Implementation of a pediatric telemedicine and medication delivery service in a resource-limited setting: A pilot study for clinical safety and feasibility

Abstract

ABSTRACTObjectiveDetermine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime healthcare access for children in low-resource settings.MethodsWe implemented a TMDS in Haiti called ‘MotoMeds’: (i) A parent/guardian of a child ≤10 years contacted the call center (6pm-5am). (ii) A provider used paper clinical decision support tools to triage the case as mild, moderate, or severe. Severe cases were referred to emergency care. For non-severe cases, call center providers gathered clinical findings to generate an assessment and plan. (iii) For households within the delivery zone, a provider and driver were dispatched with medications/fluids; the provider performed a paired in-person exam. For households outside the delivery zone, the family received phone consult alone. All families received a follow-up call at 10-days. Data were analyzed for clinical safety and feasibility.ResultsA total of 391 cases were enrolled from September 9th, 2019 to January 19th, 2021; 89% (347) received a household visit. Most cases were triaged as mild or moderate (92%; 361). Among the severe cases, 83% (20) sought subsequent referred care. The most common complaint was a respiratory problem (63%; 246). At 10-days, 95% (329) of parents reported their child’s condition as “improved” or “recovered”. Ninety-nine percent (344) rated the TMDS as “good” or “great”. The median phone consultation was 20 minutes, time to arrival at the household was 73 minutes and total workflow per case was 114 minutes.ConclusionThe TMDS was a feasible healthcare delivery model with high rates of improved clinical status at 10-days.Study registration (clinicaltrials.gov)NCT03943654