Virtual health appointments have become widespread during the Covid pandemic, and combining this approach with shared medical appointments could enable health services to break through growing backlogs and “leapfrog into a reality of health for all”, according to the WHO’s Chief Scientist, Dr Soumya Swaminathan and Kamalini Ramdas, Professor at London Business School.
Given that many essential health services have been side-lined by the pandemic, potentially leading to increases in morbidity and mortality, new ways to accelerate health care provision for routine and essential services are urgently needed.
A WHO pulse survey shows health services have been disrupted in over 80% of countries. Low-income nations are suffering most acutely where 45% of health services have been disrupted; countries in the Eastern Mediterranean, Africa and South East Asia have been the most seriously hit.
During the pandemic, on-line delivery of health care has been widely used to mitigate use of in-person appointments. Structures to support tele-health training for the medical profession have sprung up and, similarly, lessons can also be learnt from the education profession where numerous teachers with no online experience have transitioned to a virtual classroom.
As a result, Dr Swaminathan and Professor Ramdas argue many of the building blocks to enable greater provision of virtual shared medical appointments are now in place. They point out:
“Given the massive disruption to healthcare, there is an urgent need right now to leverage the growing technology in virtual healthcare and combine it with the wealth of experience in running shared in-person medical appointments which has accumulated over the last 20+ years.”
Professor Ramdas added: “In particular, given the current climate of mass testing and vaccine rollout, remote shared interactions with a healthcare worker could greatly help bust incorrect beliefs and allay concerns about vaccination, testing, and what is safe behaviour. These could even be drop-in zoom session where people can ask questions directly, which are efficient to offer and easy to access.
Shared in-person appointments have been run successfully for many essential health services around the world, for example, in the UK through the NHS, as well as in the US, Australia and India. These appointments have related to a wide range of conditions including diabetes, glaucoma, nutrition and antenatal care among others. Professor Ramdas further added:
“This shared approach has enabled improved medical outcomes for millions of patients, such as better blood sugar control and fewer emergency visits for diabetic patients, and fewer pre-term births for antenatal appointments.
“Grouped consultations boost efficiency as doctors need only share advice once to a group of patients with similar conditions, leaving medics more time to delve into complicated areas and address specific individual issues on a personal basis.
“Covid is arguably giving us an opportunity: many patients and doctors have become used to online appointments, so an urgent and valuable next step is to group patients with certain similar conditions so that shared remote appointments can be used to help improve health care for all.
“Remote shared appointments can be very efficient by helping to reduce costs, speed delivery and increase accessibility, particularly for underprivileged and remote populations. The rapid transmission of Covid around the world demonstrates the importance of looking after the health of populations around the globe, and we need to make the most of new and efficient means of delivery wherever possible. Additionally, shared virtual medical appointments also gives users immediate access to a support network, particularly when patients are grouped by local community.”
The WHO’s Global Strategy on Digital Health, released in November 2020 provides a roadmap to help countries expand digital health services rapidly.
While many of the foundations are already in place, Professor Ramdas and Dr Swaminathan acknowledge that some issues such as further IT investment, training, and building an evidence base need to be addressed in order for digital health services to become mainstream around the world.
Nevertheless, Swaminathan and Ramdas assert the importance of gearing up the provision of remote shared healthcare in light of the massive disruption to healthcare around the world arising from the pandemic and the knock-on effects for mortality.
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