Impact of Telemedicine on Hospitalisation and Mortality Rates in Community-Based Haemodialysis Centres in Singapore during the COVID-19 Pandemic

Abstract

INTRODUCTION: With the unprecedented challenges imposed on the modern healthcare system due to the COVID-19 pandemic, innovative solutions needed to be swiftly implemented to maintain clinical oversight on patient care. Telemedicine was introduced in Singapore in community-based haemodialysis (HD) centres to comply with the Ministry of Health's directives on movement restriction of healthcare workers and related measures to minimise the spread of SARS-CoV-2 in healthcare facilities. METHODS: We describe here our experience of 26 community haemodialysis centres in Singapore, analysing clinical audit data, as well as comparing hospitalisation and mortality rates as outcomes in the time frames of pre- and post-introduction of telemedicine. RESULTS: We found that the hospitalisation rate was 13.9% (95% CI: 5.6%-21.5%, P<0.001) lower in the period after telemedicine rounds were introduced. The mortality rates per 100 person-years (95% CI) were 11.04 versus 7.99 in the compared groups, respectively, with no significant increase in mortality during the months when telemedicine was performed. CONCLUSION: Patients received appropriate care in a timely manner, with telemedicine implementation, and such measures did not lead to suboptimal healthcare outcomes. Telemedicine was a successful tool for physician oversight under movement control measures implemented during the COVID-19 pandemic and may continue to prove useful in the 'new normal' era of healthcare delivery for HD patients in community-based dialysis centres, operated by the National Kidney Foundation in Singapore.