teledermatology bangladesh

8/3/2019 Teledermatology Bangladesh

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Teledermatology:

An Approach to ImproveDermatological Care in Bangladesh

Dr.Pritish Barua,MBBS(CU)

Dip.Dermatology(Australia)

Dip.Genito-Urinary Medicine(London)

SKIN VD PHYSICIAN

Lab One Health Services

Jamal Khan Road, Chittagong.

e-mail: [email protected]


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An Overview: Skin Health in Bangladesh

Bangladesh has made a significant progressby providing PHC since Alma Ata Declaration.

But surprisingly Sk in Health for All failed toget the rightful place in the PHC system ofBangladesh.

Skin care services are still based on thecentury back concept, which have failed toreach the whole population.

Dermatologists often provide primary caredue to unnecessary but unavoidable overreferral by the primary care physicians orpatient themselves. Moreover their skill &know ledge is mostly underutil ized due tolack of financial & technical resources.


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cont: skin health overview

Skin care means costly & time-consumingservices provided by the specialist or trainee

dermatologists at the govt. hospitals orprivate clinics.

covers only around 20% of the population.

Remaining 80% of the population, who arelargely poor, rural and remote, have littleaccess to proper sk in care.

So Skin health in Bangladesh reflects thestatement-3 b i l l ion peop le in 1 27 coun t r i esare dep r i ved o f bas i c care fo r the i r sk ind i seases ."


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Skin Health P icture at the PHC level Few dermatology posts at the Upazila

Health Complexes and private sector

dermatologists are not interested in ruraland remote practice.

Population at this level has to depend partlyon just a few registered doctors or largely,

on other informal heath workers who donot have the proper dermatologyknow ledge & training.

A cocktail prescription of an oral and topical

antihistamine-antibiotic-antifungal-steroidcombination without focusing community &public health aspects of dermatology.

Results in Persistent disease burden &

wastage of resources on ineffective &dangerous treatment.


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Why is This Scenario?

Policy makers often fail to recognize orignore the importance of skin care.

Skin disease is poorly taught because itdoes not possess the high drama.

Poor allocation of teaching & training time.

So when a young doctor is posted atupazila level, he has to face a lot ofproblems regarding the diagnosis andtreatment of dermatological disorders.

Failed to utilize the informal health careworkers, who are the first point of contactfor rural populations, although they haveproven their ability for improving healthstatus in Bangladesh after getting some

training in other fields of PHC


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Importance of Skin Health:-serious impact on peoples quality of life.-causing low productivity at work & school.-discrimination due to disfigurement.-indicate presence of serious diseases.

Teledermatology Bow to Target!To address the problem, there are manyoptions that can be discussed but in this

presentation, I w ould like to giveemphasis on Teledermatology- whichcould be an effective, easy and fastsolution for providing both primary as wellas specialist skin care in Bangladesh.


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Telemedicine & Teledermatology

Telemedicine is an InformationTechnology network of medical andallied expertise linked together forthe purpose of delivering medicalservices at a distance.

Teledermatology is the deliveryof skin care through telemedicinetechnology using tele-communication equipments to

evaluate clinical images &information, as well as to diagnose,prescribe therapy & advice on healtheducation & referral for patients

located at a remote area.


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De rm ato log i st s have re l ied onim ages as d i agno s t ic a i ds fo rcentur ies . The v i sua l na tu re o fde rm a to logy m akes th is

d i s ci p l ine a n o bv ious cand ida tefo r te l em ed i c ine techn iques , andthe feas ib i l i t y & re l i ab i l it y o fTe lederm ato logy i s a l r eady w e l les tab l i shed De rm ato logy i s a spec i a lt y tha tf it s w e l l t o te l em ed i c ine i n te rm sof t rea tm ent , d iagn os i s , adv i ce ,

resea rch and educa t i on .


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Diagnostic accuracy of Teleconsultationcompared w ith

Face-to-Face (FTF) consultation.


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Global Community towardsTeledermatology


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Benefits of TeledermatologyBenefits to patients-Enhanced access to a trained dermatologist-Prompt opinion, more accurate diagnosis & treatment

-Reduction of patients w aiting time & travel expenses

Benefits to local health care workers-Improved & efficient access to dermatology care-Improved management of patients with sk in problems

-New opportunities for CME-Enhanced professional collaboration & research-Access to online atlases and databases-More efficient screening of patients with skin problems-Better follow -up of patients with selected skin problems

Benefits to local health care system-Reduction in health care costs-Reduction in patients and physicians travel costs-Reduction in total number of hospital admissions-Increase efficiency in the use of human resources-Increased & effective support for local health workers

-Compilat ion of online databases


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Vision 2021-Digital Bangladesh

promises to make Bangladesh an influential IT nation.

Changed rapidly w ithin 3 years.

One of the fastest growing sectors.

Mobile Phone Subscribers:

72.963 m ill ion at the end of March 2011.

Internet Users:

10 mill ion in 2010 compared

to 4.8 mill ion in 2008.

Network Coverage:

99% of the people, 90% of the area

E- governance, commerce, bank ing, book,

health, education etc are in action!

t


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cont:

Tariff Reduction:Voice Call, SMS, MMS,Internet Bandw idth, ISD, etc.

Service Development: IP phone, valueadded services, Spectrum monitoringstation, Underground optical Fiber in Dhaka,3G Mobile services in the pipeline, etc.

Guidelines & Policies: InfrastructureSharing, National Frequency Allocation Plan,International long Distance

Telecommunication Services 2010, NationalBroadband 2010, Rural TelecommunicationNetwork Development & Guidelines 2010,Regulatory & Licensing Guidelines, Video-conferencing Guidelines, IP -PABX, Uniband,

2G mobile renewal guidelines, etc.

l d l d h


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Telemedicine in Bangladesh

Fo rm a l approach w as ta k en on l y a f te r 1999 .Government telemedicine projects are

focused mainly on administrative, data &survey purpose under the broad heading

ofe-health, not addressing telemedicine

in terms of direct or indirect doctor-patient interaction.

Commercial projects are based at

private clinics, dealing w ith real t imevideoconferencing, expensive & not

directed towards community care.

Only a few NGOs or organizations w ith social businessconcepts are working in the field oftrue telemedicinefor the under-served, rural, remote & poor population.


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Cont:Telemed BDNGOs working on Telemedicine:- UK Charity -Swinfen Charitable Trust (SCT),

- Center for the Rehabil itation for the Paralysed (CRP)- Telemedicine Reference Center Ltd. (TRCL)- Development Research Network (D.Net)- Grameen Communication- Cl ick Diagnostics- Bangladesh Rural Advancement Committee (BRAC)

- Grameen Phone,- Sustainable Development Network Program (SDNP)- Diabetic association of Bangladesh (DAB) , etc.

Societies: Bangladesh Society for Telemedicine & eHealth (BSTeH)Bangladesh Telemedicine Association (BTA)

No single focused Teledermatology project.Only 2 Bangladeshi dermatologists inThe International Society of TeledermatologyProf. Jahed-Bin-Reza and Dr.Pritish Barua

Teledermatology is still a baby.


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Tools for Teledermatology Practice (TDP)

REAL TIME TEDERMATOLOGY (RTC) :

R TC uses a synch ronous aud io -v ideo t ransm is si on toa l low a l iv e & i n t er act iv e consu lt a t ion b e tw een apa t i en t and a rem ote phy s ic i an .

MAJOR ADVANTAGES:-mim ics face-to-face consultation.

-allows a live interaction.

MAJOR DISADVANTAGES:-not cost effective

-requires higher bandwidth

-requires co-ordination

-time consuming

l


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Cont: TDP Tools

STORE AND FORWARD TELEDERMATOLOGY (SAF) :

I t i s a asynch ronou s too l , w h i ch a l low s pa t i en th i s to ry , ex am f ind ings & d ig i t a l im ages to bet rans fe rred to a de rm ato log i s t w ho eva lua tes thein fo rm at i on & re tu rns h i s im press ions &r e commenda t i on s .

MAJOR ADVANTAGES:

-less expensive

-uses easy equipments

-doesn't require d-p coordination

-saves valuable time.

MAJOR DISADVANTAGES:

-low patient satisfaction.

-unsatisfactory history & images.

C TDP T l


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Cont: TDP Tools

HYBRIDE TELEDERMATOLOY:

combine the advantages of both

RTC & SAF Teledermatology &bring together the efficiency &

the interaction w ith the patient.

WHAT TO CHOOSE ? SAF has been the focus of interest in recent years.

-S im i la r c li n i ca l ou tcom es com pared to conven t i ona lc l i n i c -based consu l ta t ions ,-Easy access to sk in ca re i n ru ra l & rem ote a reas -using a low technology, low -cost approach,

Bes t r esu l t s a re l ike l y to be ob ta ined b y com b in ingthe tw o p r im a ry m oda l it ie s -SAF & R TC . Hyb r i d m ode l sm ay w e l l f o rm the bas is o f Te l ede rm a to logy infu tu re

d f l d h


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TDP: Recommendations for Bangladesh

Our strengths:-Concept, spectrum & benefits of telemedicine.

-Application in dermatology-Different TDP models are in front us-Very good mobile & feasible computer technology-Large informal healthcare workforce.

Our Limitations:-Back dated Health Development policies & plans.-Low computer l iteracy.-Lack of sustainable financing.-Inertia among policy makers & dermatologists.

Points to remember!-Care Type, status of care provider & disease pattern.-Historical, cultural & anthropological background.-Cost-effectiveness & social acceptance.

-Accuracy, reliability, confidentiality & Legality.


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Cont: Recommendations for BD Main focus on primary skincare.

SAF as a basic TDP & RTC for audio communication.

Modification in conventional SAF process:

First Contact= informal, registered PHC provider or thepatient him/herself.

Mid Contact= a registered doctor with basic dermatology

knowledge, beside his/her clerical duties of conventionalSAF tool, also responsible for making an audiocommunication and providing consultation for basic andemergency disorders.

Mobile Phone= effective tool for first & mid-contacts. First & Mid communication= conventional SAF by e-mail

or MMS and RTC by audio-mobile-communication.

Mid & End level communication= web-based system.

Service= Charity/commercial/social business concept?

P i C P id


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PatientPrimary Care Provider

Coordinating DoctorSpecialist Dermatologist


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Images by Mobile Camera


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Patient Information Sheet

NAME:AGE : day= / month= / year=DURATION OF DISEASE:day= / month= / year=

(PRESS T AFTER = MARK i f app l i cab le and DELETE OTHERS i f no t app l icab le)

SEX : Male= / Female=PATIENT HISTORY: Pregnant=Very ill due to present problem=Living: poor= / average= / good=Living in hostel/ jail/ dormitory=Family member has same problem=Family history of Asthma/ Allergy=Followed by Fever= / Present fever=Metal/ Chemical contact associated=Related w ith Food= / Drug=OTHER DISEASES HISTORY:Jaundice= / Hep B= / C= / Thyroid=Asthma= / Diabetes= / Hypertension=

TB= / Contact or Drug Allergy=SKIN AREAS NOW INVOLVED:scalp= / face= / eye= / inside mouth=lips= / nose= / ear= / neck= / hair=chest= / abdomen= / back= / buttock=axilla= / upper arm= / lower arm=elbow= / wrist= / back of hand= palm=finger= / fing.web= / fing.nail= groin=

thigh= / knee= / lower leg=

between toes= / feet nail= / feet top=sole= / genitalia= / all over body=MAIN SYMP TOMS:Itching?:yes= / no= / constant= / occasional=When itching/ skin lesions increase?:

night= / sun,hot = / no relation=Pain/ Burning?:yes= / no= / constant= / occasional=DESCRIPTION OF LESION(S):Red dark scaly= / red dark non scaly=Papular= Nodular=/ Pustular,infected=Blistery,Bullous= / eroded,cracked=

NATURE OF RASH:has increased= / decreased=same= / comes goes= / fluctuates=SEASON RASH WORSENED:summer= / rainy=/ w inter=none=PREVIOUS/ PRESENT TREATMENT:Steroid cream/ pills=Antifungal cream/ pills=

Antibiotic cream/ pills=Antihistamine cream/ pills=Homeo,kobiraji,unani,bonaji,etc=Medication Cant remember=Didnt take any treatment=CURRENT OTHER MEDICATIONS:Antibiotics= / Bloodpressure=/ Steroid=

Diabetes= /Asthma= / Thyroid= / None=

H it i d ?


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How it is done?


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Teledermatology w ill not be the replacement oftraditional face-to-face consultation.

How eve r , c on s tr a in t s on t ime & r e sou r c e s w i ll m akeFTF consu l t a t i on ex pens i ve .

Teledermatology w ill be for the delivery ofequitable dermatology services to under-servedareas & hard to reach populations.

Understanding the present skin health status,despite our economic, cultural and technicall imitations, we have to move forward w ithTeledermatology w hich could be the mosteffective, easiest, and fastest solution forBangladesh.


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teledermatology bangladesh

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