key: cord-0888849-cejiix2h
authors: Chandra, Abhilash; Rao, Namrata; Srivastava, Divya
title: Initiating telenephrology in the coronavirus disease (COVID) era: a tertiary care experience in India
date: 2021-01-21
journal: Kidney Res Clin Pract
DOI: 10.23876/j.krcp.20.123
sha: fb21636d9936df1c1b128b7f8550ced9ed3f4d6f
doc_id: 888849
cord_uid: cejiix2h

nan

phone number provided by them. At the time of the slated appointment, a video call is made to the patient. If there is no response, an audio call is subsequently made. After a live two-way conversation, a prescription is forwarded to the patient in a portable document format (pdf). At the time of discussion with the patient, one consultant and one resident are present. Nephrology consultation is currently being offered once a week with the potential to further increase in frequency depending on the response to telemedicine services. In total, 15 to 25 consultations are completed in a single sitting. If needed, appointments for further follow-up are scheduled. Full responsibility for ethical considerations including privacy, informed consent, and confidentiality of the consults is undertaken by the hospital administration. Apart from this, digital consults are also being provided on WhatsApp (WhatsApp LLC) or via e-mail/message directly by the respective consultants.

Although good internet speed is maintained by the hospital (20-30 Mbps), disruptions due to poor signal/ technical issues on the patient's side are occasionally seen. As this is altogether new to the patients, sometimes they have difficulty communicating about accessibility problems along with minor camera focus issues. Also, the

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. emotional connection, which is crucial in explaining the severity of the disease or offering a new therapy like dialysis initiation, is often missing. This arrangement is not meant for sicker patients for whom an in-person visit to the hospital emergency department is the only option. Interdepartmental referrals are not possible in the same sitting and a new appointment for a later date is given. The number of patients seen is limited and dramatically decreased compared to regular OPDs, which leaves a wide gap in unmet need.

Compilation of the data (April to June 2020) revealed that 86% of patients seen through this setup were regular follow-ups (Table 1 ). Of these 69% of patients were chronic kidney disease patients. Most of these were either advised to continue the same treatment or were offered minor changes. The second most frequent were consults offered to patients with primary/secondary glomerulonephritis on active immunosuppression who were not able to visit OPDs because of travel constraints. The age of the patients ranged from 18 to 60 years.

Despite these limitations, telemedicine remains a viable option for patients in remote or rural areas or otherwise not able to attend in-person appointments who may continue to benefit from virtual consultation even in a post-COVID era. Because nephrological evaluation relies primarily on history and lab workup, an electronic setup might be sufficient, though it does not completely replace a thorough examination. Telemedicine is better suited to patients who have already been evaluated locally or are in a regular follow-up in the hospital OPD. It should aim to provide effective services ensuring safe and timely solutions to patients' problems. There should also be a feedback system in place to verify the patient satisfaction [2] . The current scenario demands integration of this relatively new communication system into the existing doctor-patient interactive relationship. Other than being a tool for effective patient management, its utility can be extended to impart knowledge via educational and awareness interventions, which may benefit the community as a whole.

A health telematics policy in support of WHO's health-for-all strategy for global health development. Paper presented at: WHO Group Consultation on Health Telematics

Patient and provider satisfaction with the use of telemedicine: overview and rationale for cautious enthusiasm

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eGFR, estimated glomerular filtration rate by Chronic Kidney Disease-Epidemiology Collaboration

All authors have no conflicts of interest to declare.

Conceptualization: AC, NR Data curation: All authors Investigation: AC, NR Project administration: All authors Writing-original draft: All authors Writing-review & editing: All authors All authors read and approved the final manuscript.

Abhilash Chandra, https://orcid.org/0000-0002-9055-4351 Namrata Rao, https://orcid.org/0000-0002-5733-4218 Divya Srivastava, https://orcid.org/0000-0003-1050-8521