Understanding How the National Telehealth Network in Peru Has Improved Access to High Quality Specialty Care

In 2017, the Ministry of Health in Peru (MINSA) implemented the National Telehealth Network to extend high-quality specialty care to remote and rural populations in Peru. Since its establishment, the network has been rapidly expanding, with the number of telehealth sites, teleconsultations, and participation in tele-education (telecapacitaciones) increasing each year. However, there had not yet been a study to assess the success of the program.

Thus, In partnership with MINSA, Dartmouth’s Global Health Policy Lab (GHPL)  looked at the National Telehealth  Network’s impact on health care delivery in Peru. Specifically, MINSA asked the GHPL to assess the role of telehealth and tele-education in achieving the following outcomes:  

1. Increasing the ability of medical professionals to provide care.
2. Increasing the ability for patients to access care 
3. Reducing the financial burden for patients 
4. Improving the range of services offered by the National Telehealth Network and the telehealth experience overall for both providers and patients 
5. Increasing the effectiveness of the exchange of information between healthcare establishments and improving patient outcomes 

To conduct its study of the National Telehealth Network, the GHPL utilized the American National Quality Forum’s (NQF) Telehealth Measurement Framework.  The NQF measurement framework includes four broad domains for the measurement of telehealth programs—access to care, financial impact/cost, experience, and effectiveness.

Our team created surveys and interview guides based on the four domains of the NQF measurement framework. We distributed two surveys-one directed at telehealth coordinators and the other directed at telehealth providers-nationally. We also interviewed providers, coordinators, and patients in urban and rural regions to complement our survey results and to gain a deeper understanding of the impact of telehealth on the users and patients involved. Once we obtained the data, we analyzed it by the domains in the NQF measurement framework and also presented overall key findings and recommendations.

KEY FINDINGS 

We present our overall key findings from the study. A more detailed version of Key Findings are located under the Discussion section. 

Patients in rural regions are generally unaware of telehealth services: Many coordinators and providers in rural regions expressed the need to promote and advertise telehealth services to the local population. 

Coordinator presence: Education and position matter: The level of provider engagement is related to the role and the position of the coordinator. The higher the status of the coordinator and their level of education, the higher the provider engagement. 

Direct dynamic between providers during teleconsultations:  Providers at lower-level establishments felt that teleconsultations tended to focus only on how to handle the specific case at hand,  not teaching them how to handle other cases in the future. 

Technology is sufficient for conducting teleconsultations: While lower-level establishments could benefit from more stable wifi and higher quality imaging devices, technology is not a significant barrier to conducting teleconsultations and providing care to patients. 

Similar provider and coordinator perspectives on specialties and schedules: Providers and coordinators overall perceive that the same specialites generate the most teleconsultations: internal medicine, pediatrics, OB-GYN, endocrinology, and gynecology. The only difference is that providers also included general surgery and coordinators included dermatology. Furthermore, both telehealth coordinators and providers wanted schedules for specialist teleconsultations ahead of time.

Confusion about telecapacitaciones: The majority of providers we interviewed in the field struggled to explain what telecapacitaciones were and often confused them with the explanations they received from specialists during teleconsultations.