Table 3.
Main themes in the free-text responses.
| Question | No. of answers | Type of comments | Main themes, with the number of recurrences in parentheses |
|---|---|---|---|
| Q5. If you could not follow the advice given, could you explain briefly why not | 16 | Main points | Investigation not available (5) |
| Treatment unavailable (3) | |||
| Inability to perform investigation (2) | |||
| Disagreement on expert diagnosis (2) | |||
| Discharged against medical advice (2) | |||
| Cost not affordable by patient | |||
| Patient lost to follow-up | |||
| Advice not appropriate | |||
| Not applicable | |||
| Q7e. Any other reason that you found the advice helpful | 16 | Main points | Diagnosis clarified or confirmed (2) |
| Differential diagnosis discussed (2) | |||
| Helpful discussion about diagnosis and management (2) | |||
| Triggered decision to transfer patient to specialist (2) | |||
| Confidence in experienced specialist | |||
| Advice “clear, comprehensive” | |||
| Useful information about disease (nature, management, complication signs) for patient and relatives | |||
| Technical advice about how to take an X-ray | |||
| Support in CT scan interpretation | |||
| Other comments | Patient left against medical advice | ||
| Difficulties in implementing treatment advised (e.g., chronic disease) | |||
| Treatment still in progress: too early to assess | |||
| Not applicable | |||
| Q10b. If there was a saving for the patient/family, please explain briefly | 11 | Main points | Avoid unnecessary referral to capital (4) because diagnosis given or chronicity of disease confirmed |
| No further need for the patient to consult local specialists, saving both money and time (3) | |||
| “Best diagnosis” obtained | |||
| Clear information given to family and patient | |||
| Avoid unnecessary harmful treatment or costly hospitalization | |||
| Early referral suggested for congenital cardiac disease (preventing further complications) | |||
| Specialized consultation not affordable by patient | |||
| Q10d. If there was a saving for the hospital/clinic, please explain briefly | 12 | Main points | Avoid unnecessary referral to specialist (3) |
| No need to send investigation for interpretation (3) | |||
| Avoid unnecessary and costly investigation | |||
| Ambulatory management avoiding costly hospitalization | |||
| Strengthened local staff decision to avoid costly referral | |||
| Clear information helped management | |||
| Not applicable (2) | |||
| Q11. Please add any other comments about this case specifically | 18 | About patient outcome | Patient lost to follow-up (making evaluation difficult), patient left, patient died |
| About advice | “Very helpful” both for diagnosis and patient information, “excellent,” “very practical and realistic advice with our set up” | ||
| Helpful for X-ray interpretation | |||
| Useful guidance for specialized treatment | |||
| About case | Critical cases with ICU transfer (2) | ||
| Difficult case, but a feeling to have “offered everything we can” | |||
| Difficult case, but a feeling that “comments improved both patient management and staff knowledge” | |||
| Specialized surgical treatment performed | |||
| To be improved | Problem of implementing expert advice in limited resource settings | ||
| More detailed X-ray interpretation for educational purposes | |||
| X-ray interpretation not appropriate | |||
| Difficult to upload a large file to the server | |||
| Expert to be better informed about limited resource settings to adapt better their advice | |||
| Appropriateness and usefulness of expert advice improved after several emails (from Eurocentric – further investigations and management recommended – to field centered) | |||
| Q12. Please add any other comments about the service generally | 17 | Service | “Excellent” (3) |
| “Very rapid and extremely useful to the field and consequently the patients” | |||
| “Very useful – practical and informative” | |||
| “Appreciated a lot” (2), “appreciated really” | |||
| “Important with benefit for both client and medical personnel” | |||
| “Effective” because quick answer | |||
| “Very good quality and helpful” | |||
| “Is the best” | |||
| “Really quick with the best of ideas” | |||
| “Good quality and very quick” | |||
| “Advice adapted to MSF environment” | |||
| “Good way of communication” | |||
| Other comments | Using email instead of the telemedicine system has delayed the expert advice | ||
| A delay in getting the answer reduces the benefit of expert advice | |||
| Headquarters’ support is appreciated | |||
| “Helpful to have opinions from different specialists on submission of one case” | |||
| “It is great to be able to have expert advice in a very short time. It helps a lot to evaluate better and to make the right decisions for unknown diseases/symptoms. Great, great thanks” |
Note that one answer may include more than one theme.