Infectious diseases are one of the leading causes of mortality around the globe. Multiple factors spread infectious diseases in humans, such as travelling, environmental change, and unhygienic human lifestyle and microbial adaptation. It has been reported that no borders are sufficient to contain infectious diseases. Therefore, every emerging illness must be evaluated as a threat to Malta. Although 70% population of Malta enjoys good health, there are significant disparities to access healthcare services in Malta among income groups (European Commission, 2017). People with high incomes can easily access quality healthcare services. However, 55% of low-income people face barriers to access healthcare services (European Commission, 2017). In such a situation, there is a higher risk of widespread global pandemics such as COVID-19. The containment of these infectious outbreaks depends on the appropriate counselling of the patients and the whole community. However, the traditional health system of Malta lacks any form of telemedicine counselling that is critical to prevent the risk of an outbreak.
One of the reports suggests that the mode of transmission of COVID-19 is human-to-human contact (Li et al., 2020). The health authorities have urged people to stay calm and not to panic. In Malta, the government has already established a coordinated team for national response to counter COVID-19 cases. Despite these measures, the number of instances of COVID-19 is rising by the day. In contemporary testing times, a novel telemedicine platform, Mobidoctor.eu provides an opportunity to offer holistic counselling services to all the patients irrespective of their location and income-status. The general practitioners registered on Medidoctor.eu provide several services such as counselling, management recommendations, awareness, and direct consultation. Furthermore, general practitioners can also coordinate with each other and develop a robust plan for individual patients. In this way, Mobidoctor.eu can improve the consultation services, bypass the long queues, and protect people in Malta from widespread outbreaks such as COVID-19.
In Malta, the risk of infectious diseases has remained lower even diseases such as HIV and TB. However, in recent years the number of infectious disease cases are increasing at an unprecedented rate and Malta has been found to have the third-highest number of HIV cases in the EU (ECDC, 2016). This large number of cases can be attributed to the influx of migrants as well as unprotected sexual contacts. Likewise, the cases of TB are also going up with 7.5 cases per 100,000 population (ECDC, 2016). This rise of infectious diseases poses a serious threat to the healthcare system of Malta. General practitioners are one of the main stakeholders to deal with contagious conditions in the patients. In Malta, people favour consultation with their family doctors regarding their health status. Studies have revealed that the rate of consultation with GPs is higher in Malta as compared to other European countries (Gauci et al., 2007). It is the need of the hour that appropriate measures are taken to prevent infectious diseases from becoming pandemic.
The cost of healthcare is increasing all over the world, and Malta is not an exception as the cost of healthcare services is 8.4% of the GDP (Azzopardi Muscat et al., 2017). Besides that, private spending on health is one of the highest in Malta. In such a situation, the risk of pandemic outbreaks severely jolts the whole system. It requires a robust and cost-effective alternative system for health counselling. Reports from Malta suggest that people are not satisfied with the medical examinations due to long queues. These long waiting times is a significant challenge for the healthcare system in the times of healthcare emergency. The gatekeeping systems of traditional health clinics are weak, and the rate of referrals is higher in Malta. In such a situation, it is a relatively daunting task for the general practitioners to offer consultation to all the patients directly. Therefore, a more robust and safe setup is required.
The system such as Mobidoctor.eu can offer a reliable alternative option for the general practitioners as well as the patients. In Mobidoctor.eu patients do not have to wait in long queues, and they can book an appointment with their preferred general practitioner at any time with ease. Mobidoctor.eu offers a bypass to the traditional gatekeeping system and delivers holistic consultation services to the patients.
It has been reported that there is a number of striking similarities of telemedicine with traditional in-person counselling. For instance, the use of audio-video counselling enables general practitioners to see patients and communicate properly. Contrarily, some of the disadvantages that online counselling may have a poor quality of video and distorted audio (Schuster et al., 2018). But, it is essential to highlight that there are no such issues in Mobidoctor.eu as it is developed on an efficient network that facilitates smooth communication between the GP and the patients.
In a study, it has been reported that online counselling is highly cost-effective and time-saving for both the patients and the healthcare professionals (Otten et al., 2016). Likewise, another study reported that healthcare practitioners save a significant amount of time by the use of online portals for telemedicine consultation (Greenhalgh et al., 2016). Healthcare professionals have reported enjoying the flexibility of the telemedicine consultation system as compared to in-person counselling. Therefore, Mobidoctor.eu is a novel system that has not been used previously, and it provides flexibility to the healthcare practitioners as well as the patients. The time saved by the use of Mobidoctor.eu can be efficiently utilized to provide consultation services to other patients.
One of the telemedicine applications JeffConnect in the United States saves a huge amount of money from emergency visits by $309 to $1500. It has also been reported to save costs of $114 per visit to alternative care services (Cheney, 2019). Thus, the use of MobiDoctor as a platform of Telemedicine consultation in Malta is also expected to reduce the unnecessary financial cost and improve the quality of consultation services to the patients.
The significant advantage of Mobidoctor.eu consultation is that it enables people in remote areas to access the services of General Practitioners easily. For instance, in the United States, people living in rural and urban areas with a shortage of healthcare professionals and thus face difficulty with continuity of care. The use of telemedicine application Jeffconnect to access quality consultation without travelling long distances. Likewise, Mobidoctor also offers a similar alternative to the patients in Malta.
Mobidocotor.eu consultation is not only helpful to the patients but also saves a lot of money that is incurred during a face-to-face consultation. The reports from Medicare America shows that telemedicine consultation services cost only $14.4 million, which is 0.01% of the total healthcare spending in the United States (Mahar, 2019). Besides that, telemedicine consultation also helps in optimizing the entire healthcare system, reduce the burdens of appointments on the primary care providers, improves patients’ adherence and prevent unnecessary emergency visits.
The initial response to the COVID-19 Malta is similar to that of other countries. The Health Ministry has urged the public to stay calm. Besides that, the Ministry of Health has confirmed to establish a dedicated ward at Boffa Hospital in Malta to deal with eventualities of COVID-19. Furthermore, the healthcare staff and other social workers are provided adequate training to manage infected people. The training protocols were taken from the World Health Organization. Currently, there are no bans on flights, and there are regular flights from all around the world. However, the Medical Association of Malta and UHM, has demanded a complete ban on flights from high-risk areas to implement quarantine measures effectively.
In addition to these, the Malta Chamber of SMEs has published precautionary guidelines for the public to stay safe from the growing threat of COVID-19. These measures include refraining handshakes, avoiding crowded places, regularly using sanitizing products, using disinfectants to clean the surfaces and improving fresh airflow. Furthermore, the Chamber of SMEs also rated China, Northern Italy, Japan, Iran, Singapore, and South Korea as the worst-hit countries and people coming from these countries are quarantined. The Prime Minister of Malta, Robert Abela, announced an emergency and immediately closed all the educational institutions until March 20. Moreover, the Prime Minister also notified that all the mass gatherings are banned and sports events would be conducted behind closed doors.
The recent outbreaks of global epidemics have increased the importance of utilizing telemedicine to deliver healthcare services without risking the potential spread of the diseases. The advancement in communication technology has also helped to integrate telemedicine in the healthcare systems. Mobidoctor is a unique, telemedicine consultation service. The usage of Mobidoctor allows the patients to avoid hospital visits as the general practitioners provide quality consultation.
Studies have reported the beneficial impact of telemedicine in the management of chronic diseases (Bashshur et al., 2014; Bashshur et al., 2016). In epidemics, an effective and timely response is the key to control the spread of disease. A controlled response is only possible through coordination among the health authorities, hospitals, and patients. The outbreak of COVID-9 has identified the crisis of the healthcare system to deal with a health emergency. The traditional communication systems, such as face-to-face consultations between the physicians and the patients seem dangerous. Besides that, the traditional systems pose high cost in the form of widespread of the disease. The National Telemedicine Center of China (NTCC) responded with an Emergency Telemedicine Consultation System (ETCS) to deliver a coordinated response (Zhai et al., 2020). The Chinese health authorities developed a telemedicine system in conjunction with China Mobile and Huawei Technologies.
The basic mechanism of action of ETCS is to enable access to healthcare counselling through remote terminals. In China, this system has been found to serve the purpose of the management of COVID-19 patients. The first telemedicine consultations were provided on January 28, 2020, to a total of 654 patients with severe and moderate respiratory infections (Zhai et al., 2020). The follow-up revealed that 420 patients had been cured. Furthermore, it was also reported that telemedicine enables to document a patient’s health data and provide real-time information to the healthcare team. In this way, the risk of direct physical contact between COVID-19 patients, thus reducing the risk of potential transmission of infection among physicians and nurses. Besides that, the telemedicine system is based on a multidisciplinary team that enhances its robustness in the management of infectious diseases. Likewise, Mobidoctor.eu provides immediate diagnosis and management strategies for remote patients. Besides that, it enables effective management of quarantined patients through video conferencing.
Furthermore, teleconsultation is a need of the hour to avoid direct physical contact between the patients and the healthcare providers. In this way, the quarantined people can be delivered effective consultation and improve disease control. Teleconsultation has been utilized on previous occasions as well. In 2003, Taiwan used teleconsultation to control the spread of Severe Acute Respiratory Syndrome (SARS) (Ohannessian, 2015). In 2013, China used teleconsultation to control H7H9 influenza (World Health Organization, 2013) and in the US during the Ebola outbreak to isolate and quarantine Ebola patients returning from West Africa (Centers for Disease Control and Prevention, 2014).
Similarly, in South Korea, telemedicine was provided to quarantined patients of Middle-East respiratory syndrome (MERS) at Samsung Medical Center. These pieces of evidence from previous outbreaks suggest that telemedicine is a control strategy to counter the risk of the COVID-19 outbreak. Therefore, the use of Mobidoctor.eu can serve the purpose of Malta as it offers a unique approach to deal with infectious patients and spread awareness among the general public without any major obstacle.
Mobidoctor.eu is the first telemedicine consultation system in Malta. It is developed with the utmost care to cater to the needs of patients as well as general practitioners. A system is an alternative option during infectious outbreaks. It allows people to directly communicate with the general practitioner and avoid the risk of being infected from other patients at the hospitals. The traditional health system of Malta faces issues of long waiting time for consultation and patients are not satisfied with the services. Therefore, in contemporary circumstances, a platform such as Mobidoctor.eu is critical to deal with the threat of COVID019. This platform can offer effective consulting services to the quarantined people, and the risk of spread through direct contact can be avoided. Besides that, Mobidoctor is also a valuable tool for remote patients who are unable to see the general practitioners directly.
Azzopardi Muscat, N., Calleja, N., Buttigieg, S. and Merkur, S., 2017. Malta: health system review. Health systems in transition, 19(1), pp.1-137.
Bashshur, R.L., Shannon, G.W., Smith, B.R., Alverson, D.C., Antoniotti, N., Barsan, W.G., Bashshur, N., Brown, E.M., Coye, M.J., Doarn, C.R. and Ferguson, S., 2014. The empirical foundations of telemedicine interventions for chronic disease management. Telemedicine and e-Health, 20(9), pp.769-800.
Bashshur, R.L., Shannon, G.W., Smith, B.R. and Woodward, M.A., 2015. The empirical evidence for the telemedicine intervention in diabetes management. Telemedicine and e-Health, 21(5), pp.321-354.
Centers for Disease Control and Prevention, 2014. Preparing for Ebola: What US hospitals can learn from Emory Healthcare and Nebraska Medical Center.
Cheney, C., 2019. Cost Savings for Telemedicine Estimated At $19 to $120 Per Patient Visit. Health Leaders. Retrieved from https://www.healthleadersmedia.com/clinical-care/cost-savings-telemedicine-estimated-19-120-patient-visit
ECDC., 2016. HIV/AIDS Surveillance in Europe 2018. European Centre for Diseases Prevention and Control.Retrieved from https://www.ecdc.europa.eu/sites/default/files/documents/hiv-aids-surveillance-europe-2018.pdf
European Commission., 2017. State of Health in the EU, Malta: A Country Health Profile 2017. European Observatory on Health Systems and Policies. Retrieved from https://ec.europa.eu/health/sites/health/files/state/docs/chp_malta_english.pdf
Gauci, C., Gilles, H., O'BRIEN, S., Mamo, J., Stabile, I., Ruggeri, F. M., ... & Spiteri, G., 2007. Estimating the burden and cost of infectious intestinal disease in the Maltese community. Epidemiology & Infection, 135(8), 1290-1298.
Greenhalgh, T., Vijayaraghavan, S., Wherton, J., Shaw, S., Byrne, E., Campbell-Richards, D., ... & Hodkinson, I., 2016. Virtual online consultations: advantages and limitations (VOCAL) study. BMJ open, 6(1), e009388.
Li, Q., Guan, X., Wu, P., Wang, X., Zhou, L., Tong, Y., Ren, R., Leung, K.S., Lau, E.H., Wong, J.Y. and Xing, X., 2020. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. New England Journal of Medicine.
Mahar, J.H., 2019. The Future of Telemedicine (and What’s in the Way). Consult QD. Retrieved from https://consultqd.clevelandclinic.org/the-future-of-telemedicine-and-whats-in-the-way/
Ohannessian, R., 2015. Telemedicine: Potential applications in epidemic situations. European Research in Telemedicine/La Recherche Européenne en Télémédecine, 4(3), pp.95-98.
Otten, E., Birnie, E., Ranchor, A. V., & van Langen, I. M., 2016. Online genetic counseling from the providers’ perspective: counselors’ evaluations and a time and cost analysis. European Journal of Human Genetics, 24(9), 1255-1261.
Schuster, R., Pokorny, R., Berger, T., Topooco, N., & Laireiter, A. R., 2018. The advantages and disadvantages of online and blended therapy: survey study amongst licensed psychotherapists in Austria. Journal of medical Internet research, 20(12), e11007.
Times of Malta., 2020. Coronavirus: Authorities Urge Calm While Preparing for an Outbreak. Times of Malta.Retrieved from https://timesofmalta.com/articles/view/coronavirus-authorities-urge-calm-while-preparing-for-an-outbreak.776306
World Health Organization., 2013. Human infection with influenza A(H7N9) virus in China–update. Disease Outbreak News. Retrieved from http://www.who.int/csr/don/2013_04_13/en/
Zhai, Y., Wang, Y., Zhang, M., Gittell, J.H., Jiang, S., Chen, B., Cui, F., He, X., Zhao, J. and Wang, X., 2020. From Isolation to Coordination: How Can Telemedicine Help Combat the COVID-19 Outbreak?. medRxiv.