Pathways to optimize a pediatric telemedicine and medication delivery service: A multi-level qualitative study in Haiti

Background While telemedicine has become an established component of healthcare delivery globally, challenges to scaling emerging initiatives persist across multiple levels. Over the last 5 years, our team has developed a pediatric telemedicine and medication delivery service (TMDS) in Haiti that integrates clinical guidance with rapid access to medications. Building on successful proof-of-concept studies, we are now well positioned to characterize both general challenges to telemedicine scale-up and those unique to the TMDS model.

In this study, we conducted focus group discussions and administered written questionaries to TMDS staff, including physicians, nurses, and medication delivery drivers. Using framework matrix analysis we identified key challenges and opportunities associated with the TMDS model.

Areas for improvement related to obtaining quality information from virtual exams, the reliability of technology and communication infrastructure, conditions necessary for effective in-person exams, the limited scope of the TMDS workflow and clinical resources, and uncertainty surrounding long-term sustainability. These insights informed the development of targeted action items categorized into three domains: conceptual, physical and mission-oriented.

The findings will guide our internal scale-up strategy and may offer guidance to similar telemedicine initiatives. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by the Childrens Miracle Network at University of Florida to EJN, The National Institutes of Health (5R21TW012332-02) to EJN and private donations to the University of Florida Foundation. The funders had no direct role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was reviewed and approved by the University of Florida Institutional Review Board (202002693) as well as the Comité National de Bioéthique (National Bioethics Committee of Haiti; Ref2021-11). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes The funding statement has been updated and the manuscript has been further edited by additional co-authors. Data Availability All data produced in the present study are available upon reasonable request to the authors Abbreviations - TMDS - telemedicine and medication delivery service - CFIR - Consolidated Framework for Implementation Research - ICT - communication technology infrastructure - INACT-H - Improving Nighttime Access to Care and Treatment-Haiti - IT - information technology - eCDS - electronic clinical decision support