The utility of a smartphone electronic referral application in facilitating telemedicine in pulmonology

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BACKGROUND: A streamlined referral system for respiratory diseases is essential, and telemedicine offers a viable solution, particularly within the public healthcare sector. There is a paucity of data on the utility of the Vula medical referral application in pulmonology, a field that lends itself to telemedicine. OBJECTIVES: To perform a 1-year retrospective observational study to assess the Vula medical referral application utility in a tertiary referral centre in Cape Town, South Africa (SA). METHODS: This retrospective study was conducted at a large tertiary-level hospital located in Cape Town, SA. All adult patients referred to the Division of Pulmonology at the institution from January to December 2023 via the Vula virtual referral platform were included. During the study period, all physicians who contacted the pulmonology outpatient department (OPD) or the pulmonologist-on-call were requested to use the Vula virtual referral platform. Emergency referrals (e.g. life-threatening haemoptysis) were discussed in person, but details were still uploaded to Vula. Results were extracted from archived data. RESULTS: During the study period, a total of 2 073 adult patients were referred through Vula. Of these, 1 699 referrals (82%) resulted in a working diagnosis or respiratory syndrome requiring further evaluation, identified by either the referring physician or the pulmonologist. The most common reasons for referral were suspected malignancy (n=767, 45%) and post-tuberculosis lung disease (n=170, 10%). Nearly half (868, 42%) of the referrals required only medical advice on further management, or assistance with medical image interpretation. A further 538 patients (26%) were scheduled for diagnostic or therapeutic procedures without an outpatient review. Only 537 patients (26%) were ultimately given an appointment date for further evaluation in the pulmonology OPD. CONCLUSION: Telemedicine in the form a smartphone electronic referral application significantly improved access to and efficiency of pulmonology services in a resource-constrained environment. Approximately 75% of referrals required either guidance with further medical management, assistance with thoracic imaging interpretation, or diagnostic or therapeutic procedures, significantly reducing the outpatient load.

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