Determine the clinical safety and feasibility of implementing a telemedicine and medication delivery service (TMDS) to address gaps in nighttime access to healthcare for children in low-resource settings.
We implemented a TMDS called ‘MotoMeds’ in Haiti as a prospective cohort study. A parent/guardian of a sick child ≤10 years contacted the call center (6pm-5am). A nurse provider used decision support tools to triage cases (mild, moderate, severe). Severe cases were referred to emergency care. For non-severe cases, providers gathered clinical findings to generate an assessment and plan. For cases within the delivery zone, a provider and driver were dispatched and the provider performed a paired in-person exam as a reference standard for the call center assessment. Families received a follow-up call at 10 days. Data were analyzed for clinical safety and feasibility.
A total of 391 cases were enrolled from September 9, 2019, to January 19, 2021. Most cases were not severe (92%; 361); household visits were completed for 89% (347) of these cases. Among the 30 severe cases, 67% (20) sought referred care. Respiratory problems were most common (63%; 246). At 10-days, 95% (329) of parents reported their child “improved” or “recovered”. Overall 99% (344) rated the TMDS as “good” or “great”. The median phone consultation time was 20 minutes, time to household arrival was 73 minutes, and total time was 114 minutes/case.
The TMDS was a feasible healthcare delivery model. Although many cases were likely self-limiting, the TMDS was associated with high rates of reported improvement in clinical status at 10 days.

Copyright © 2022. Published by Elsevier Inc.