Significance of Telehealth services like Remote SMAs

Synopsis: The COVID-19 pandemic disrupted Normal health Services in India. The telehealth services like Remote Shared Medical Appointments (SMAs) should be used.

Background:

• The March 2020 lockdown reassigned healthcare professionals towards COVID-19 specific duties.
• This deviated the focus from other healthcare domains in India and across the world. 

How Covid-19 disrupted normal Health care services:

• As per a survey of WHO, Essential services like immunization and childcare got disrupted in the majority of the 105 countries surveyed.
• Around 45% of low-income countries witnessed a disruption in 75% of services. While this figure for high-income countries was only 4%. 
• Impacts on India: 
  • Fear of transmission and lockdown resulted in the fall of diagnostic services. In tuberculosis detection cases 50% fall was reported from April-December 2020. Whereas, in antenatal care visits  56% decline was observed during the first half of 2020.  
  • The inequalities got widened when people in rural and remote areas were not able to travel to cities for getting specialized care.
  • However, the use of technology helped to mitigate the impact.

Virtual Consultation India 

1. The E-Sanjeevani platform of the Indian Government provides virtual consultations to patients. It includes patient-to-provider and provider-to-provider consultation.
2. A hub and spoke model used for this platform. It connected smartphone-equipped rural wellness centres to specialist doctors located in cities.
3. Private players and non-governmental organizations also used the technology for reaching out to patients.

However, given the scale of India’s population which is devoid of healthcare, a switch towards remote shared medical appointments is needed.

About Remote Shared Medical Appointments:

• Remote Shared Medical Appointments virtualizes the process of in-person shared medical appointments (SMAs). It is an effective practice in the US for more than 2 decades.
• Thus, It involves the virtual interaction of a doctor with multiple patients having similar issues.
• Advantages:
  • Patients get more time with doctors.
  • This process develops a sense of bonding among patients.
  • This process provides better productivity as patients learn from each other’s questions.  

Utility for India:

1. SMAs have been very effective in the case of diabetes. It is notable that India is home to the largest number of diabetes patients.
2. Aravind hospital in Puducherry has shown the potential of SMAs to combat glaucoma, a disease that causes gradual blindness.
3. Offering this facility through the E-Sanjeevani platform can help the country meet the healthcare gap in rural India.
4. SMAs will encourage people interaction and attract supplementary providers like physiotherapists and optometrists.
5. The current COVID-19 vaccine drive will also be strengthened as providers can offer sessions to burst the myths related to vaccine efficacy.   

Way Forward:

1. The switch to a new technique of healthcare delivery will require adequate training and mentoring of both providers and patients.
2. Collaboration with training platforms like ECHO is desired to encourage the adoption of virtual SMAs. It trains primary healthcare providers in multiple states.
3. India is blessed to have very low data rates where 1.5 GB data/day is easily affordable for many Indians. This automatically gives the country a significant edge towards augmenting telehealthcare.
4. Further, the strengthening of digital health services will also be in line with WHO’s Global strategy on Digital health. It would help in realizing the dream of ‘Health for All”.