A Study to Assess the Effectiveness and Reliability of the Telemedicine Bringing Specialist Healthcare to the Rural India with Optimized Cost-effective Services.

R. P. Pareeka, Rajat Agarwala, Gautam Jaina and Eadara Srikanthb

a. Department of Pharmacy, Birla Institute of Technology & Science, Pilani-333031, Rajasthan. INDIA

b. Public Health Specialist,HyderabadE-mail- pareekrp@gmail.com

INTRODUCTIONIn today’s world, despite several advances made in the Medical field, the benefits are still available to the privileged few residing mainly in the urban areas. With the advent of Communication Technology, especially the Satellite Communications (SatCom) [1] combined with Information Technology; we have means to extend the benefits from the advanced medical sciences, even to the remote and inaccessible areas. It is known that 75% of the qualified doctors practice in urban centers, whereas the vast majority of India’s population (the second largest population in the world) lives in the rural areas. Telemedicine facilitates the provision of medical aid from a distance. It is an effective solution for providing specialty healthcare in the form of improved access and reduced cost to the rural patients and the reduced professional isolation of the rural doctors. Telemedicine assures to provide high quality healthcare to traditionally under privileged population & save the time wasted by both providers and patients in traveling. Thus, reducing costs of medical care.

LT RESULTS

REFERENCES

METHODOLOGY . CONCLUSIONWith the rapid growth of telecommunication technologies and the availability of adequate bandwidth at reasonable cost, telemedicine is bound to spread all over the country and reach the far-flung areas. A need has therefore arisen to put in place a regulated network with proper referral mechanism for tele-consultations from the periphery to higher health-care centers. Subsequently, the total cost is almost reduced by 75% (as seen in the case study presented here) by the use of telemedicine services. Moreover reduced time consumption, quick medical service, and less travel add up to the benefits of using it. These advantages can safely be concluded from above study. The time saved can assist in generating income. Further studies are required to be done on a larger scale to get proper cost-effective Telemedicine facilities in the rural areas of our country.

1. SamplingStudy was conducted in rural areas around Pilani (Rajasthan) by distributing self-designed pre tested questionnaires to assess the access of the respondents to the health care facility and the hurdles and problems faced by them to access the health care. Along with the distribution of questionnaire, some diagnostic tests were conducted on the respondents with the use of telemedicine kit. Based on convenience the size of the samples was decided as 300 samples. The data collection was started in the month of February 2011 and continued till end April 2011.2. Questionnaire designThe main emphasis of the questionnaire was to obtain the information about the access to the health care facility. The access was defined in terms of both physical and economic access. Broadly, the questionnaire consisted of the demographic information, nearby hospital, distance from the nearest health facility, mode of transport used by the respondents to avail the services from the health care facility, approximate cost of travel, waiting time to meet the health staff and the number of times the respondents visited the health care facility per month. 3. Methods & MaterialsA telemedicine kit provided by the Maestros Ltd. Mumbai was used for the study. The kit had the provision for conducting Blood pressure recordings, spirometry, ECG, Pulse oximetry by the kit and Blood sugar level by glucometer. Temperature was measured separately by a thermometer. To maintain the quality, the data was crosschecked for any errors, which if present were rectified.[2]

Fig 2: Frequency of visits to hospital/ month

Fig 4: Aggregate chart of respondents in the income group of less than 5 thousand per month

Fig 3:Amount spent on transport to reach healthcare facility 

Fig 1: Distance to nearest healthcare facility

From Fig.1 it can be inferred that around 88% of the respondents had to travel more than 5km to avail health facility with 45% respondents travelling more than 10km. The nearest hospital for almost all the respondents was Birla Sarvajanik, Pilani or other private hospitals in Pilani Fig.2 depicts that among the respondents 13% of them are visiting the hospital more than 3 times per month. This may be due to any of the chronic conditions they or their family members are suffering Fig.3 represents that around 18% of the respondents are spending more than Rs 150 per visit on transport to the hospital and around 16% spending between Rs 50 to Rs 150 per visit. More than 50% of the respondents spend less than Rs 50 on transportation per visit. Majority of these in the 50% are the people who walk for some distance ranging from 2-5km to catch a community transport. 8.8% of the respondents chose to walk to avail the health care.Fig.4 represents the burden of cost on the respondents in the income group of less than 5 thousand per month in availing healthcare and among the respondents in this group around 45% of them said that they visit hospital for more than 2 times/ month (may be even more than 3). Among those visiting more than 2 times, 60% of them were suffering from some sort of chronic condition. Around 20% of them said that spend more than Rs 150 /-per visit to hospital which accounts to Rs 500 – 600/- per month. More than 60% of them informed that their cost of treatment per month was in between Rs 1000 to Rs 3000/- per month and around 10% spend between Rs 1000 to Rs 3000 per month towards treatment.

[1] Dr. K. Ganapathy, Neurosurgeon, Apollo Hospitals, Chennai, India. Telemedicine in India-the Apollo experience[2] Karp WB, Grigsby RK, McSwiggan-Hardin, M, et al. Use of telemedicine for children with special health care needs. Pediatrics 2000, 105, 843-847[3] www.indg.gov.in

As per the data obtained in a rural setting like Pilani, we aim to apply the bottom-up approach to test the scalability and efficacy of telemedicine technology into the next curve. There are around 6 million villages in India, with an average literacy rate of around 63 % , which increases the possibility of setting up community centers in these villages, as it

was done in Pilani. Our future study is to access the feasibility of having a community center in every village.

The Way Ahead