Date of Award

5-2022

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Dilraj Sokhi

Second Supervisor/Advisor

Jasmit Shah

Department

Internal Medicine (East Africa)

Abstract

Background: Neurological diseases are a leading cause of morbidity and mortality worldwide with a great burden lying in Sub-Saharan Africa. The paucity of neurologists in the region makes neurological care disproportionately inaccessible. Utility of tele-medicine is low cost, time efficient, convenient, reducing the carbon footprint and ultimately increasing health care access.

Objective: We identified whether the concept of tele-neurology was feasible within our setup for patients with stable neurological diseases while establishing the cost effectiveness, efficiency, convenience and the carbon footprint burden.

Methods: We conducted a prospective cross-sectional study. New patients were triaged by the neurologist based on guidelines from the Association of British Neurology to fit the tele-consultation profile or not. Follow-up patients were triaged by the nurse for the same. Recruited participants had a pre tele-neurology questionnaire capturing their demographic data, email address, mobile number, time, travel distance and the cost of coming to clinic on a normal day sent electronically. The patients then underwent a tele-consult with a post tele- neurology survey sent thereafter. A prescription and lab request was emailed to the patient or an AKU outreach clinic near them.

Results: From 219 enrolled patients, 66.7% (146/219) responded [74% (108/146) had both F2F and TNC]: age 40.9 (30.6-55.20 years; 63.0% (92/146) female ;2.7% (4/146) from neighboring countries; follow up period with neurologist (DSS) 6.8 (1.5-29.8) months. The most common presentations were headache [26.0% (38/146)], seizures [26.0% (38/146)] and neurodegenerative [15.1% (22/146) disorders. For TNC >90%;(i) found it as comfortable as F2F (p=0.35) with no violation of their privacy; (ii)saved time [3.0 (2.0-4.0) hours], travel [11.0 (7.2-21.1) km] and cost [$10.5-20]; (iii)were iv satisfied with their neurological concerns addressed; and (iv) would use TNC again. Conversely,15.1% (22/146) disagreed with TNC being as effective as F2F, including the neurologist not addressing their health problems satisfactorily (p=0.03). Our TNC service saved our patients $6,125, 1,143 hours and 25,506 km of travel, equating to 3.5 tons (21 trees) of carbon dioxide emissions.

Conclusion: Our regionally unique study demonstrated that TNC service is an acceptable, efficient, effective and environmentally-friendly care delivery model in our resource poor setting.

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