Yes/No question. Logistic regression was used to determine factors associated with adherence to telemedicine advice during the pandemic.

RESULTS

A total of 505 patients were consulted by telemedicine. Nine patients were excluded due to incomplete records. Most of the tele-consultations were done for patients living in eastern Nepal with chronic non-communicable diseases (NCD), such as diabetes mellitus (31.5 %) hypertension (30.4 %) and chronic kidney disease (11.3 %). Overall, 86.1 % patients were managed without need for in-person hospital visit. 98.3 % patients were satisfied with the telemedicine service and were willing to use the service in the future. Adherence to the test advised through telemedicine was significantly associated with availability of telemedicine service within their district (OR 1.79; 95 % CI 1.17-2.73; p = 0.007). Adherence to medicine prescribed was significantly associated with male gender (OR 1.62; 95 % CI 1.02-2.57; p = 0.041) and COVID-19 infection (OR 0.27; 95 % CI 0.15-0.50; p < 0.001). Adherence to advice given (medicine and tests) was independent of age, presence of non-communicable disease or media used for communication.

CONCLUSION

This study highlights the benefits of telemedicine in a LMIC during a pandemic. Patients adhered to the medical guidance provided by tele-medicine. Telemedicine should be integrated into national disaster preparedness strategies to ensure continuity of care during crises like the COVID-19 pandemic, especially in low- and middle-income countries like Nepal.