2020 № 2 Telemedicine and COVID-19: quality of patient-initiated teleconsultations in case of acute respiratory disease
There is a global increase in demand for direct-to-patient telemedicine consultations due to COVID-19 pandemic. We made a quality assessment of the patient-initiated consultations in case of acute respiratory viral infection symptoms (COVID-19). There are 20 teleconsultations of 2 simulated patients in 10 the most popular telehealth services. An incomplete history of the disease was recorded in 50.0% of cases, incomplete allergy anamnesis – in 60.0%, and epidemiology anamnesis – in 35.0%. Information on chronic illnesses (critical for COVID-19 suspected situations) is fully collected only in 50.0% of cases. Due to defects in the history taking the target diagnostic concept was achieved in 30.0% of teleconsultations, target actions were recommended in only 35.0%. Telemedicine services did not provide continuity of medical care. In 60.0% of cases, medications were prescribed, including injectable antibacterial agents, which completely contradicts not only the legislation, but also the accepted international methods and practices of distance counseling. The quality of the direct-to-patient telemedicine services remains unsatisfactory. There is no effective quality control and quality assurance systems.
2020 № 1 The quality of primary direct-to-consumer telemedicine consultations (by results of testing telemedicine services)
The adoption of a number of special regulatory documents has significantly expanded the possibilities of using
telemedicine technologies in the Russian Federation. A significant number of services have appeared on the market, offering
direct-to-consumer and patient initiated telemedicine consultations. The explosive growth in the number of such services requires
a careful study of the telemedicine interaction quality. The research objective is to assess the quality of remote interaction of
participants in primary telemedicine consultations with simulated patients. For testing, we used descriptions of simulated patients
basing on real records of patients from the therapeutic department of the municipal clinical hospital. For objectification and
analysis of the telemedicine interaction process (collection of complaints, questioning, recommendations, etc.) a checklist has been compiled. Initially, the study included such services as “Yandex. Health”, “MMT (OnlineDoctor)”, “TelemedHelp”, “Doctor at work”,
“DoctorSmart”, “DocDoc”; then, for technical reasons, 2 services were excluded from the study. Two simulated patients were sent
to 4 services; as results, 8 primary teleconsultations were made. In all cases, incorrect, incomplete collection of anamnesis data
was recorded. Target diagnosis (in the form of diagnostic concept) was achieved in 25% of cases, and target prescriptions were
made in 50% of cases. A personal consultation and additional examinations were recommended in 75% of teleconsultations.
There was no continuity, drugs were somehow prescribed in 62.5% of cases. As results, an urgent development of methods of
internal and departmental quality control of medical care provided with the use of telemedicine technologies is required.