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ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 169-174

Impact evaluation and cost–Benefit analysis of remote orthopedic consultation methods in a low-resource health-care setting


1 Department of Pediatric Orthopedics, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Prosthodontics and Crown and Bridge, Christian Dental College, CMC, Ludhiana, Punjab, India
3 Health Systems Management Program, Fanshawe College, London, Ontario, Canada
4 Department of Orthopedics, Orthopedics Unit III, Christian Medical College, Vellore, Tamil Nadu, India
5 Department of Orthopedic, Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Deeptiman James
Department of Pediatric Orthopedic, 1106, Paul Brand Building, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cjhr.cjhr_93_20

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Background: Geographic barriers, inadequate infrastructure, and large-scale logistics severely limit telemedicine and e-health systems' ability to make orthopedic care accessible to masses in rural centers. With <1% of the registered hospitals in our country connected through telemedicine, novel alternatives are necessary for effective remote consultation in low-resource health-care settings. Materials and Methods: A retrospective cohort analysis to compare the impact of “e-mail and telephone-” and “WhatsApp-” assisted remote orthopedic consultations (ROCs) on surgical decision-making and outcome of complex orthopedic conditions treated at a remote location hospital in Central India was conducted by assessing the response time, clarity, peer review accessibility, cost-effectiveness and functional outcome parameters (Visual Analog Score [VAS] and Single Assessment Numerical Evaluation [SANE]), complication rates, and duration of hospital stay. Unpaired t-test was used for statistical analysis. Results: Forty-eight patients were included in the study. Remote consultation was carried out through “e-mail and telephone” for 17 patients and through “WhatsApp” for 31 patients. “WhatsApp-” assisted remote consultation enabled quicker response (P < 0.0001), ensured nonambiguity (P < 0.0001), was cost-effective, and facilitated more peer review (P < 0.0001). Mean VAS and SANE scores reflected better outcome in the “WhatsApp-” assisted remote consultation (P < 0.0001), but hospital stay and complication rates were higher in this group. Conclusions: “WhatsApp-” assisted ROC had a higher impact and was cost-effective in management of complex orthopedic conditions in the low-resource setting.


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