Virtual health and COVID-19: Is this the future of cardiovascular disease care delivery?

by:
Lilian Mbau

With the ongoing COVID-19 pandemic, virtual health is being embraced more than ever (1). This is especially so for cardiovascular disease (CVD) care because patients with underlying conditions such as CVD or associated risk factors have an increased risk of dying from COVID-19 infection (2). In addition, virtual health provides an option for physicians who are older or have underlying conditions and therefore at higher risk of severe illness if infected by Coronavirus to continue providing their much-needed services during this time. Virtual health refers to the use of digital and telecommunication technologies to deliver health care. The application varies from complementing to totally substituting health service delivery depending on the needs of the patients and resources available (3). The scale-up in the use of virtual health presents a lot of opportunities. Still, at the same time, several issues need to be addressed, such as regulatory and ethical considerations.

The use of telemedicine and similar virtual health platforms has been ongoing for decades, but the scale of implementation has been unprecedented with the advent of the COVID-19 pandemic. The pandemic has reduced barriers to virtual health care adoption and accelerated the enactment of regulations to guide its implementation. In the United States, most consultations are currently happening virtually. In China, virtual health was embraced soon after the pandemic began with significant government support, which paid for the online physician consultations. Other countries that have embraced virtual health include Canada and Scotland. In Scotland, it is estimated that the use of videoconferencing has increased by 1000% (1).

Virtual health has also been embraced in Africa, although the pace is slower. For a long time, telemedicine has been explored to solve the shortage of human resources, especially specialists, including cardiologists. However, its use remains limited due to technological and non-technological factors. Non-technological factors include lack of adequate political support, lack of regulatory frameworks, and lack of funding (4). There is a minimal investment from governments, and often these services are paid for out of pocket. This limits their uptake and sustainability. Technology barriers have also hindered the scale-up of virtual health in Africa; however, mobile phones which have a broad penetration are now providing a suitable alternative (1).

An example successful deployment of telemedicine is at the adult congenital heart disease program, Massachusetts General Hospital in Boston. There has been a significant drop in the workload from 400 patients a day to less than 40. Dr. Ami Bhatt, the director of the program reported positive benefits of telecardiology on the physician-patient relationship. Patients are made to feel like they are equal partners in the relationship and that their needs are respected. On the other hand, the health provider is freed from the hustle of running a clinic and focuses more on listening and educating the patient. The result is improved satisfaction which can help address the high burnout and suicide rates experienced by overworked physicians (5).

In Kenya, several private hospitals in Nairobi, the country’s capital city, have initiated online consultation services. Unfortunately, these services are still limited to major towns. The Kenya Healthcare Federation estimates that there are 41 registered e-health providers in Kenya some of whom provide online consultation services. Online consultations platforms such as AskADoc and Daktari Africa are gaining popularity.  Daktari Africa, for example, has been in existence since 2015 and currently has 512 doctors and serves more than 10,000 patients across the country. The platform has experienced increased use since the pandemic began especially by patients with chronic diseases such as diabetes and hypertension. Following a consultation, the patient has the option of getting medication delivered to their home. The platform has however faced challenges expanding to the rural areas due to unstable internet access. Patients using the platform report that they spend less money overall due to reduced consultation fees as well as savings in transportation (6)

As clinicians quickly put mechanisms in place to incorporate telehealth, questions still remain regarding the lack of physical examination and human contact, which has for a long time been regarded as a core component of the patient-physician relationship (6). It is still not clear what implications this will have on the quality of care (1). The American College of Cardiology (ACC) has issued guidance on establishing telecardiology services. One of the critical elements to consider includes the choice of patients eligible for telecardiology services. Patients who are too ill, unstable, or challenging to assess must be directed to face-to-face consults (7). It is also essential to consider critical elements that need to be put in place when setting up telecardiology services. Such services include remote monitoring of implanted devices as well as access to noninvasive monitoring equipment (e.g., blood pressure cuffs, weighing scales, or oxygen saturation monitors). Patients can share their results either before or during the consult, depending on the systems in place. In most cases, prescriptions can be given virtually except for controlled substances. However, if diagnostic tests are required, an in-person visit will be necessary (7).

Questions remain as to the future of virtual health and the role it will continue playing in the delivery of cardiovascular health services after the containment of the pandemic. For countries in Africa, I believe this is the best time to lobby for more investment towards this, the benefits of which will be reaped long after the pandemic has been contained.

References

1.         Webster P. Virtual health care in the era of COVID-19. Lancet [Internet]. 2020;395(10231):1180–1. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30818-7

2.         European Society of cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. 2020;1–115.

3.        Deloitte. Transforming care delivery through virtual health | Deloitte US [Internet]. 2017 [cited 2020 May 25]. Available from: https://www2.deloitte.com/us/en/pages/life-sciences-and-health-care/articles/virtual-health-health-care-providers.html

4.         Wamala D, Augustine K. A meta-analysis of telemedicine success in Africa. J Pathol Inform. 2013;4(1):6.

5.         ACC. Adopting Telemedicine During the COVID-19 Pandemic: A Return to Patient-Focused Care – American College of Cardiology [Internet]. 2020 [cited 2020 May 25]. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/03/01/08/42/feature-adopting-telemedicine-during-the-coronavirus-2019-covid-19-pandemic-a-return-to-patient-focused-care

6.        Ngila F. Just a click away: Apps bring doctors to your home [Internet]. Daily Nation. 2020 [cited 2020 Jun 1]. Available from: https://www.nation.co.ke/dailynation/healthy-nation/just-a-click-away-apps-bring-doctors-to-your-home-302612

7.         ACC. Telehealth: Rapid Implementation For Your Cardiology Clinic [Internet]. 2020 [cited 2020 May 25]. Available from: https://www.acc.org/latest-in-cardiology/articles/2020/03/01/08/42/feature-telehealth-rapid-implementation-for-your-cardiology-clinic-coronavirus-disease-2019-covid-19

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