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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2013  |  Volume : 24  |  Issue : 4  |  Page : 818-821
Accountable kidney care: Role of telemedicine in a developing country

1 Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, India
2 Department of Hospital Administration, Nizam's Institute of Medical Sciences, Hyderabad, India

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Date of Web Publication24-Jun-2013

How to cite this article:
Taduri G, Billa S, Varaprasad SN, Nimma S, Venkata DK. Accountable kidney care: Role of telemedicine in a developing country. Saudi J Kidney Dis Transpl 2013;24:818-21

How to cite this URL:
Taduri G, Billa S, Varaprasad SN, Nimma S, Venkata DK. Accountable kidney care: Role of telemedicine in a developing country. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2021 May 8];24:818-21. Available from: https://www.sjkdt.org/text.asp?2013/24/4/818/113906
To the Editor,

Early disease detection and disease management can tremendously improve the patient outcomes and decrease the health care expenditure in any country. India is a vast country with large variations in the health care delivery system, which differs from region to region. [1] Primary health centers are available at the villages, but specialty services like renal services are not provided due to of the lack of needed equipment and non-availability of specialists. [1],[2] Patients with kidney diseases are managed by the tertiary care hospitals, which are predominantly located in the urban areas, and these have limited manpower and infrastructure that can be spared to cater the remote village regions. [3] Therefore, in spite of having the needed expertise, they are not adequately involved in health care delivery at a community level. Because of these factors, people with non-communicable diseases at villages, specifically the kidney diseases, are accessing the health care institutions only at an advanced stage, which is known to increase the morbidity and mortality. [4] Therefore, early kidney disease detection becomes mandatory, especially in a developing country like India. [5],[6],[7] This will result in its timely management, which in turn will improve the patient outcomes as well as decrease the health care expenditure.

Telemedicine technology can effectively assist in the specialist time and equipment transportability to remote localities for running disease-specific screening and management programs. [8] With this idea, we conducted a study involving the Nizam's Institute of Medical Sciences, a university hospital catering to the Andhra Pradesh state population, and two technological institutes of the Government of India, namely, the Electronic Corporation of India Limited and the Indian Space Research Organization. Villages located in Prakasham district of the state of Andhra Pradesh were chosen for the study as there were anecdotal reports of the high prevalence of kidney diseases from this region.

The Prakasham district is located 450 km away from the university hospital [Figure 1]. A mobile medical vehicle was used for the conduct of the study [Figure 2]. The university center at Hyderabad was connected to the mobile with vehicle with the help of satellite connectivity. The mobile vehicle was equipped with a semi-autoanalyzer, ultrasound machine, blood pressure machines, anthropometric measurement equipment, digital radiology and electrocardiography [Figure 3]. Equipment provided in the vehicle was connected to the server in the medical van, which was in-turn was connected to the satellite through an antenna. The satellite connectivity provided by the Indian Space Research Organization was used as the majority of the villages did not have any internet connectivity. The mobile medical van was provided with two laboratory technicians, two data entry operators and two drivers. The laboratory technician and the data entry operators were trained to operate the equipment and to establish the connectivity between the mobile van and the university center. The university center had a consultant nephrologist, an administrative coordinator and a data entry operator for the online consultation. The nephrologist along with the administrative coordinator had initially physically visited all the villages and educated the villagers regarding the kidney disease screening. Later, a detailed screening of the kidney disease was conducted in all villages that were chosen for the study. The target population for screening was selected by creating awareness among the local population by print media and involving the local volunteers. The mobile medical vehicle was scheduled in each village for a specific time period at an accessible place, like a school or an administrative building. The laboratory technicians performed history recording, physical examination and required laboratory examinations. The data entry operators then transferred the images and data to the university center with the help of the satellite connectivity. The nephrologist at the university center coordinated the screening programme by online tele-consultations and needed advice. Serum creatinine was tested on a semi-autoanalyzer using the modified Jaffe method. Urine multi sticks (Bayer Multi sticks) were used for testing the albumin, sugar and blood in the urine.
Figure 1: Location of the remote study region (Ongole) and the university hospital (Hyderabad) in the state of Andhra Pradesh, Southern India.

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Figure 2: Mobile medical vehicle with satellite antenna for communication with the university hospital.

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Figure 3: Interiors of the mobile medical vehicle showing the portable ultrasound, ECG machine, autoanalyzer and other communication devices.

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A total of 12 villages were chosen for the kidney disease screening using the telemedicine facility. The total number of patients screened by the mobile vehicle was 1193. There were 616 males and 577 females, with a mean age of 48 ± 16 years. The number of patients with diabetes seen was 18 (1.5%). Albuminuria was detected in 125 (10.4%) patients and abnormal serum creatinine (more than 1.5 mg/dL) was seen in 279 (23.3%) patients.

It is well known that management of end-stage disease requires enormous resources and is associated with high morbidity and mortality. [4],[5] Majority of our village population cannot afford the end-stage management as there is no universal health care policy. [9],[10],[11] The expenditure of providing treatment for the diseases of kidney is constantly increasing and the role of screening and early detection of kidney diseases has been shown to cut down the cost of health care in the long run. [2],[11],[12] Health care delivery reforms proposed suggest that an accountable health care delivery by tertiary care organizations can reduce the cost and provide a value-based health care. [13],[14] The existing primary health care centers located in villages do not have the required trained manpower and equipment for conducting the kidney disease-specific screening programs. [15] Tertiary care organizations located in urban areas, which have the needed expertise in the screening and management of kidney diseases, are not actively involved as accountable care organizations; instead, they provide only advanced care for those who are accessing them. Logistics like the cost involved in mobilizing the manpower and equipment to remote villages are the main obstacles for accountable kidney care by tertiary care organizations.

We have demonstrated in the present study how a tertiary care organization like ours located in an urban area can provide an accountable kidney care to remote villages by conducting the disease-specific screening and treatment to the rural population. The observed kidney disease prevalence was high compared with the other regions of the state. This observation has initiated a major public health intervention to reduce the burden of kidney diseases in the community. The fruitful and unfruitful roles of tele-medicine in kidney disease management were shown by previous studies. [8],[16] By adapting the telemedicine technology, the kidney disease care can be offered for the rural and other remote locations in a country like India where there is a large variation in the health care accessibility and delivery. The tertiary care hospitals can offer kidney disease-specific accountable care by adopting the telemedicine technology.

   Acknowledgments Top

The authors would specially like to acknowledge the Indian Space Research Organization, Electronic Corporation of India, Singareni Collieries Company Limited and Government of Andhra Pradesh for providing the needed technical and logistic assistance.

   References Top

1.Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98.  Back to cited text no. 1
2.Mani MK. Prevention of chronic renal failure at the community level. Kidney Int Suppl 2003;83:S86-9.  Back to cited text no. 2
3.Bajpai V, Saraya A. Healthcare financing: Approaches and trends in India. Natl Med J India 2010;23:231-5.  Back to cited text no. 3
4.Levin A. Consequences of late referral on patient outcomes. Nephrol Dial Transplant 2000; 15 Suppl 3:8-13.  Back to cited text no. 4
5.Black C, Sharma P, Scotland G, et al. Early referral strategies for management of people with markers of renal disease: A systematic review of the evidence of clinical effectiveness, cost-effectiveness and economic analysis. Health Technol Assess 2010;14:1-184.  Back to cited text no. 5
6.Obrador GT, Pereira BJ. Early referral to the nephrologist and timely initiation of renal replacement therapy: A paradigm shift in the management of patients with chronic renal failure. Am J Kidney Dis 1998;31:398-417.  Back to cited text no. 6
7.Wavamunno MD, Harris DC. The need for early nephrology referral. Kidney Int Suppl 2005;94:S128-32.  Back to cited text no. 7
8.Gómez-Martino JR, Suárez MA, Gallego SD, et al. Telemedicine applied to Nephrology. Another form of consultation. Nefrologia 2008;28:407-12.  Back to cited text no. 8
9.Balarajan Y, Selvaraj S, Subramanian SV. Health care and equity in India. Lancet 2011; 377:505-15.  Back to cited text no. 9
10.Kher V. End-stage renal disease in developing countries. Kidney Int 2002;62:350-62.  Back to cited text no. 10
11.Agarwal SK. Chronic kidney disease and its prevention in India. Kidney Int Suppl 2005; 98:S41-5.  Back to cited text no. 11
12.Mani MK. Experience with a program for prevention of chronic renal failure in India. Kidney Int Suppl 2005;94:S75-8.  Back to cited text no. 12
13.Devore S, Champion RW. Driving population health through accountable care organizations. Health Aff (Millwood) 2011;30:41-50.  Back to cited text no. 13
14.Lieberman SM, Bertko JM. Building regulatory and operational flexibility into accountable care organizations and "shared savings." Health Aff (Millwood) 2011;30:23-31.  Back to cited text no. 14
15.Kalita A, Zaidi S, Prasad V, Raman V. Empowering health personnel for decentralized health planning in India: The Public Health Resource Network. Hum Resour Health 2009; 7:57.  Back to cited text no. 15
16.Alamartine E, Thibaudin D, Maillard N, et al. Telemedicine: An unfruitful experience of tele-expertise in nephrology. Presse Med 2010;39: e112-6.  Back to cited text no. 16

Correspondence Address:
Gangadhar Taduri
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad
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DOI: 10.4103/1319-2442.113906

PMID: 23816742

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