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[Preprint]. 2025 May 3:2025.03.26.25324692.
doi: 10.1101/2025.03.26.25324692.

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

Frantz Emmanuel Garilus  1 , Kerven Cassion  1 , Youseline Cajusma  1 , Katelyn E Flaherty  1   2 , Jude Ronald Beausejour  1 , Lerby Exantus  3 , Valery M Beau de Rochars  4 , Chantale Baril  3 , Torben K Becker  2 , Rochelle K Rosen  5 , Eric J Nelson  1 , Molly B Klarman  1
Affiliations

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

Frantz Emmanuel Garilus et al. medRxiv. .

Update in

Abstract

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.

Methods: 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.

Results: 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.

Conclusion: The findings will guide our internal scale-up strategy and may offer guidance to similar telemedicine initiatives.

Keywords: framework matrix analysis; pediatrics; scaling; telemedicine.

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Conflict of interest statement

Competing interests: Authors declare that they have no competing interests.

Figures

Figure 1.
Figure 1.
General workflow of a telemedicine and medication delivery service (TMDS). The parent of a sick child contacts the call center. A TMDS nurse receives the call and conducts a virtual exam by asking the parent targeted questions about the child and their symptoms. The nurse references clinical resources to create a treatment plan that includes disposition, medications/fluids, and follow-up recommendations. Families are contacted by phone at 24 hours and/or 10 days. A version of this figure was published previously[35].
Figure 2.
Figure 2.
Positioning a TMDS for scale; barriers and solutions between operations and mission.
See this image and copyright information in PMC

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