Clinical Research: Development of a sustainable telehealth system for follow-up of CKD in inaccessible rural and poor urban areas in Bolivia

Name: Raul Plata-Cornejo

Hospital / Affiliation: Instituto de Nefrologia

Home Country: Bolivia

Host Country: MARIO NEGRI INSTITUTE, Italia 

Year: 2011

Status of your program: Completed

Title of the project: 

Development of a sustainable telehealth system for follow-up of CKD in inaccessible rural and poor urban areas in Bolivia

Topic: 

Chronic Kidney Disease 

Short description of the project or abstract:

Many studies worldwide demonstrate the effectiveness of awareness campaigns and screening interventions for the detection of kidney disease and its risk factors. However, these actions alone only represent a first step in the process of decreasing the burden of CKD on people and societies in developing countries such as Bolivia. In the absence of efficient, sustainable actions for patient enrollment in long-term, follow-up programs targeted at decreasing risk factors and preventing CKD progression, the value of awareness campaigns and screening actions is limited. If such programs are successfully put in place, ESRD (End-Stage Renal Disease) can be prevented or delayed using relatively cheap strategies, provided that the follow-up rate, the number of patients returning to the point of care for follow-up evaluations, is high.

Due to the paucity of nephrology specialists in Bolivia, it is not conceivable nor sustainable to envision a deployment of specialistic points of care in the territory. In this context, it might be more efficient to set-up such points of care in the periphery where non-specialist physicians and basic laboratory facilities are located, which are then digitally connected to few centers where closely connected nephrology specialists provide their expertise remotely, leveraging on the fast development of telecommunication infrastructures taking place in Bolivia and other developing countries.

This project aimes is to set-up a teleheath-based system allowing a pool of nephrology specialists located at central Headquarters, specifically at the Instituto di Nefrolog?a of La Paz, to provide long-term follow-up nephrological care to populations located in peripheral centers throughout Bolivia in a sustainable way. In peripheral centers, patient recruitment and follow-up visits will be performed in ambulatories (UFR, Unidad Funcional Renal) directly located on the territory by non-specialist physicians, which will act according to the specialists’ indications and perform patient evaluations and data collection on their behalf. Data, collected through an electronic clinical record system, will be available in real-time to specialists at the Headquarters. Planning of visits, ambulatory logistics, management of consumable supplies will be performed through the telehealth system under direction of the Headquarters. The system also will allow physicians in the UFR to establish connection to Headquarters for audio and video calls and supervision during Ultrasound examination. Sustainability is an important aspect in the project. The adopted workflows and technologies will be aimed at allowing a small number of specialists located at the Headquarters to manage a large number of patients at the UFR’s. Patients will have access to the service after payment of a small amount of money, in line or lower to the cost of a standard, non-specialist evaluation (such amount may be covered by insurance should individuals benefit from it). The program is aimed at demonstrating that the increased efficiency in running costs achieved by adopting a telehealth-based approach allows the system to be self-sustainable in the medium and long term, ensures follow-up rates of above 50% and leads to quality of care in line with international nephrological guidelines.

Learning or Research objectives:

• To design and implement a telehealth-based nephrological care system targeted at providing long-term follow-up to CKD patients as well as to subjects with a high risk of developing CKD
• To achieve follow-up rates from an estimated 20% to above 50%
• To design and test a business model for self-sustainability of the telehealth-based system