The doctor is on call with Abu Dhabi Telemedicine Centre
Finding basic out-of-hours medical care in the UAE is not easy.
When someone suffers fever and vomiting in the night, the decision on whether to ride it out or hotfoot it to the nearest accident and emergency department is usually based on a quick search of the internet or advice from a friend or family member.
Chances are a trip to the hospital to see a general practitioner would end with the patient being sent home with basic instructions for plenty of fluids and rest. A wasted journey and a waste of money and resources.
In 2013 in Abu Dhabi alone, there were almost 7 million outpatient visits. The average number of insurance claims for outpatient clinic visits for Thiqa insurance card holders (Emiratis and their families) was 14.5, compared with five for other people.
The Abu Dhabi Telemedicine Centre, which opened with little fanfare in October, is part of the strategy to bring these numbers down and reduce unnecessary trips to clinics and hospitals.
It is similar to the United Kingdom’s NHS Direct phone line, which offered out-of-hours nurse-led advice for more than 15 years before closing down last year.
Its doctors are available to provide basic diagnosis and treatment advice at any time of the day or night, with no direct charge to the patient.
It is already receiving “hundreds of calls” every day, according to its general manager, Hasan Al Attas, most of which are from people who would otherwise be sitting in a hospital or doctor’s waiting room.
“We were established to address a concern in the health-care market in Abu Dhabi, the over-utilisation of outpatient services,” he says. “This has led to higher costs of health care in the UAE and accessibility issues for services or patients who need medical services.
“The current utilisation of the outpatient services is one of the highest worldwide. The average visit for an Emirati resident or patient is close to 12 times per year. The international average is between three and four times a year.”
It is part of a global trend using telemedicine to provide better access and reducing caseload on existing infrastructure, he adds.
The clinic, based on Al Maryah Island, has 11 full-time doctors who work in shifts to cover the calls 24/7. There are also nine nurses taking initial calls and case details.
At the first registration the caller gives the staff his or her Thique or Daman insurance details. The bill is then sent directly to Daman and there is no co-pay fee.
Currently, only Thiqa and Daman Enhanced plan holders are eligible to use the service, accounting for about 1.2 million residents. Around 90 per cent of the patients so far have been members of Daman’s Thiqa programme – the health insurance scheme for Emiratis. The other 10 per cent are expatriates.
The doctors are allowed to give general medical advice and suggest over-the-counter medicines where necessary. If a prescription is needed, they can recommend three specialist doctors in their area, who are also covered by the insurance plan, for a face-to-face consultation. They are trained to recognise emergencies and can help calm the patient while they wait for an ambulance.
Al Attas says he is working on expanding the role of the centre when telemedicine legislation, which is relatively new, is expanded. Mubadala Healthcare is also working on a plan for a “shared IT platform” linking clinics and hospitals, including the Cleveland Clinic Abu Dhabi, Healthpoint and Imperial College London Diabetes Centre, and allowing for patient file sharing.
The Health Authority-Abu Dhabi concedes that patients have “undirected access to services and speciality care”, which leads to inappropriate use of services and that the emirate doesn’t adequately support self-care.
“When there is a condition, patients should be supported to care for themselves, where appropriate and supported by well-developed primary and subacute care, including home care and the integrated use of telemedicine,” it says in its annual report, produced in November.”
“Currently the infrastructure is not connected from an IT point of view,” Al Attas says. “There is no connectivity among the providers in the public or private system and as a natural result, people start shopping around for opinions and there’s no restrictions from the regulator or the insurance provider to restrict the number of visits.
“As we speak, the regulators here are fully aware that this is a concern and we’re working together to resolve that. One step forward to reduce the number of high outpatient visits is establishing ADTMC.”
Al Attas is keen to stress that all the doctors on the end of the phone are “qualified, licensed and credentialed”.
They are licensed by the Health Authority-Abu Dhabi and underwent telemedicine training with Swiss firm Medgate, which has partnered with Mubadala on this project.
The staff also take annual exams to maintain their telemedicine credentials.
Sameera Al Obaidli is one of the centre’s doctors. She says the service can be especially useful for pregnant women and new mothers.
“If you’re having breastfeeding problems, or wondering where and how to keep breast milk, it can be very helpful,” she says. “In all the calls we ask specific questions and if they can send us a picture, even better.”
Al Obaidli and the other doctors have been trained to use the Medgate guideline system, which has information and treatment guidelines on thousands of ailments.
Late last month the centre also launched a new mobile app, TeleMed, which enables the patient to send up to three photos directly to their patient file with the centre. They can also send photos of medication labels and medical record for clarifications or second opinions.
If a child has a rash, for example, a parent can take a photo looking down at the area, a zoomed-in shot, and a shot from the side to show if there is any elevation.
This helps the person at the other end of the line diagnose and recommend appropriate treatment.
The app also helps the patient find nearby clinics and pharmacies if they need to go and get a prescription.
So far at least 60 per cent of the cases received have been closed after the initial call, meaning no further treatment or referral was necessary.
Calls are answered by a nurse who takes initial details from the patients about the complaint and also insurance and identification information. They can then request an immediate callback within 30 minutes or schedule a time that suits, such as in their lunch hour or after work if the case is not urgent. At the first call patients set up security questions for future calls.
They also get a callback within two weeks to check on their condition.
Al Obaidli and her colleagues are trained to listen for diagnostic cues on the phone such as laboured breathing or certain types of coughing. They also might ask the patient to make sure there is something in the photos providing scale, such as a dirham coin next to a rash or blemish. If a patient has back pain, for example, there are certain movements they can recommend to assess what might be the cause of the pain and what action should be taken.
Jenny Kline, a mother of two young children in Abu Dhabi, says she would find the service a “comfort”.
“It’s difficult sometimes to know where to go, especially at night. I don’t know of any visiting doctors here, so having someone on the phone would comfort us. At least it’s an expert opinion ... not a guess based on the internet,” she says.
The UAE toll-free number for Abu Dhabi Telemedicine Centre is 800 4959.