Against the backdrop of the COVID-19 pandemic, healthcare systems have had to urgently restructure their usual working patterns. Many clinics and hospitals have been converted to treat coronavirus patients. At the same time, cases that do not require hospitalization are beginning to be monitored remotely. This contributed to the intensive development of telemedicine practices. Health, safety and environmental scientists Marina Dvoryashina and Elena Tarasenko have analyzed how telemedicine has developed in Russia since the beginning of the epidemic, and how it has become available to the general public.
Forced digital hack
With the increase in cases of coronavirus, distancing practices have appeared in almost all areas of life. First of all, health systems face the need to make effective use of digital opportunities. So, for example, an application appeared almost immediately that tracks the movement of infected people and allows them to report their condition to doctors.
Several Russian hospitals, both public and private, as well as telemedicine platforms, have started offering free remote consultations on COVID-19. The sharply increasing demand for high-quality professional information and recommendations from doctors against the background of lockdowns, self-isolation and the massive transition to telework has increased the need for telemedicine consultations.
Telemedicine is the use of computer and telecommunications technologies to exchange medical information. It is carried out via communication channels (landline, mobile, video conferencing, instant messaging, etc.). Consultations can be conducted in real time, or in a “deferred” mode (for example, by e-mail).
All this, as the scientists note in their review published in IFAC-PapersOnLine, has created a situation where telemedicine can achieve a breakthrough in development. At the expense of this, ensuring the inclusion and diversity of medical services and reducing inequality in their access.
But during the first shocks of the pandemic, that wasn’t the point at all. Health systems have become severely overstretched. True, medical institutions in the Russian regions, according to scientists, have some time to prepare for the influx of patients infected with COVID-19. This was facilitated by the low density, lack of movement and tourist activity of the population – both inside the country and abroad. That is, the virus did not spread through Russian regions as quickly as in many European countries and the United States.
However, Moscow and major Russian cities quickly became the epicenter of the spread of COVID-19. At its inception, the epidemic reduced the number of outpatient visits to patients by 25%, which greatly increased the volume of teleconsultations.
Thousands of Muscovites were treated at home, due to the low level of infection severity. But it was necessary to constantly monitor their condition. Specialists from the Telemedicine Center of the Moscow Health Department did this around the clock under closed conditions, working according to a special algorithm. Currently, such work around the clock is also continuing.
In 2021, Moscow entered the top three in the ranking of innovations in the fight against COVID-19, compiled by the International Analytical Center startup. Only New York and San Francisco are ahead of the Russian capital in the ranking.
As the authors note, similar telemedicine centers have been established in all Russian regions. In addition, the telemedicine center set up at Kommunarka Hospital also provided tele-consultations to districts on COVID-19 treatment. In total, from spring 2020 to spring 2021, 72,000 remote consultations, including complex cases, were carried out at the request of doctors from regional medical institutions.
Currently, telemedicine consultations on the treatment of COVID-19, at the request of the regions of Russia, are carried out in the following federal medical centers: hmm. Sechenov, OSB RDKB FGBAO HE RNIMU im. n. Pirogov, “FGBU” NMITs AGP them. aka. in and . Kulakov “,” FGBU” NMIC FPI “from the Russian Ministry of Health, FGBU” NMCC im. n. Pirogov.
Moscow patients with COVID-19, according to the current protocol, can remotely communicate with doctors several times a day. Usually, patients complain to doctors of frequent symptoms, high fever and general malaise. And sometimes, according to doctors, patients just need support, ”say the scientists. For this purpose, a special psychological service operates within the framework of the Moscow Health Service, which provides doctors with additional psychological training so that they can competently deal with the fears and fears of patients.
Despite their effective use today in healthcare, telemedicine technologies require a lot of questions. What about those patients who do not have computers, tablets, smartphones and can access the Internet in general, or those who do not know how to use the means of telecommunication – in the absence or low digital knowledge?
The authors note that in the case of COVID-19, if the patient does not have a computer or smartphone, clinicians can consult via a regular voice communication by phone. “This is very important for elderly patients who live alone and do not have access to modern means of communication,” comment the scientists.
Since telemedicine can work with different groups of people, telemedicine can be said to expand the frontiers of access to healthcare services. But achieving full inclusion and equal access is not easy. There are a lot of barriers here.
Telemedicine technologies have been prioritized amid the pandemic, like most hospitals redirected, to help COVID-19 patients. At the same time, as the authors note, remote processing and counseling in Russia is still directed to a limited social circle – primarily to those who speak Russian, know how to navigate information online and know how to use platforms such as ZoomAnd the MS . teams or The WhatsApp (Owned by Meta Corporation, a recognized extremist organization in Russia).
Patients with low levels of digital literacy often do not understand how to install these programs on their devices. The question remains whether medical centers should help patients with such problems.
There is a risk of increasing disparities in accessing telehealth during the pandemic between certain ethnic, social, economic and minority groups. The authors list groups with very low or no chances of receiving telemedicine. He. She:
Patients with speech disorders.
Older people and people with disabilities, low levels of digital literacy and lack of Internet access;
People with serious diseases such as oncology;
immigrants from other countries with a low level of education and poor knowledge of the Russian language;
People from sparsely populated and remote areas that have no internet access at all.
These groups may not always be able to afford remote physician appointments, or not at all, but they also have limited access to “traditional” physician services. And in the context of the pandemic and lockdowns, the problem is compounded doubly. Hiking or trips to the doctors either become dangerous due to infection risks, or impossible due to quarantine and other restrictions.
Post Corona virus
Another question related to telemedicine technologies is how to get sick with serious diseases that require urgent diagnosis, treatment, etc. The COVID-19 pandemic has caused a lot of problems for these patients. In fact, many of them have been left out of the sights of the health care system, which has directed all its forces to fight the coronavirus.
In many regions of Russia, people with tumors and various chronic or cardiovascular diseases have difficulties in obtaining medical care. The authors note that the first complaints from patients began arriving in early April 2020. It was then that the closure was imposed in Russia, and many medical organizations began to operate as if in wartime.
For example, in St. Petersburg, the work of all hospitals, which usually operated as planned, was limited for a certain period, and outpatient care was temporarily stopped, both in private and public clinics. This caused a huge public outcry, forcing local authorities to reinstate the possibility of providing medical care to patients with particularly serious illnesses, such as tuberculosis, diabetes and HIV, as well as to those patients whose condition could seriously deteriorate if left without. Medical support.
At the beginning of 2021, the Sodeistvie Russian Society of Oncology conducted an anonymous survey among patients about problems related to the availability of diagnosis and treatment that they faced during the pandemic in 2020. In total, about 800 people from 76 Russian regions participated in the survey.
More than half of the respondents (53.2%) indicated that medical institutions only accept people in need of emergency care, and 9% complained that they were able to get an appointment with a doctor only a month after the appointment. More than 75% were dissatisfied with the way hematology care was delivered in their area. Many have faced various challenges in accessing treatment, from doctor appointments to accessing up-to-date diagnoses and treatments. Thus, the pandemic, the authors argue, has exacerbated already existing health and Internet access problems.
Volunteers to help
Telemedicine was actively developing long before the epidemic. In Russia, a law regulating this field was adopted in 2018. However, the move towards a new form of medical services is still only at the beginning. Distant opportunities help the health care system to be more patient-centered, and at the same time require solving many problems.
As a result of the analysis, scientists formulated recommendations, the implementation of which, in their opinion, could improve the quality of telemedicine in Russia. For example, one of them concerns the creation of a private telemedicine platform that provides patients with one-click access to doctors or medical clinics.
Patients also need professional support and help in mastering modern technologies. Perhaps university and medical college students, as well as volunteers from NGOs, could help people with low levels of digital literacy. All of these measures have the potential to lower barriers to equitable access to telemedicine during a pandemic.