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Sankalpo GHOSE, BS, Medical Student,1,2 Ryan LITTMAN-QUINN, BA,2 Neo MOHUTSIWA-DIBE, BDS,3 Tsholo 3 3 2,4 MOLEFI, BDS, Motsholathebe PHUTHEGO, BS, DDS, MS(OMFS), Carrie L. KOVARIK, MD,
1
Medical College of Wisconsin, Milwaukee, WI, USA; 2Botswana-UPenn Partnership, Gaborone, Botswana; 3Princess Marina Hospital, Department of Oral Medicine, Gaborone, Botswana; 4 University of Pennsylvania Medical Center, Department of Dermatology, Philadelphia, PA, USA, email: carrie.kovarik@uphs.upenn.edu
BACKGROUND
Telemedicine is becoming a more relevant and realistic means of providing for the delivery of health information and services to resource-poor populations. In Botswana, there is at present only one oral and maxillofacial surgeon in public service. As a result, all complex oral medicine and oral surgery cases in the country - numbering about 300 per year - are referred to his practice in the capital city of Gaborone, in a process limited by cost, time, transportation, and lack of reliable means for follow-up. We present preliminary results of a pilot study evaluating the use of mobile telemedicine for diagnosis and triage of oral medicine and oral surgery in Botswana.
OBJECTIVES
1. To demonstrate that mobile telemedical technology can connect resource-poor areas with remote oral medicine and oral surgery specialists. 2. To demonstrate that mobile telemedical technology is a reliable method for diagnosing, triaging, and treating complex cases in oral medicine and oral surgery.
A total of 69 remote consultations 43 actual, 26 test concerning complex cases from one central and four satellite hospitals were successfully conducted between March and October of 2010, building upon institutional and preparatory work ongoing since September, 2009.
NYANGABGWE REFERRAL HOSPITAL, FRANCISTOWN
Cases: 13 Average response times (hrs) Before protocol: 64.8 After protocol: 9.2
The data we collected is of two sorts: 1. A detailed demographic of the patient population in complex oral medicine and oral surgery cases 2. A record of the telemedical systems use itself, particularly in terms of time taken at each step The organization of this data into a cross-referenceable and updateable model is a further result of this pilot, which has analytic and management functionality. One particular example of our use of this relates to the introduction of a written protocol: The introduction and distribution of an institutional and documented standard was shown to result in drastic and measurable improvement, especially in response time.
IMPLICATIONS
PRINCESS MARINA HOSPITAL, GABORONE
Cases: 8 Average response times (hrs) Before protocol: 171.2 After protocol: 1.2
Mobile telemedical technology can: Connect patients and populations in resource-poor areas with remote specialists Provide a reliable method for diagnosing, triaging, and treating complex cases in oral medicine and oral surgery Approach real-time operation Collect vast amounts of data that are readily filtered and analyzed for use In our experience, this requires: Solid and sustained partners at every level of the healthcare system, from patients, to health workers, practitioners, and specialists, to government ministers and corporate officers. The technology aims to improve, not replace, the existing structure, even if its improvements have the potential to effect large systematic leapfrogs Active monitoring, support, and management of software, hardware, protocols, and practitioners
ACKNOWLEDGEMENTS
Software development, technical support, and program consultation provided by ClickDiagnostics (Boston, USA). SIM card and data plans donated by the Orange Foundation of Botswana. Institutional and grant support provided by the Center for International Health (Milwaukee, USA) and the BotswanaUPenn partnership (Gaborone, Botswana).