Assessing effectiveness of
telemedicine intervention for creating awareness of pain education in
rural areas of Central India
Patel N.P.1, Jain R.2
1Dr Narmada Prasad Patel, Associate Professor of Medicine, LN Medical
College, Bhopal, MP, India, 2Dr Roopesh Jain, Professor of
Anaesthesiology, LN Medical College, Bhopal, MP, India
Address for
correspondence: Dr Narmada Prasad Patel, Email:
narmadapatel2006@rediffmail.com
Abstract
Introduction:
Pain and palliative care is a growing need of the current healthcare
system. This is because of the changing trends of disease related
morbidity and mortality from acute communicable disease to chronic non
communicable diseases. Development and easy availability of
telecommunication mediums may be useful for creating awareness of pain
and palliative care education in rural Indian setting. Material and
Method: We tried to assess effectiveness of telemedicine intervention
for creating awareness of pain education in rural area of Central
India. Total of five villages were connected through high speed
broadband services to a tertiary care centre (LN Medical College
Bhopal). This medical college acted as a nodal centre for the
peripheral rural areas for providing telemedicine intervention.
Results: Telemedicine appears to be an effective and acceptable mode of
creating awareness of pain and palliative care in rural population of
Central India. Conclusion: Telemedicine interventions may be able to
bridge the gap between rural and urban part of Central India and may
prove to be useful in low resource setting.
Keywords:
Pain and Palliative Care, Telemedicine, Pain education, Awareness, Non
communicable diseases
Manuscript received:
4th June 2017, Reviewed:
14th June 2017
Author Corrected:
20th June 2017, Accepted
for Publication: 26th June 2017
Introduction
Pain and Palliative care is a growing need of the current healthcare
system. This is because of the changing trends of disease related
morbidity and mortality from acute communicable disease to chronic non
communicable diseases [1,2,3]. Pain and Palliative care has been
recognized by World Health Organization (WHO) and defined as an
approach which improves the quality of life of the patients and their
families facing life threatening illness through prevention and relief
of suffering by means of early identification and impeccable assessment
and treatment of pain and other problems as physical, psychosocial and
spiritual [4]. Lack of awareness has been found for pain education
across the developing countries like India in rural population except
in South India where majority of population is aware of pain and
palliative care. In Central India there is no such model for awareness
of population for pain education. The need of awareness for pain
education is growing in view of increased incidence of non communicable
diseases accounting for around 62% of total disease burden and nearly
50% mortality in India as in 2004 [5]. The improvement in life
expectancy of Indian population is leading to increase in percentage
geriatric population which subsequently need the services of pain and
palliative care healthcare personals [6,7,8,9]. India is witnessing
increase in healthcare facilities but they are predominantly
mushrooming in metro cities and urban areas. Basic healthcare needs of
rural populations are yet to be fulfilled. The non communicable
diseases like coronary artery disease, hypertension, diabetes ,
cancers, end stage renal disease, heart failure etc have not spared the
rural India and are contributing to the disease burden significantly.
The need of spreading awareness about education of pain and palliative
care is initial step in providing better health care service and end of
life care to the rural population. The National Program for Prevention
and Control of Cancer, Diabetes, Cardiovascular disease and Stroke is
run by government of India also focus on establishing and developing
capacity for pain, palliative and rehabilitation care. There are
several barriers in implementing the pain and palliative care service
to the remote rural areas which need to be identified and accordingly
policies need to be designed for the large population of rural areas.
The common barriers may be very less number of pain and palliative care
specialist, availability of services only at tertiary care centers,
poor connectivity of remote rural population with road, train or air,
illiteracy, poor or no government policy framework, lack of awareness
about pain and palliative care services even among doctors and
paramedical staff in rural areas etc.
Hence we need to do workup about the explored and unexplored barriers
in order to improve the availability and access of pain and palliative
care services to the remote rural population of the country. For this
we need to create connection between doctors at rural area and
specialist pain and palliative care physician which may help to
overcome the barriers of means of transportation and hence patient need
not to come to tertiary care centre of each and every problem. The
widespread availability of advanced telecom technology has made the
connection between doctor in periphery and specialist pain and
palliative care physician very much possible. Taking these things in
consideration we wanted to assess the effectiveness of telemedicine in
contributing towards improving awareness of pain and palliative care
medicine.
We planned our study with the following objectives
1. To identify the use of telemedicine intervention for
creating awareness for pain and palliative care for rural population in
central India.
2. To assess their effectiveness.
3. To identify provider and user acceptability and feasibility
of these interventions to form a suitable guideline and model for
promotion and development of pain and palliative care education in
rural population in central India.
Material
and Method
This study is a cross-sectional, observational survey involving five
villages in central India.
Inclusion criteria:
villages having facility of high speed broadband connections located in
Central India.
Exclusion criteria: inadequate
connectivity or poor facility of high speed internet facility in the
village.
Participants:
They were the people residing in these villages.
Total of five villages included in this project based on availability
of facility of high speed broadband connection. The primary care
physicians available in the village were enrolled and one room is taken
and facility for video conferencing developed for telemedicine. These
villages connected through a tertiary care centre (LN Medical College
Bhopal) which acts as a nodal centre for telemedicine intervention.
Different telemedicine interventions were used for awareness like
videoconferencing, telephonic advice and support services, Small mobile
what’s up group for each village, online educational program
through website etc. Once in a month these villages are supposed to
organize an awareness campaign this centre which is connected to
tertiary care centre and a talk with video film for awareness of pain
is being telecast through webcast.
No statistical tests were employed as it was an observational survey
for feasibility, acceptability and effectiveness of telemedicine.
Results
The project was continued for a period of one year and the results were
seen in terms of feasibility and effectiveness of the telemedicine
intervention. These interventions were found to improve communications
among health care workers and rural population. They were able to
express them in more effective way. The treatment modalities were
explained to them through various means and the acceptability was
improved when things were offered after making them aware about the
details and goals of treatment modalities. Majority of them were able
to understand various methods and goals of treatment including
palliative and rehabilitative care.
The telemedicine interventions were found to improve awareness about
pain and palliative care. People in the villages were found to be very
curious about the new modalities available for diagnostic and treatment
of serious conditions like cancer, cardiovascular, renal conditions.
People showed great enthusiasm in knowing about early identification of
serious conditions and how it help to reduce morbidity and mortality
related to serious conditions. They were also keen to know and
understand various risk factors responsible for development and
progression of chronic not curable conditions like advanced
malignancies, cardiovascular, neurological and renal conditions. They
were clearer in their understanding of objectives of treatment
involving the improvement in quality of life care. The study also
boosted self confidence of caregiver and professionals at rural places
as they felt connected to higher centre and may be able to find help in
case if they need it. The study has shown promising results in terms of
reducing the barriers of means of transportation. The cost implications
are also favorable and this model may be useful in imparting healthcare
services with better outcome.
Discussion
Health care services for all still seem as distant reality in a huge
country like India. The widespread reach of basic healthcare is still a
tough fight for our country. Although we are able to provide
satisfactory awareness and treatment modalities for infectious disease
to even distant areas through wide spread national program but the same
remain untrue when it comes to the other segment of non communicable
diseases [10,11,12]. We in India have very limited resources in terms
of number of healthcare workers including specialist doctors and
paramedical staff. This is very unfortunate but true that majority of
our resources whatever are available to the country are crowded in and
around the urban areas [13,14,15]. This becomes a challenge to impart
services to huge population of 1250 million people. Despite of best
possible efforts to increase number of doctors through opening of new
medical colleges, these efforts still remain inadequate in
consideration to growing complexity of healthcare spectrum and huge
population of country. The challenge of improving healthcare facilities
is huge and complex and hence effort has to be done to overcome the
possible barriers for same. Apart from improving manpower and
infrastructure we need to find out all possible ways to reach to the
goal.
Improving awareness remains a very good and effective tool to help in
solving health related issues. Technology remain one very powerful tool
in current time [16]. With the widespread availability and
acceptability of telecommunication technology, telemedicine appear to
be promising in current scenario. With the better availability of
telecommunication technology at least some barriers may be breached if
not all. The project also gives insight regarding better utilization of
available resources. The specialist doctor sitting at tertiary level
may be able to assist the primary care physician serving in rural
areas. This model also provides better accessibility of specialist
service at multiple peripheral areas. It encourages patients and
caregivers involvement in plan of management of disease symptoms and
removes fear among patients, caregiver and professionals at rural area
and hence improves self confidence of patients, relatives and
professionals at rural areas.
Treatment cost has profound implications in any part of world but
especially so in cases of developing countries with huge population
like India [17,18,19]. This project tries reduces cost, travel time and
psychological burden of travelling.
Last but not the least the project also help to meets the educational
goals in creating awareness of pain and palliative care.
Conclusion
1. Telemedicine appears to be an effective and acceptable mode
of creating awareness of pain and palliative care in rural population
of Central India.
2. Rural population is showing great enthusiasm in
this project.
3. Telemedicine as a tool for creating awareness of
pain and palliative care education is a useful & convenient.
4. This project creates need for development of a
policy for creating awareness of pain and palliative care services in
rural areas of Madhya Pradesh.
Funding:
Nil, Conflict of
interest: None initiated.
Permission from IRB:
Yes
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How to cite this article?
Patel N.P, Jain R. Assessing effectiveness of telemedicine intervention
for creating awareness of pain education in rural areas of Central
India. Int J Med Res Rev 2017;5(07):765-768.doi:10.17511/ijmrr.
2017.i07.16.