Feasibility, outcomes, and safety of tele‐hepatology services during the COVID‐19 pandemic

Background & Aims: COVID-19 has hampered health-care delivery globally. We evaluated the feasibility, outcomes, and safety of tele-hepatology in delivering quality-care amidst the pandemic. Approach and Results: A telemedicine setup using smartphones by hepatologists was organized at our tertiary-care centre after pilot testing. Consecutive patients availing tele-hepatology services were recruited between March and July 2020. An adapted-MAST-model (Model for assessment of telemedicine) was used after validity and reliability testing, to evaluate services 7-21 days after index teleconsultation. Of 1419 registrations, 1281 (90.3%) consultations were completed. From 245 randomly surveyed patients, 210 (85.7%) responded [age (years, IQR): 46 (35-56); 32.3% females]. Seventy-percent patients belonged to the middle or lower socio-economic class whereas 61% were from rural areas. Modes of teleconsultation were audio (54.3%) or hybrid video-call (45.7%). Teleconsultation alone was deemed suitable in 88.6% patients. Diagnosis-rate and compliance-rate were 94% and 82.4%, respectively. Patient's convenience-rate, satisfaction-rate, improvement-rate, success-rate and net promoter score were 99.0%, 85.2%, 49.5%, 46.2% and 70, respectively. Physical and mental-quality of life improved in 67.1% and 82.8% patients, respectively post index-teleconsultation. Man-hours and money spent by patients were significantly lower with teleconsultation (p<0.001), however, man-hours spent by hospital per teleconsultation were higher than in physical-outpatient services (p<0.001). Dissatisfied patients were more likely to have lower diagnosis-rate, unsuitability for teleconsultation, noncompliance, poorer understanding, and uncomfortable conversation during teleconsultation. Connectivity-issues (22.9%) were the commonest barrier. Three patients, all of whom were advised emergency care during teleconsultation, succumbed to their illness. Conclusions: Tele-hepatology is a feasible and reasonably effective tool for rendering health-care services using smartphones during the COVID-19 pandemic. Systematic implementation, possible integration into routine healthcare delivery and formal cost-effectiveness of tele-hepatology services need further exploration.