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Digital Health and Telemedicine in Morocco: Progress and Challenges

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  • Université Mohammed VI des Sciences et de la Santé
... Several initiatives were also launched, covering various fields such as teleoncology, teleradiology, telecardiology, and teleechography. However, most of them have never been scaled up to a large extent [11]. ...
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The Moroccan healthcare system is facing several challenges in ensuring equitable access to quality services and reducing or at least controlling their rising cost. Telemedicine can address these two needs by optimizing the use of existing human and material resources through telecommunications. Today, the gradual increase in the population’s healthcare needs poses a major challenge to the Moroccan healthcare system, given the shortage of personnel in healthcare facilities and the persistent difficulties in accessing certain regions. In this regard, Morocco has established a regulatory framework defining the rules for the practice of telemedicine. Several initiatives have been launched, particularly in the public sector, aiming to cover 80% of medical deserts in Morocco by 2025.
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The Moroccan healthcare system is grappling with a pronounced lack of resources, particularly in terms of human personnel. Presently, Morocco has 28,892 doctors, which equates to a ratio of around 7.8 doctors per 10,000 inhabitants, whereas the WHO recommends a minimum of 23 doctors per 10,000 inhabitants. More than half of these doctors work along the Casablanca-Rabat axis, underscoring a significant disparity between urban and rural areas. In addition, about 270 rural municipalities find themselves in a state of critical medical isolation, denoting their location more than an hour away from a hospital facility. Among these municipalities, 160 are classified as priority, encompassing roughly two million inhabitants. Hence, the Moroccan healthcare system is confronted with several challenges in ensuring equitable access to quality services and curbing the escalating costs. Telemedicine holds the potential to address these twin needs by optimizing the utilization of existing human and material resources through telecommunications. In fact, telemedicine enables a reimagining of the healthcare landscape, promoting a territorial rebalancing in favor of regions with lower medical density. In this context, Morocco has established a regulatory framework outlining the rules for telemedicine practice. Numerous initiatives have emerged, particularly within the public sector, such as the National Telemedicine Initiative launched in October 2018, with the aim of covering 80% of medical deserts in Morocco by 2025. Nevertheless, despite the concerted efforts, there remain challenges to overcome in order to make strides and achieve the objectives set forth by the Moroccan healthcare system. This literature review aims to examine and analyze the current state of telemedicine in Morocco. It seeks to highlight the challenges, initiatives, regulatory progress, and existing gaps in the landscape of telemedicine in Morocco.
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Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection. Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients. Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting. Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%). Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.
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Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of healthcare services, in particular for the elderly and those with chronic conditions, who are particularly vulnerable to COVID-19 infection. Objective: The aim of this project is to support primary healthcare provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. Methods: The project followed the six steps of the Design Science implementation methodology framework: problem identification and motivation, definition of the objectives aligned with Goal-oriented care, artefact design and development based on Scrum, solution demonstration, evaluation, and communication. Results: The digital platform was developed for the specific objectives of the project and successfully piloted in three primary healthcare centers in the Lisbon Health Region. The health professionals (53) were able to remotely manage their first patients safely and thoroughly with high degrees of satisfaction. The first COVID-19 messages were sent to the patients, addressing infodemic issues. Conclusions: This study presents the rapid design and implementation of a digital platform to support primary healthcare services. Although still in the first steps of implementation, we are seeing promising results with a positive uptake by healthcare providers and patients. There are several limitations including a limited number of participating health care units. Further research is planned to deploy the platform to many more primary healthcare centers and evaluate the impact on patient's health related outcomes. Clinicaltrial:
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Background Tele-rehabilitation (TR) may be an effective alternative or complement to centre-based cardiac rehabilitation (CBCR) with heart failure (HF) patients, helping overcome accessibility problems to CBCR. The aim of this study is to systematically review the literature in order to assess the clinical effectiveness of TR programs in the management of chronic HF patients, compared to standard of care and standard rehabilitation (CBCR). Methods and Results We conducted a systematic review and meta-analysis of randomized controlled trials on the effect and safety of TR programs in HF patients, regarding cardiovascular death, heart failure-related hospitalizations, functional capacity and quality of life. We searched 4 electronic databases up until May 2020, reviewed references of relevant articles and contacted experts. A quantitative synthesis of evidence was performed by means of random-effects meta-analyses. We included 17 primary studies, comprising 2206 patients. Four studies reported the number of hospitalizations (TR: 301; Control: 347). TR showed to be effective in the improvement of HF patients’ functional capacity in the 6 Minute Walk-Test (Mean Difference (MD) 15.86; CI 95% [7.23; 24.49]; I2 = 74%) and in peak oxygen uptake (pVO2) results (MD 1.85; CI 95% [0.16; 3.53]; I ² = 93%). It also improved patients’ quality of life (Minnesota Living with Heart Failure Questionnaire: MD −6.62; CI 95% [−11.40; −1.84]; I ² = 99%). No major adverse events were reported during TR exercise. Conclusion TR showed to be superior than UC without CR on functional capacity improvement in HF patients. There is still scarce evidence of TR impact on hospitalization and cv death reduction. Further research and more standardized protocols are needed to improve evidence on TR effectiveness, safety and cost-effectiveness.
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The unforeseen pandemic of COVID-19 forced all countries worldwide to appreciate digital solutions and their potential contributions in managing such outbreaks. Countries began to share their knowledge and ongoing experiences on how to employ the latest technologies to trace infected cases, warn people on potential danger, increase social and population awareness, and how to provide effective and efficient telehealth services. MENAHIA (The Middle East and North Africa Health Informatics Association), established in 2018, as a new IMIA regional chapter which has started regional work in several areas of collaboration and knowledge sharing, particularly focused on the common basis of MENA countries’ needs towards health informatics solutions regarding COVID-19 crisis management. This article briefly presents health informatics activities and prospects by countries of the Region with a non-exclusive focus on the COVID-19 pandemic. Needless to say, not all the countries have reported using this platform, and some may have reported through other venues.
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Background: Many African healthcare systems are seeking innovative solutions to improve access to specialized care. Accordingly, Sao Tome and Principe (STP) has adopted telemedicine to overcome the shortage of healthcare professionals, since 2011, and to support daily connections with Portuguese specialists, through a teleconsultation platform. This study presents a comprehensive assessment of the telemedicine service development, evolution, and impact in global health in the context of a low and middle-income country (LMIC). Methods: A case study approach was used and combined with the Momentum framework's critical success factors to successfully launch telemedicine services analysis, in order to help understand implementation and scale-up processes, as well as the role of strategic partnership in leveraging healthcare services with technology. Results: From 2011 to 2019, the telemedicine service in STP performed a total of 4,966, real-time teleconsultations, 137,976 exams, and clinical files introduced in the telemedicine platform. At present, fourteen medical specialities are providing remote access to care from Portugal. The most frequent specialties were teleradiology (72%), teleophthalmology (13%), teleotorhinolaryngology (9%), and telepediatric (4%). Moreover, behind this platform local human resources were trained to perform teleconsultations with autonomy. Additionally, the Marquês Valle Flor Institute's leadership has been a successful factor. Conclusion: These results suggest a consistent evolution of the service established through the system's integration into the daily routine and with the Portuguese health service. This sustainable telemedicine service is therefore an excellent example of the contribution that information technologies can make to LMIC, especially in the context of universal healthcare coverage.
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Funding Acknowledgements Type of funding sources: None. Introduction Centre-based cardiac rehabilitation (CR) programs have been forced to close due to the need for physical and social distancing imposed by COVID-19 pandemic. A major problem emerges concerning the potential harmful effects resulting from the suspension of the centre-based CR programs, leading to physical inactivity and unhealthy lifestyle routines. Therefore, the development of alternative delivery models to maintain access to CR programs and to avoid physical inactivity should be organized and tested. Purpose To assess the physical activity (PA) levels in a group of patients with known cardiovascular disease (CVD), after completing 3-months of a home-based multidisciplinary digital CR program, organized as an alternative method to the centre-based CR suspended program. Methods One hundred and sixteen patients with CVD (62.6 ± 8.9 years, 95 males) who were previously attending a face-to-face CR program were included and the following parameters were assessed at baseline and 3 months: self-reported PA and sedentary behaviour, adherence to the online CR program, cardiovascular and non-cardiovascular symptoms, feelings towards the pandemic, dietary habits, risk factor control, safety and adverse events. The intervention consisted in a multidisciplinary digital CR program, including online exercise training sessions, online educational sessions, psychological online group sessions, risk factor control, nutritional and psychological consults and patient regular assessment by cardiologist and nurse. Results Ninety-eight CVD patients successfully completed all the online assessments (15.5% drop-out). It was observed a significant increase from moderate-to-vigorous PA (230 ± 198 mins/week to 393 ± 378 mins/week, p < 0.001) and a decrease of the sedentary time at 3-months (6.47 ± 3.26 hours/day to 5.17 ± 3.18 hours/day, p < 0.001). Seventy percent of the patients met the PA recommendations and 41% reached more than 300 minutes per week of moderate to vigorous PA at 3 months. Almost half of the participants (46.9%) did at least more than one online exercise training session per week and attended at least one of the online educational sessions. There were no major adverse events reported and only one minor non-cardiovascular event occurred. Conclusion Patients with CVD, who suspended centre-based CR due to COVID-19 pandemic and started a home-based multidisciplinary digital CR program, had a significant improvement in moderate to vigorous PA after 3 months. Therefore, home-based CR programs showed to be a good option for selected clinically stable patients, who are eligible for CR and cannot attend a centre-based CR program due to COVID-19 pandemic or eventually other reasons.
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The prevalence of Heart Failure is growing exponentially in the last decades, particularly amongst older adults. Heart Failure is a chronic cardiovascular disease that demands self-care management and substantial healthcare resources. For that reason, it is highly associated with hospital readmissions and mortality. Due to increased hospitalization costs, excessive waiting times and lack of specialized healthcare professionals to follow-up this growing population, telemedicine and telemonitoring technologies have become the best solutions to support health providers in the disease management tasks. Telemonitoring technologies offer better and more comfortable care because the elderly do not have to leave the comfort of their home to interact with the doctors, giving and receiving daily feedbacks trough these new applications, wearables, and health care platforms. This paper provides a comprehensive review covering the current progress of research in telemedicine and telemonitoring and their applications to Heart Failure Management services. It presents SmartBEAT, which demonstrated during a pilot phase, a user adherence of 97% for three months. Furthermore, SmartBEAT plus, an improved solution, is described, and the system usability a technology acceptance will be evaluated through a pilot with 40 Heart Failure Patients, involving nurses and cardiologists.
Preprint
BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of healthcare services, in particular for the elderly and those with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project is to support primary healthcare provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS The project followed the 6 steps of the Design Science implementation methodology framework: problem identification and motivation, definition of the objectives aligned with Goal-oriented care, artefact design and development, solution demonstration, evaluation, and communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in three primary healthcare centers in the Lisbon Health Region. The health professionals were able to safely and thoroughly manage their first patients remotely with high degrees of satisfaction. The first COVID-19 messages were sent to the patients, addressing infodemic issues. CONCLUSIONS Although still in the first steps of implementation, we are seeing promising results with a positive uptake by healthcare providers and patients. Further research is planned to evaluate the impact on patient’s health related outcomes. We are confident that this platform could be scaled-up to all primary healthcare centers in Portugal in the next months, ready to tackle a second wave of COVID-19.
Article
Heart failure is a major health and economic challenge in both developing and developed countries. Despite advances in pharmacological and device therapies for patients with a reduced left ventricular ejection fraction (LVEF) and heart failure, their quality of life and exercise capacity are often persistently impaired, morbidity and mortality remain high and the health economic and societal costs are considerable. For patients with heart failure and preserved LVEF, diuretic management has an essential role for controlling congestion and symptoms, even if no intervention has convincingly shown to reduce morbidity or mortality. Remote monitoring might improve care delivery and clinical outcomes for patients regardless of LVEF. A great variety of innovative remote monitoring technologies and algorithms are being introduced, including patient self‐managed testing, wearable devices, technologies either integrated into established clinically indicated therapeutic devices, such as pacemakers and defibrillators, or as stand‐alone are in development providing the promise of further improvements in service delivery and clinical outcomes. In this article, we will discuss unmet needs in the management of patients with heart failure, how remote monitoring might contribute to future solutions, and provide an overview of current and novel remote monitoring technologies.