Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic

Objectives: The COVID-19 pandemic undermined the health service delivery and utilization of essential health care services globally. The current study therefore aimed to explore the health-seeking behaviors and challenges faced by patients for the management of gastrointestinal diseases. Methods: A cross-sectional study was conducted at the outpatient department of Gastroenterology, Liaquat National Hospital, Karachi from March 2020 to July 2020 during the COVID-19 lockdown phase to explore patient experiences. Data was collected using a survey questionnaire. All patients of either gender were included after informed consent. Statistical analysis of the data was conducted using SPSS 21.0. Results: A total of 184 patients were included who visited the hospital to seek medical services during the COVID-19 lockdown phase. The mean age of the population was 42.7 years (±16.13). Of these, n=94 (51.1%) were males All patients had gastrointestinal issues with different comorbid conditions. One forty-seven n=147 (79.9%) presented with active complaints whereas, n=37 (20.1%) patients visited the hospital for their follow-up checkup. Out of 184 patients, n=33 (17.9%) patients reported of having fear of visiting hospital due to COVID-19 outbreak. A statistically significant difference p<0.001 was noted between the history of comorbidities and patient delaying a visit to the healthcare due to the fear of COVID-19. Additionally, 61 (73.5%) patients with co-morbidity faced difficulty in finding public transport (p=0.01). Nevertheless, n=171 (93.0%) patients expressed satisfaction with the services provided by the hospital during the lockdown phase. Conclusion: Patients with gastrointestinal conditions were largely affected by lockdown largely due to fear of contacting COVID-19 disease and inaccessibility to the public transportation. Widely available telemedicine service might overcome these shortcomings and ensure continuity of quality care. doi: https://doi.org/10.12669/pjms.38.3.4799 How to cite this:Kalwar HA, Kamani L. Problems faced by patients and health service utilization experiences of gastrointestinal patients during lockdown due to COVID-19 pandemic. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4799 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Use of and Satisfaction with Telemedicine Services during the Pandemic. Findings from the COVID-19 Snapshot Monitoring in Germany (COSMO)

Our aim was to investigate to what extent physician visits were replaced by telemedicine services because of the COVID-19 pandemic and the satisfaction with such telemedicine services. Cross-sectional data from the “COVID-19 Snapshot Monitoring in Germany” (COSMO, wave 49 from 11 to 12 August 2021 with n = 967). The average age was 44.9 years (SD: 15.6 years, ranging from 18 to 74 years) and 50.8% were female. Indiviuals were asked whether any physician visit was replaced by a telemedicine service (e.g., video consultation) since March 2020 because of the pandemic (yes, once; yes, several times; yes, always; no, not replaced; no, there was no need to see a doctor). Additionally, individuals who gave positive responses (i.e., yes, once; yes, several times; yes, always) were asked how satisfied they were with the corresponding telemedicine services (from 1 = very dissatisfied to 7 = very satisfied). While 55.4% of the respondents reported no need to see a doctor and 31.3% of the respondents did not replace physician visits by telemedicine services, about 13.3% of the respondents did replace physician visits by telemedicine services (4.8%: yes, once; 6.4%: yes, several times; 2.1%: yes, always). Among the individuals who used such services, the average satisfaction was moderately high (4.7, SD: 2.0). Additionally, several correlates of the replacing telemedicine service use were identified (e.g., perceived severity of a COVID-19 infection). In conclusion, about one out of seven individuals replaced physician visits by telemedicine services during the pandemic. For example, knowledge about the correlates of satisfaction with such services might be of importance to increase the quality of such services.

Views and Perceptions on Telemedicine by Consumers in Delhi

Telemedicine, also known as telehealth, has been around for decades, but despite its many perceived benefits, its adoption has remained low. The objective our study was to know how consumers felt about telemedicine service during COVID -19 and to find out factors influencing consumers' perceptions of telemedicine services, a survey was done using a questionnaire. Social media and e-mail were used to inform people about the research due to onset of pandemic. An e online survey was done from the period of April 1st to June 30th, 2021 in India’s capital Delhi and adjoining areas, 122 service users were sampled for the survey. A 10-item scale was used to assess telemedicine satisfaction, revealing that all participants were satisfied with their telemedicine experience(s) in general. The elements of perception were studied using factor analysis. The results of the analysis revealed that an individual's intention to utilize a system or technology may be influenced not only by factors affecting the user's direct encounter with the system or technology but also by factors affecting the service provider. Patients place a high value on these qualities, thus service providers can design their interface, appointment procedure, and consultation process around them.

The Indian healthcare system turns to digital health: eSanjeevaniOPD as a national telemedicine service

Healthcare infrastructure in the emerging economies is largely concentrated in their urban areas, and the burgeoning rural population is usually deprived of quality medical care. Telemedicine systems are expected to bridge this gap. This case study documents telemedicine’s significance and allows students to examine India’s national patient-to-doctor telemedicine service, eSanjeevaniOPD. The portal provides free and contactless consultation by a government doctor using video calls. COVID-19 hastened the adoption of eSanjeevaniOPD in the country, but its post-covid future would largely depend on feature innovation, architecture development, and digital strategies. With a total of three million teleconsultations in one year, eSanjeevaniOPD is one of the world’s largest digital healthcare delivery systems. This case provides insight into Indian health infrastructure, summarizes the journey of eSanjeevaniOPD, and raises questions on the digital transformation of the Indian healthcare delivery system.

Clinical outcomes after telemedicine abortion with and without ultrasound: a multinational cohort study

Objective: To evaluate the association between pre- and postabortion ultrasound and clinical outcomes after telemedicine abortion. Design: Cohort study Setting: Chile, Northern Ireland, Poland, South Korea. Population: 5298 women who performed abortion through the telemedicine service Women on Web (WOW), January 1st 2016 – December 31st 2019. Methods: We performed a retrospective cohort study on the associations between use of ultrasound pre-abortion and clinical outcomes using unconditional multivariate logistic regression. Intervention rates following routine or clinically indicated postabortion ultrasound were analysed using descriptive statistics. Main outcome measures: Self-reported rates of heavy bleeding, clinical visits within 2 days of the abortion, treatment for incomplete abortion, continuing pregnancy, and satisfaction. Results: Women with and without a pre-abortion ultrasound had similar rates of heavy bleeding (10.5% vs10%, AOR 0.98, 95% CI= 0.8-1.19), continuing pregnancy (1% vs 1.3%, AOR 0.68, 95% CI= 0.39-1.19), and satisfaction (96.8% vs 97%, AOR 0.95, 95% CI= 0.67-1.35). Women with a pre-abortion ultrasound were more likely to visit a hospital within two days of the abortion (6.6% vs 4.4%, AOR 1.35, 95% CI= 1.04-1.75) and receive treatment for incomplete abortion (13.7% vs 8.7%, AOR 1.58, 95% CI= 1.32-1.9). Overall rates of surgical evacuation for incomplete abortion were 9.8% after routine postabortion ultrasound and 27.6% for clinically indicated ultrasound. Conclusion: Non-use of pre-abortion ultrasound was not associated with higher rates of adverse clinical outcomes or lower satisfaction. Routine postabortion ultrasound may result in unnecessary clinical interventions. The results come from observational data where a certain selection bias is possible.

IMPLEMENTASI ALGORITMA NAÏVE BAYES CLASSIFIER DAN SUPPORT VECTOR MACHINE PADA KLASIFIKASI SENTIMEN REVIEW LAYANAN TELEMEDICINE HALODOC

Halodoc is a telemedicine-based healthcare application that connects patients with health practitioners such as doctors, pharmacies, and laboratories. There are some comments from halodoc users, both positive and negative comments. This indicates the public's concern for the Halodoc application so it is necessary to analyze the sentiment or comments that appear on the Halodoc application service, especially during the COVID-19 pandemic in order for Halodoc application services to be better. The Naïve Bayes Classifier (NBC) and Support Vector Machine (SVM) algorithms are used to analyze the public sentiment of Halodoc's telemedicine service application users. The negative category sentiment classification result was 12.33%, while the positive category sentiment was 87.67% from 5,687 reviews which means that the positive review sentiment is more than the negative review sentiment. The accuracy performance of the Naive Bayes Classifier Algorithm resulted in an accuracy rate of 87.77% with an AUC value of 57.11% and a G-Mean of 40.08%, while svm algorithm with KERNEL RBF had an accuracy value of 86.1% with an AUC value of 60.149% and a G-Mean value of 49.311%. Based on the accuracy value of the model can be known SVM Kernel RBF model better than NBC on classifying the review of user sentiment of halodoc telemedicine service

Evaluation of patients treated by telemedicine in the COVID-19 pandemic by a private clinic in Sao Paulo, Brazil: A non-randomized clinical trial preliminary study

Introduction: As a result of the coronavirus disease 2019 (COVID-19) pandemic the year 2020 brought major changes on the delivery of health care and face to face physician patient communication was significantly reduced and the practice of remote telehealth care using computer technology is assuming a standard of care particularly with COVID-19 patients with attempts to reduce viral spread. Objective: To describe the clinical practice experience using telemedicine towards COVID-19 and the respective clinical outcomes. Methods: We performed a pilot open-label non-randomized controlled clinical trial. The patients were divided into four groups according severity of symptoms: (1) asymptomatic (2) mild symptoms (3) moderate symptoms and (4) severe symptoms and were followed up for five days counted from the beginning of the symptoms. A drug intervention was performed in group 3 for which the protocol followed as suggested by the International Pulmonology Societys consensus for adults with moderate symptoms: first day (attack phase) hydroxychloroquine sulfate 400 mg 12/12h second to fifth day (maintenance phase) 200 mg (half pill) 12/12h. The medication was associated with azithromycin 500mg once a day for five days. For children with moderate symptoms were used: hydroxychloroquine sulfate 6.5 mg/kg/dose every 12 hours in the first day and 3.25 mg/kg/dose every 12 hours from day 2 to 5. The therapeutic response was telemonitored. Group 4 patients were directly oriented to seek hospital care. During the use of the drugs, the patients were telemonitored daily. Results: One hundred eighty-seven patients were seen with mean age of 37,6 years (about 15,6). The most frequent symptom was cough (57,6%) followed by malaise (60,3%) fever (41,1%) headache (56,0%) muscle pain (51,1%). Of all the patients that sought telemedicine service in our center 23% were asymptomatic despite contact with people with probable diagnostic of COVID-19 29,4% reported mild symptoms 43,9% moderate symptoms and 3,7% severe symptoms. It was possible to observe in patients treated their symptoms of COVID-19 (group 3) with hydroxychloroquine and azithromycin for five days presented statistically better improvement of the symptoms when compared to those that did not follow the protocol (p = 0.039). Three patients were hospitalized and discharged after recovery. Conclusions: Our study showed that patients with COVID-19 who had delivery of health care through telemedicine initiated in early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. Our results indicate that the use of telemedicine with diagnosis and drug treatment protocols is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the general population to infected patients in a pandemic situation.