The project seeks to test the feasibility of using telemedicine for improving access to diabetes care in remote areas of Nepal.
Expected impact
2 health care workers trained in screening for diabetes and in the use of computers and cameras for teleconferences
20 people with diabetes will receive regular diabetes care
20 people with diabetes will receive telemedicine treatment
Results at project completion
7 doctors and 20 paramedics from Hetauda and Manari have been trained.
Tele-consultation was set up in Manari primary health centre in July 2009. Video conferencing is carried out with yahoo messenger and run on Wednesdays and Sundays. 4 patients are seen per week and 20 patients are enrolled for this intervention.
In the neighbouring district, 20 km away, 20 patients have been enrolled to serve as control groups and will thus only receive traditional health care for comparison with intervention group. Collection of baseline labs and end of the project labs on 40 patients has been conducted.
Health education material including training manual, poster, brochure and a video for patients and auxiliary health care workers has been developed in Nepali.
Project details
Most of the population in Nepal live in rural areas where access to health care is sparse. Coupled with increasing diabetes prevalence in both rural and urban areas of Nepal, this means that a lot of people with diabetes do not receive proper care.
In addition, even where rural health care is available, it is often delivered by health care workers, who are not sufficiently trained in diabetes management. The result of uncontrolled diabetes is an increased risk of chronic complications such as renal failure, blindness and limb amputations.
However, a new mode of delivering health care to remote rural areas is telemedicine entailing that health care is delivered through telephone, internet or videoconferencing. The use of telemedicine is becoming more and more frequent especially in the developing world, and in relation to this project, it will now also be tested in the fight against diabetes.
Approach
This project is headed by Shahid Gangalal National Heart Centre in Kathmandu. The centre is the only public institute in Nepal providing quality cardiovascular care. However, since diabetes is often the harbinger of cardiovascular disease, the centre has now expanded its area of interest to include diabetes.
The project will test the feasibility of using telemedicine for delivery of diabetes in care in the rural area of Makawanpur by having a doctor situated in Kathmandu providing consultations via telephone and videoconference. This complements the efforts of the Ministry of Health which is trying to implement telemedicine as a means of health care delivery to hard to reach, remote areas.
Initially, 2 health care workers at the primary health centre in Makawanpur will be trained in screening for, identifying and providing basic treatment of diabetes and hypertension and in using the equipment for telemedicine e.g. computers.
The training will take place at the Shahid Gangalal National Heart Centre in Kathmandu and will last 3 days. During the training the health care workers will also be equipped with education materials for patients regarding diabetes, its complications and means of prevention.
Subsequently, a diabetes camp will be arranged and 40 people with type 2 diabetes attending will be selected to participate in the project. All participants will get basic laboratory tests such as urine micro albumin, HbA1c and lipid profile done and have their height, weight, BMI, waist circumference and blood pressure measured at both baseline, at follow-up visits and at the end of the project. 50% of them who will constitute the intervention group, will in addition be invited to participate in a video session on diabetes and a live video/telephone conference at which they will have the possibility of talking to the doctor in Kathmandu.
The doctor in Kathmandu will not only provide consultations and diabetes education to the patients in the interventions group. The health care workers at the health centre in Makawanpur will also have the opportunity to receive advice and further training from the doctor regarding the management of diabetes.
After one year, it will be possible to compare any changes in the various parameters e.g. HbA1c and blood pressure from baseline for both the group that received telemedicine and the group that did not. The hope is that providing telemedicine in rural areas will improve the management of diabetes and eventually prevent long-term diabetes related complications.
