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Continuity of Care in a Seamless Way for NCD Patients

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CONTENT

1

Research Theme & Methodology

2

Target Audience Statistics and Definition

3

4

Unmet Need Identification

Market Demand & Constraints

Solution Corridor

Technical or Regulatory Issues & Insights

5

6

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1

Research Theme

& Methodology

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1.1 Sub-Challenge/ Research Theme

How might we provide seamless access to continuous care at different facilities for NCD patients on the go in the case where access to health facilities and insurance for care is fragmented and not synchronized ?

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1.2 Research Design

The research was designed to assess the need for continuous care for NCD patients on the go in a seamless way taking into consideration the target market, market demand, market constraints, technical or regulatory issues and pitfalls in the medical insurance system.

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1.3 Data Collection & Parameters

An online survey technique was used to explore the target audience’s behavior and their dynamics concerning the research theme. Furthermore, face-to-face interviews were conducted via various online platforms or voice calls.

Element

Description

Respondent type

People on the go

Reasons for choice (e.g user, stakeholder)

They are users of the proposed solutions

Sampling method (e.g. random, referrals)

Random. This is done to have very diverse views on the subject matter

Research method (e.g. interview, observation)

Interviews

Surveys

Type of data (e.g. notes, pics)

Data Collection Survey

Notes

Recorded audio files

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1.4 Data Analysis

Data was collected using both the online survey and interviews. The data sets were cleaned and analyzed in Microsoft Excel. Affinity maps were used to group the ideas and challenges the respondents laid down during the interview. A relationship was then drawn from the online survey and the interview.

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2

Target Audience Statistics & Definition

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2.1 Target Audience Statistics

A total of 33 respondents took part of the research and below is detailed statistics of the respondents

Gender:

Male = 64%

Female = 36%

Age Distribution:

20 - 25 = 21%

26 - 30 = 63%

> 30 = 16%

Sector of Occupation:

Health Sector = 27 %

Non-Health Sector = 73 %

Job Descriptions of the Respondents

Health Sector: Lab Scientist, Medical Doctors, Nurses, Nutritionist, Optometrists, Medical Officer

Non-Health Sector: Engineers, Bankers, Academia, IT Managers, Business Executives, Consultants, Teachers, Students & Administrators

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2.2 Target Audience Statistics CNTD'

Medical Insurance:

Medically Insured = 73 %

Not Insured = 27 %

Type of Medical Insurance

National Health Insurance Scheme = 74%

Private Health Insurance Scheme = 26%

Means of Getting Care

Receiving Care from Single Facility = 73%

Receiving Care from Multiple Facilities = 27%

Frequency of Mobility & Encountering New People;

58% have a normal frequency of mobility whereas the remaining goes to the people with either high and low frequency of mobility. In addition to this 73% of the respondent also meets new people within their community from time to time.

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2.3 Defining the Target Audience

Participants were made to choose on a scale of 1 to 5 on how NCD patients need continuous care in their community and the results are presented in the table below.

Scale

Frequency

Percentage

1

0

0 %

2

3

9 %

3

2

6 %

4

7

21 %

5

21

64 %

From the table, it is evident that most of the respondents, that is 64% strongly believe that people on the go with NCDs need continuous care even though most of the respondents receive care from a single medical care facility.

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2.4 Selected Quotes from the Respondents

“5 , Continuous care is highly needed because it provides constant monitoring for the patients in achieving their desired health goals.” - Clement (Public Health Officer)

“5 . Healthcare is important so access to continuous care could allow everyone to receive the needed care.” - Senam (Nutritionist)

“5, Yes, it allows patient’s information to be easily accessed by other facilities for better continuity of care. Other facilities would be able to decipher what exactly has already been done and what needs to be done to help.” - Afadi (Nurse)

On the Scale of 1 to 5, do you think people need to have access to continuous care? Why do you think so?

“ 5,Yes, Absolutely. They need access to continuous care because when one, person transfers from one provider to another, the new provider has access to the previous data and it’ll be valuable in dealing with the case. The continuous data flow is valuable” - Daniel (Software Engineer)

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3

Unmet Need Identification

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3.1 Unmet Need Identified

1. Overall, the majority of the respondents are currently not having remote access to their medical provider and/or continuous. 97% of respondents would love to have remote access to their medical provider.

2. In addition to this 91% of the respondents also wanted an integrated medical system for the exchange of information between medical providers for the purpose of providing continuous care for NCD patients.

It can be concluded that there is an unmet need of having a remote access to the medical providers as well as the non-existence of a sychronized systems which permits information flow for the purpose of continuous care for NCD patients.

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3.2 Quotes from the Respondents

“From my experience, there was a similar situation and they contacted a relative for the medical information via phones”- Clement (Public Health Officer)

How do you deal with people who have a hospital card or an insurance card that does not work with the system you have? Are there any ways in which you can help them?

“It depends on the facility. Some facilities run a cash-and-carry system whereby without payment, care is not given. Others allow insurance – private or national. Having the NHIS even restricts some levels of access since it does not cover everything. As a practitioner, there is not much you can do. I can only recommend which facility may be able to accommodate the patient in that situation.”- Poku (Medical Doctor)

“Aside from making them pay cash, there is not much to be done for such patients”- Ann (Nurse)

“From experience, usually, when you go to a new system, you are made to register afresh. Sometimes, they may require a transfer of data from your previous provider, but it is not always the case”- Daniel (Software Engineer)

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4

Market Demand & Constraints

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4.1 Market Demand

The market demand for the solution was determined by the willingness of the respondents to pay for services that provide integration and coordination of their medical information for the purpose of receiving care from their medical providers as well as having remote access to their medical providers.

1. 88% of the respondents are willing to pay for such services in order to receive continuous care and also have remote access to their medical provider.

2. Most of the respondents, about 97%, are willing to also refer other people to such services even though 12% of the respondents are not willing to pay for the service.

The above is an indication that there is some sort of demand of a continuity of care in a seamless way in Ghana.

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4.2 Key Behavioral or Market Constraint Identified

Some key behavioral or market constraint were observed from the responses of the interviewees. According to the interviews, some behavioral or market constraint identified for continuity of care in a seamless way are below;

  1. Data and Security Challenges
  2. Commitment from Hospital Administrators
  3. Financial Challenges
  4. Government Policies
  5. Unwillingness of Institution to work together
  6. Logistic Issues
  7. Funding
  8. Network Issues
  9. Trust Barriers
  10. Electricity Supply
  11. Administration requirement for the continuity of care

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4.2 Key Behavioral or Market Constraint Identified CNTD

Further survey was conducted to test whether the current medical system and the medical insurance are synchronized to some extend. The results from the survey are presented below;

An average of 61 % of the respondent confirmed that they do not receive the same level of care from different facilities with their medical insurance as well as their medical insurance does not permit remote access or continuity of care from their current medical provider.

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4.3 Quotes from the Respondents

  1. Financial Barriers
  2. Trust Barriers – The knowledge that Client/patient data and records are safe
  3. Administrative requirements – IT usability and competence
  4. Insecurity. Unstable power supply -

Dennis (Medical Doctor)

What are the main challenges with synchronizing systems? What are 2-3 factors that are likely to make it impossible to synchronize systems and what to do about them.

  1. Technological advancement in data management
  2. Electricity supply
  3. Infrastructure - computers, servers, etc -

Poku (Medical Doctor)

  1. Human factor – the willingness to build. Facilities must be ready to build the system between each other.
  2. Willingness to use: Incentive to use the system so the workers can be able to use it well
  3. Data and Privacy – The protection of the data of the patients and the assurance that the data won’t be accessed by just anyone.- Daniel (Software Engineer)

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5

Solution Corridor

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5.1 Solution Corridor of the Proposed Solution

These are the areas, the interviewees think that the proposed solution will be impacted by the solution. Some of the areas which will be impacted are as follows;

  1. Early Detection
  2. Extension of Health Care Coverage
  3. Improvement in Primary Healthcare
  4. Investment into the future to support clinical research and management
  5. Improvement of Patient care
  6. Conduct research related to NCDs

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5.2 Quotes from the Respondents

What are the main challenges with synchronizing systems? What are 2-3 factors that are likely to make it impossible to synchronize systems and what to do about them.

“Easy flow of information on medical care”

Clement (Public Health Officer)

“The synchronised system will bring about cost-effectiveness, and allow health workers to become more competent, and lead to improvisation of quality healthcare services. This would also help scale up interventions that have been rolled out to cater for NCD cases and reduce morbidity and mortality of NCD cases.”

Senam (Nutritionist)

“ Can improve NCD patient care. It would ensure clarity of NCDs, and be good for optimisation to make healthcare delivery less stressful and cumbersome. Investment into the future to support clinical research and management of NCDs”

Dennis (Medical Doctor)

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6

Technical or Regulatory Issues & Insights

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6.1 Technical or Regulatory Issues

Most of the respondents were not aware of any related technical or regulatory related to the provision of continuity of care in a seamless. So for this, existing related literature was reviewed to have a sense of the technical and regulatory issues related to provision of care.

Author and Year

Technical , Regulatory and Ethical Implications

Kotsopoulou (2015)

  1. Privacy and security limits
  2. Patients autonomy

Botrugno (2018)

  1. Legislation of the medical device
  2. Lack of European set of law for telemedicine
  3. Data protection and security

Parimbelli (2018)

  1. Liability in case of system error
  2. Lack of guidelines for technology development

Kluge (2018)

  1. Ethical and legal codes for health informatic professionals

Kluge (2011)

  1. Interoperability and standardization

Crico (2018)

  1. Lack of uniform set laws across Europe especially for health data management

Ho (2018)

  1. The reliability of some symptoms checkers are questionable

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6.2 Technical or Regulatory Issues for Consideration

The technical, regulatory and ethical issue for consideration are as follows;

• Informed consent

• Licensing

• Clinical privileges and credentials

• Internet prescribing

• Conflicts of interest

• Malpractice insurance

• Protected health information

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6.3 Technical or Regulatory Issues Referenced Articles

  • Kluge EH. Ethical and legal challenges for health telematics in a global world: Telehealth and the technological imperative. Int J Med Inform 2011;80:1–5.

  • Kotsopoulou A, Melis A, Koutsompou VI, Karasarlidou C. E-therapy: The ethics behind the process. Procedia Comp Sci 2015;65:492–499.

  • Kluge EH, Lacroix P, Ruotsalainen P. Ethics certification of health information professionals. Yearb Med Inform 2018;27:37–40.

  • Ho A, Quick O. Leaving patients to their own devices? Smart technology, safety and therapeutic relationships. BMC Med Ethics 2018;19:18.

  • Parimbelli E, Bottalico B, Losiouk E, Tomasi M, Santosuosso A, Lanzola G,Quaglini S, Bellazzi R. Trusting telemedicine: A discussion on risks, safety, legal implications and liability of involved stakeholders. Int J Med Inform 2018;112: 90–98.

  • Botrugno C. Telemedicine in daily practice: Addressing legal challenges while waiting for an EU regulatory framework. Health Policy Technol 2018;7:131–136.

  • Crico C, Renzi C, Graf N, Buyx A, Kondylakis H, Koumakis L, Pravettoni G. mHealth and telemedicine apps: In search of a common regulation. Ecancermedicalscience 2018;12:853.

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6.5 Overall Insights (Conclusions)

  1. People on the go are truly the intended users of the proposed solution.
  2. The major unmet need identified was the non-existent of remote access to their medical providers as well as continuity of care for NCD patients
  3. Some market constraints identified was unsynchronized medical and insurance systems as well as financial challenges, data security issues, logistics issues and many others.
  4. The respondent who works in the health sector are even not aware of any regulatory or technical issues which will impede the success of the solution.