Assessment of Challenges and Opportunities and Identification of Approaches and Innovations in COVID-19 Pandemic Management by Different States in India: A Qualitative Approach

Objective The primary objective of the study was to compare the challenges in implementing various COVID-19-related public health strategies and activities between the selected high health index and low health index states. The secondary objective was to identify the differently managed mechanisms adopted by the health-care delivery system across the states to maintain their functioning during the COVID-19 pandemic. Setting Eight states were divided into two groups; based on their health index and vulnerability index ranking—Kerala, Maharashtra, Gujarat, and Karnataka in top four (Group 1) and Delhi, Tripura, Rajasthan, and Orissa in bottom four states (Group 2). Results There was lack of private sector involvement in both the groups of the states, more so in Group 2. Although transport-related issues were similar in both groups, lack of provision of vehicles for transport for carrying out various COVID and non-COVID activities seemed to be more prominent in Group 2. More obstacles related to infrastructure were observed in Group 1 states. In terms of innovations, commonalities lay in convergence of multiple departments for monitoring, contact tracing, essential supplies, and transportation. Both groups managed routine health services and fund allocation with nearly equal vigour. Major challenges faced were related to human resource, policy management, transportation, routine health services, data management, and infrastructure. HR-related challenges in top four states included confusion due to frequent change in guidelines, unclear micro-containment, and testing guidelines. Discharge guidelines and SOPs related to home isolation of slum dwellers, inter-departmental cooperation and coordination issues faced in greater proportion in top four states; issues with fund allocation for local needs were faced by the Group 2 states. Innovations implemented to meet hurdles faced during the pandemic could be categorized under heads of ‘human resource’, ‘community actions’, ‘policy management’, ‘inter-departmental coordination’, ‘use of technology and media’, and ‘fund allocations’. There was private–public partnership; use of other human resource for health-care delivery; use of technology for health-care delivery was seen in all states but more so in Group 1 states. Conclusion States with higher health index and lower vulnerability index, i.e., Group 1 states faced fewer challenges than those in Group 2. Innovative measures taken at local level to tackle problems posed by the pandemic were unique to the situations presented to them and helped control the disease as effectively as they could.

Physicians’ Perceptions Toward Use of Telemedicine During COVID-19 Pandemic in Riyadh, Saudi Arabia (Preprint)

BACKGROUND The use of communication technologies to deliver health care remotely is known as telemedicine. The coronavirus disease 2019 (COVID-19) pandemic had a variety of consequences for health-care delivery in 2020. As a result, it was necessary to adapt and deliver high-quality care to patients while limiting possible viral exposure for both patients and health-care workers. During the pandemic, physicians employed video visits, phone visits, and electronic written visits (e-consultations), all of which have the ability to provide a comparable quality of care while removing social barriers. OBJECTIVE The study’s aim is to assess physicians’ perspectives and attitudes concerning the usage of telemedicine in Riyadh hospitals during the COVID-19 pandemic. The main domains of the assessment are physicians’ overall experience with telemedicine use before and during COVID-19, future adaptability to using telemedicine, perceptions about patients’ experience, and the influence of telemedicine on burnout. METHODS Methods: An anonymous 28-question cross-sectional survey was developed using SurveyMonkey and distributed to all physicians from all specialty disciplines across Riyadh city hospitals. RESULTS A total of 362 doctors were included in the study. Among them, 28.7% were consultants, 30.4% were specialists, and 40.9% were residents. Male doctors formed the majority (56.1%). When asked about the frequency of using telemedicine, 41.4% answered “frequently,” 26% responded “occasionally,” and 32.6% said “never.” Thirty one percent of doctors agreed and somewhat agreed that the “quality of care during telemedicine is comparable with face-to-face visits.” About 55% doctors believed that telemedicine consultation is a cost-effective way, compared to face-to-face visits. Most of the doctors were skilled (70%) at telemedicine, and they were also able to solve technology issues during telemedicine visits (54%). Overall, the physicians felt that their patients liked telemedicine: 68% said they felt comfortable using telemedicine and 76% said theyfound that it saved time. As per the burnout question, 4.1% of doctors felt burnout every day, 7.5% felt burnout a few times a week, and 27.3% felt burnout a few times per month. CONCLUSIONS Physicians had a generally favorable attitude toward telemedicine, believing that the quality of health-care delivery using it was comparable to that of in-person care. Future research is needed to investigate how physicians’ attitudes toward telemedicine have changed since the pandemic, as well as how this virtual technology might be used to improve their professional and personal well-being.

The Perioperative Patient Experience During COVID-19

Background Access to elective surgical procedures has been impacted by the COVID-19 pandemic. Methods We sought to understand the patient experience by developing and distributing an anonymous online survey to those who underwent non-emergency surgery at a large academic tertiary medical center between March and October 2020. Results The survey was completed by 184 patients; the majority were white (84%), female (74.6%), and ranged from 18 to 88 years old. Patients were likely unaware of case delay as only 23.6% reported a delay, 82% of which agreed with that decision. Conversely, 44% felt that the delay negatively impacted their quality of life. Overall, 82.7% of patients indicated high satisfaction with their care. African American patients more often indicated a “neutral” vs “satisfactory” hospital experience ( P < .05) and considered postponing their surgery ( P < .01). Interestingly, younger patients (<60) were more likely than older (≥60) patients to note anxiety associated with having surgery during the pandemic ( P < .01), feeling unprepared for discharge ( P < .02), not being allowed visitors ( P < .02), and learning about the spread of COVID-19 from health care providers ( P < .02). Discussion These results suggest that patients are resilient and accepting of changes to health care delivery during the current pandemic; however, certain patient populations may have higher levels of anxiety which could be addressed by their care provider. These findings can help inform and guide ongoing and future health care delivery adaptations in response to care disruptions.