#5841 UTILITY AND ACCEPTANCE OF TELENEPHROLOGY AMONG KIDNEY TRANSPLANT RECIPIENTS IN A PUBLIC SECTOR HOSPITAL IN A DEVELOPING COUNTRY
Authors: Subbiah Arunkumar , George Kristin , Yadav Raj Kanwar , Bagchi Soumita , Mahajan Sandeep , Bhowmik Dipankar , Agarwal Sanjay Kumar 
Published: June 2023

Abstract

Background and Aims
The importance of telemedicine in delivering renal health care has come to light during the COVID-19 pandemic. Moreover, specialist care to transplant recipients is often limited to urban areas especially in developing countries. Telenephrology offsets this discrepancy enabling quality care to patients in rural areas. But, apart from availability, the true success and future of telenephrology depends primarily on patients’ acceptance. This study was performed to assess the feasibility, patient attitude and acceptance of telenephrology services among renal transplant recipients at our institute, a public sector hospital in a developing country.

Methods
This single-centre cross-sectional study included renal transplant recipients who availed our telenephrology services for at least 3 months. A total of 100 transplant recipients were selected by stratified random sampling from the list of attendees of telenephrology consultation and included in this study. The study questionnaire was administered in local language by the telephone interview method.

Results
The mean age of our study cohort was 32.83 ± 9.96 years (16 – 55yrs) and 92% were males. The median number of teleconsultations availed by the patients was 5 (1-20). The questionnaire was answered by the patient himself/herself in 89% cases, spouse in 7% and children in 3% cases. Only thirty-nine (39%) patients were graduates or post graduates. Over one-half (51%) of the patients belonged to the lower-middle socioeconomic class as per the modified Kuppuswamy classification. Prior to initiation of the telenephrology service, the median distance travelled to attend our out-patient department (OPD) was 304.5 Km (6 – 1673 km). Most (87%) of our patients used public transport to attend OPD. Three-fourths (79%) of the patients were accompanied by family members for their OPD visit. Attendees incurred productivity loss due to missed work days in 57% of the cases. The median cost of each OPD visit was 3000 (40-15000) INR. Almost all the transplant recipients felt that Telenephrology service was a right approach during the COVID-19 pandemic. 98% of the patients said that they were confident discussing their complaints over phone while 99% of our patients were comfortable sharing reports over phone. Majority (&gt;90%) of the patients gave a satisfaction score of 4 (out of 5) for their telenephrology experience. The most important benefit (79%) of telenephrology as perceived by the transplant recipients was financial benefit of avoiding travel and workdays saved. Regarding the problems faced during teleconsultation, 22% patients responded that they wish to see the doctor in person to feel satisfied; 5% had problems with availability of investigations locally. Only a small fraction (2%) of patients had difficulty in explaining symptoms over a tele-consult. A significant (97%) patients felt that Telenephrology services should continue in combination with physical OPD services.

Conclusion
Telenephrology is feasible and acceptable to kidney transplant recipients irrespective of literacy status across all socio-economic classes. In developing countries like India, telenephrology has immense potential to provide quality nephrology care.