How a telehealth company delivered vital care in rural Chile
The Covid-19 pandemic has exposed vast gaps in people's experiences of healthcare depending on where they live.
Digital healthcare services have emerged as a way to reduce these inequalities. Telehealth in particular, its usage massively boosted as a result of the pandemic, can deliver doctor consultations remotely, eliminating the need to travel long distances for a face-to-face appointment.
Recently, telehealth company Tyto Care began delivering primary care to the under-served community of San Bernardo in rural Chile. This city, on the outskirts of the capital Santiago, has a population of around 300,000 people, of which almost 23,000 are adults over 65, and about 18,000 have two or more chronic conditions.
In addition, there are about 65,000 people under the age of 18, 85 per cent of whom are below the poverty line, with childhood obesity, possible diabetes, and a considerable increase in heart problems being potential risks.
Almost 80 per cent of Chile’s landscape is made up of rugged mountains, and most of the country's population lives in or near them. However almost 60 per cent of doctors and over 40 per cent of hospital facilities are concentrated in the central part of the country. This makes it a challenge for people to access even basic healthcare services; the lack of human resources and tools required in a medical environment mean that even a simple checkup requires long, harsh travel, and wait times for basic care can exceed 500 days.
The municipality pf San Bernardo decided to invest in the implementation of Tyto Care. Over the course of three days, clinicians visited 100 families using Tyto Care’s handheld remote examination device. Vitaltec, a healthcare provider who represents and distributes Tyto Care products in Chile, helped deliver the care programme.
The device works with AI-driven software to examine the heart, lungs, throat, skin, ears, and body temperature, with earbuds for enhanced audio. Tyto can be used for diagnosing acute conditions like colds, flu, ear infections, bronchitis, and sore throats, as well as monitoring patients with chronic conditions such as high blood pressure, asthma, COPD, and diabetes.
The camera built into the device can photograph skin conditions, rashes, and bites and forward these images to a specialist. Data is stored on a mobile device for later reference, or can be forwarded instantly to a clinician for consultation.
In a trial programme running for three days this past September, the medical teams travelled door to door, making 230 visits to over 300 patients from 100 families in the remote village of San Bernando, and performed much-needed checkups.
The goal was to visit families who had not received medical attention of any kind for over a year. They identified both simple and more serious conditions, sharing them with specialist consultants when necessary to diagnose or treat specific illnesses. They met children who had never been to a doctor, as well as older patients with serious yet treatable conditions who were not getting timely care.
The majority of the diagnoses were for diabetes and cardiological issues, something that was a predictable outcome in a country fighting an obesity epidemic.
The nurses were able, often without further consultation, to reommend adjustments to existing treatments, medical prescriptions, or exercise regimens.
According to David Batikoff, CEO of Vitaltec, “We have a list of 1,689 patients in this region who are registered for home care, but the system simply isn’t able to send clinicians to visit more than once a year. With Tyto, we will visit 100 per cent of the list once a month, spending only about 30 per cent of the total budget. As there are not enough doctors, and expenses are too high to pay them to visit a poor municipality, we will use trained nurses to bring the patients to the doctors, virtually.”
“It was very touching,” adds Batikoff, “To see how the people reacted. The most common response when we knocked on the door was astonishment. They asked what they had done to deserve a private visit. It was hard for them to grasp that as a citizen of Chile, this was their right.”
One of the nurses on the team saw this delight first-hand: “Patients were nervous at first, but as everything went smoothly, patients loved being treated by specialists. They were so accustomed to having to travel for hours - in the best case - and then at the hospital waiting an additional 3-4 hours. Especially for chronic and disable patients, imagine their happiness not needing to travel far from home… and to receive an even better consultation than they were accustomed to!”
Batikoff predicts that, based on the success of the programme, they will see an expansion to other Chilean villages.
“In our community, there are other groups with the same or worse circumstances, so we are eager to begin there and scale this project with Vitaltec and Tyto. We invite to all municipalities and governors to try out the implementation of these devices and leverage telehealth to keep costs down and give citizens the quick attention they need.”
COVID-19 app for NHS staff launches as restrictions lift
A new app has launched today to support UK hospital staff who have been redeployed to care for COVID-19 patients.
The Acute COVID app has been co-developed by Chelsea and Westminster Hospital NHS Foundation Trust and its charity CW+, along with health tech company Imagineear Health.
It provides information to healthcare staff via a step-by-step guide, aimed at both doctors and nurses. This includes the different stages of COVID-19 so they have guidance around triage at A&E, hospital admission, in-hospital treatments, and advanced care management.
The app also provides training on non-invasive ventilation. In the first wave of the pandemic the numbers of patients needing this type of ventilation led to staff who would not normally administer this to patients having to do so.
Additionally the app signposts staff to where they can access mental and physical wellbeing support, acknowledging the levels of staff burnout, particularly among frontline staff, the pandemic has created.
The launch of the app comes on the same day England lifts its COVID-19 restrictions, labelled "freedom day" by some. However infection rates have soared in recent weeks and the move has been fiercely opposed by scientists and doctors, both in the UK and abroad.
In a letter published in medical journal The Lancet backed by 1,200 international scientists, experts called the unlocking "a threat to the world", as allowing infection rates to rise enables the virus to mutate and potentially become resistant to the vaccination.
At the weekend the newly appointed health secretary Sajid Javid announced he had tested positive for coronavirus, and both Prime Minister Boris Johnson and the chancellor Rishi Sunak are self-isolating.
Meanwhile in the first week of July more than 500,000 alerts were issued by the NHS Covid-19 app telling people they had been exposed to the virus. As a result businesses are considering cutting their opening hours while staff are self-isolating at home. The government has issued guidance saying that fully vaccinated frontline NHS staff in England will be allowed to carry on working even if they've come into contact with someone with COVID-19.