2023-09-28 14:46:10 +00:00
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abstract: 'Non-physician clinicians (NPCs) in low and middle-income countries
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(LMICs) often have little physical proximity to the resources-equipment,
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supplies or skills-needed to deliver effective care, forcing them to
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refer patients to distant sites. Unlike equipment or supplies, which
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require dedicated supply chains, physician/specialist skills needed to
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support NPCs can be sourced and delivered through telecommunication
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technologies. In LMICs however, these skills are scarce and sparsely
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distributed, making it difficult to implement commonly used real-time
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(synchronous), hub-and-spoke telemedicine paradigms. An asynchronous
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teleconsultations service was implemented in Turkana County, Kenya,
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connecting NPCs with a volunteer network of remote physicians and
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specialists. In 2017-18, the service supported over 100
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teleconsultations and referrals across 20 primary healthcare clinics and
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two hospitals. This qualitative study aimed to explore the impact of the
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telemedicine intervention on health system stakeholders, and perceived
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health-related benefits to patients. Data were collected using
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Appreciative Inquiry, a strengths-based, positive approach to assessing
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interventions and informing systems change. We highlight the impact of
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provider-to-provider asynchronous teleconsultations on multiple
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stakeholders and healthcare processes. Provider benefits include
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improved communication and team work, increased confidence and capacity
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to deliver services in remote sites, and professional satisfaction for
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both NPCs and remote physicians. Health system benefits include
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efficiency improvements through improved care coordination and avoiding
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unnecessary referrals, and increased equity and access to
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physician/specialist care by reducing geographical, financial and social
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barriers. Providers and health system managers recognised several
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non-health benefits to patients including increased trust and care
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seeking from NPCs, and social benefits of avoiding unnecessary referrals
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(reduced social disruption, displacement and costs). The findings reveal
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the wider impact that modern teleconsultation services enabled by mobile
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technologies and algorithms can have on LMIC communities and health
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systems. The study highlights the importance of viewing
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provider-to-provider teleconsultations as complex health service
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delivery interventions with multiple pathways and processes that can
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ultimately improve health outcomes.'
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affiliation: 'Kumar, P (Corresponding Author), Hlth E Net Ltd, Nairobi, Kenya.
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Kumar, P (Corresponding Author), Strathmore Univ, Sch Business, Inst Healthcare
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Management, Nairobi, Kenya.
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Fry, M. Whitney; Saidi, Salima; Kithyoma, Vanessa; Kumar, Pratap, Hlth E Net Ltd,
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Nairobi, Kenya.
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Musa, Abdirahman, Minist Hlth Serv \& Sanitat, Nairobi, Turkana County, Kenya.
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Kumar, Pratap, Strathmore Univ, Sch Business, Inst Healthcare Management, Nairobi,
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Kenya.
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Fry, M. Whitney, Iris Grp, Nairobi, Kenya.
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Kithyoma, Vanessa, MHlth Kenya Ltd, Nairobi, Kenya.'
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article-number: e0238806
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author: Fry, M. Whitney and Saidi, Salima and Musa, Abdirahman and Kithyoma, Vanessa
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and Kumar, Pratap
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author-email: pkumar@strathmore.edu
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author_list:
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- family: Fry
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given: M. Whitney
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- family: Saidi
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given: Salima
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- family: Musa
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given: Abdirahman
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- family: Kithyoma
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given: Vanessa
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- family: Kumar
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given: Pratap
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da: '2023-09-28'
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doi: 10.1371/journal.pone.0238806
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files: []
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issn: 1932-6203
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journal: PLOS ONE
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keywords-plus: 'MIDDLE-INCOME COUNTRIES; MOBILE-HEALTH; CARE; CLINICIAN; MORTALITY;
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SERVICES; PROGRAM; PEOPLE'
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language: English
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month: SEP 15
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number: '9'
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number-of-cited-references: '45'
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orcid-numbers: 'Kumar, Pratap/0000-0002-9807-3579
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Fry, Whitney/0000-0001-5442-7964'
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papis_id: b375752708eb31c43494696b004bbba6
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ref: Fry2020eventhough
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times-cited: '6'
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title: '``Even though I am alone, I feel that we are many″ - An appreciative inquiry
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study of asynchronous, provider-to-provider teleconsultations in Turkana, Kenya'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000573375500018
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usage-count-last-180-days: '1'
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usage-count-since-2013: '2'
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volume: '15'
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web-of-science-categories: Multidisciplinary Sciences
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year: '2020'
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