Feasibility And Evaluation Of Tele-Hepatology Services During Covid-19 Pandemic In India: An Observational Study (Tele-Hep-India Study)

Background: Telemedicine has emerged as an essential tool for health-care delivery amidst the COVID-19 pandemic We evaluated the feasibility and impact of tele-hepatology services in a resource-constrained set-up Methods: Consecutive patients with liver diseases availing tele-hepatology services via smartphone 4G network at a tertiary-care centre were recruited The evaluation was done using an adapted MAST-model (content-validity: 99 3%, reliability: 0 778) in a telephonic-survey design between March and July 2020 The feasibility, impact, and safety of tele-hepatology services were evaluated from a random sample of patients, 7-21 days after the consultation Results: Of 1419 registrations, 1281 consultations (90 3%) were completed with 42 manhours (interquartile range;IQR: 40-44) per tele-OPD Twohundred- ten out of 245 random patients (85 7%) responded during survey [age-in years: 46 (IQR: 35-56) and females: 32 3%] Audio (54 3%) or video-calls (45 7%) were common modes of consultation One-hundred-eighty-six patients (88 6%) were suitable for tele-consultations Diagnosis was achieved in 197 patients (94%) (Table 1) and 173 patients (82 4%) complied with the treatment Patient\u0027s satisfactionrate, improvement-rate, and success-rate were 85 2%, 49 5% and 46 2%;respectively Convenience and confidence in tele-consultation during the prevailing situation were expressed in 208 patients (99 0%) and 176 patients (83 8%);respectively Physical-quality of life (QOL) and mental-QOL was improved in 141 patients (67 1%) and 174 patients (82 8%);respectively Median cost (Indian rupees) and manhour saved per tele-consult were 699 (IQR: 399-2999) and 10 6 (IQR: 6 4-15 1) Dissatisfied patients were likely to have low diagnosis-rate, unsuitability for tele-consultation, noncompliance to treatment, unsuccessful consultation, poor understanding, and uncomfortable conversation during teleconsultation Twenty-two patients were hospitalised and 3 patients died during follow up and none were related to teleconsultation Patient-reported barriers for tele-consultation were connectivity-issues (22 8%), language-barrier (1 4%), unavailability of smart-phone (1 4%) and reimbursement issues (0 4%) Conclusion: Telemedicine is a feasible, acceptable, and reasonably effective tool for rendering healthcare services utilising limited resources during turbulent times of COVID-19 pandemic Systematic implementation and formal cost-effectiveness of telemedicine should further be explored in hepatology services(Table Presented)