Evaluation of the Efficiency of Telemedicine in the Management of Cardiovascular Diseases in Primary Healthcare in Sub-Saharan Africa: A Medico-Economic Study in Cameroon.

OBJECTIVE: To assess the efficiency of tele-expertise (tele-ECG) for patients and for health facilities in managing patients with cardiovascular diseases (CVDs) in primary health care in Cameroon. METHOD: This study was a medico-economic study combining two approaches: cost minimization and cost-effectiveness analysis. It was conducted alongside the previous published controlled multicenter study carried out in Cameroon's two health facilities where tele-ECG has been implemented (intervention centres) and two other where telemedicine has been not implemented (control centres). RESULTS: The average total cost for patients was 9 286 F CFA (US$: 16) in the intervention centres compared to 28 357 F CFA (US$: 49) in the control centres (p <0.01). The calculated ICER favouring tele-ECG was 25 459.6 F CFA (US$: 44). DISCUSSION: Telemedicine is efficient for managing patients with CVDs in primary health care in Cameroon. It enables health facilities in remote areas to offer new healthcare services at a lower cost and improve patients' financial access to healthcare.

Evaluation of the Effectiveness of Telemedicine in the Management of Cardiovascular Diseases in Primary Health Care in Cameroon: An Interventional Study.

OBJECTIVE: This study aimed to evaluate the effectiveness of tele-expertise (tele-ECG) in primary health care in Cameroon for the management of patients with cardiovascular diseases or risk factors. METHOD: It is a controlled multicenter study carried out in Cameroon's two health facilities where tele-ECG has been implemented (intervention centers) and two other where telemedicine has been not implemented (control centers). Patients having cardiovascular risk factors or diseases received usual primary health care in the control centers. In contrast, they received usual primary health care and could perform an ECG associated with cardiologists' remote expertise (tele-ECG) in the intervention centers. The primary outcome was to evaluate the rate of patients' access to an ECG test and to cardiologist' expertise. RESULTS AND DISCUSSION: Telemedicine is effective for the management of patients with cardiovascular diseases in primary health care. It could improve healthcare providers' clinical processes, clinical outcomes of patients and their satisfaction.

The RAFT Telemedicine Network: Lessons Learnt and Perspectives from a Decade of Educational and Clinical Services in Low- and Middle-Incomes Countries.

BACKGROUND: The objectives of this paper are to (i) provide an overview of the educational and clinical experiences of the Réseau en Afrique Francophone pour la Télémédecine (RAFT) network, (ii) analyze key challenges and lessons learnt throughout a decade of activity, and (iii) draw a vision and perspectives of its sustainability. METHODS: The study was carried out following three main stages: (i) a literature review, (ii) the analysis of key documents, and (iii) discussions with key collaborators of the RAFT. RESULTS: Réseau en Afrique Francophone pour la Télémédecine has been offering an important quantity of educational, clinical, and public health activities during the last decade. The educational activities include the weekly delivery of video-lectures for continuing and post-graduate medical education, the use of virtual patients for training in clinical decision making, research training activities using ICTs and other e-learning activities. The clinical and public health activities include tele-expertise to support health professionals in the management of difficult clinical cases, the implementation of clinical information systems in African hospitals, the deployment of mHealth projects, etc. Since 2010, the RAFT has been extended to the Altiplano in Bolivia and Nepal (in progress). Lessons Learnt and Perspectives: Important lessons have been learnt from the accumulated experiences throughout these years. These lessons concern: social and organization, human resources, technologies and data security, policy and legislation, and economy and financing. Also, given the increase of the activities and the integration of eHealth and telemedicine in the health system of most of the countries, the RAFT network faces many other challenges and perspectives such as learning throughout life, recognition, and valorization of teaching or learning activities, the impact evaluation of interventions, and the scaling up and transferability out of Africa of RAFT activities. Based on the RAFT experience, effective integration and optimum use of eHealth and telemedicine in low- and middle-income countries (LMICs) health systems should take into account the context (resources, infrastructure, and funding), the needs of key stakeholders, and the results derived from theoretical and practical experience. The relevant items highlighted to illustrate the sustainability of the RAFT network and the analyses performed in this study, should serve as discussion basis for the development of eHealth and telemedicine in LMICs.

Developing clinical skills using a virtual patient simulator in a resource-limited setting.

OBJECTIVE: to measure the effect of training with a virtual patient (VP) simulation system on clinical skills of healthcare professionals in Africa. METHODS: A randomized controlled intervention was carried out at Yaounde Central Hospital (Cameroon). The intervention consisted of two groups training on one of the two clinical vignettes implemented in the VP simulator. Four actors were trained to play standardized patient (SP) roles. The clinical skills (performance score) of participants were assessed on both clinical vignettes using these SPs. RESULTS: Twenty medical students from FMSB were recruited. The difference in overall score was observed between participants who received training from the VP system (higher average) and those who did not receive the training (lower average). This difference is statistically significant, especially when the focus is on participants' scores in the relevant items for proper management of the case. CONCLUSION: This study suggests that the training with a medical consultation VP simulator can develop the operational clinical skills of the user.