title: Access to Specialized Care Through Telemedicine in Limited-Resource Country: Initial 1,065 Teleconsultations in Albania.
abstract: To analyze the initial experience of the nationwide clinical telemedicine program of Albania, as a model of implementation of telemedicine using "Initiate-Build-Operate-Transfer" strategy.
  
  
  
  This was a retrospective study of prospectively collected data from teleconsultations in Albania between January 1, 2014 and August 26, 2015, delivered synchronously, asynchronously, or a combination of both methods. Patient's demographics, mode of consultation, clinical specialty, hospitals providing referral and consultation, time from initial call to completion of consultation, and patient disposition following teleconsultation were analyzed. Challenges of the newly created program have been identified and analyzed as well.
  
  
  
  There were 1,065 teleconsultations performed altogether during the study period. Ninety-one patients with autism managed via telemedicine were not included in this analysis and will be reported separately. Of 974 teleconsults, the majority were for radiology, neurotrauma, and stroke (55%, 16%, and 10% respectively). Asynchronous technology accounted for nearly two-thirds of all teleconsultations (63.7%), followed by combined (24.3%), and then synchronous (12.0%). Of 974 cases, only 20.0% of patients in 2014 and 22.72% of patients in 2015 were transferred to a tertiary hospital. A majority (98.5%) of all teleconsultations were conducted within the country itself.
  
  
  
  The Integrated Telemedicine and e-Health program of Albania has become a useful tool to improve access to high-quality healthcare, particularly in high demanding specialty disciplines. A number of challenges were identified and these should serve as lessons for other countries in their quest to establish nationwide telemedicine programs.
authors.affiliation: 1 Department of Surgery, Westchester Medical Center and New York Medical College , Valhalla, New York.|2 Department of Surgery, University of Arizona , Tucson, Arizona.|3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Rifat
authors.initials: R
authors.lastname: Latifi
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .|4 Department of Epidemiology and Biostatistics, University of Arizona , Tucson, Arizona.
authors.forename: Jayleen K L
authors.initials: JK
authors.lastname: Gunn
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Evis
authors.initials: E
authors.lastname: Bakiu
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Arian
authors.initials: A
authors.lastname: Boci
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Erion
authors.initials: E
authors.lastname: Dasho
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .|5 Department of Neurosurgery, University Trauma Hospital , Tirana, Albania .
authors.forename: Fatos
authors.initials: F
authors.lastname: Olldashi
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Pellumb
authors.initials: P
authors.lastname: Pipero
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: John A
authors.initials: JA
authors.lastname: Stroster
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Orland
authors.initials: O
authors.lastname: Qesteri
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Julian
authors.initials: J
authors.lastname: Kucani
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Ardi
authors.initials: A
authors.lastname: Sulo
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Manjola
authors.initials: M
authors.lastname: Oshafi
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Kalterina L
authors.initials: KL
authors.lastname: Osmani
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .|6 Trauma Section, University Trauma Hospital , Tirana, Albania .
authors.forename: Agron
authors.initials: A
authors.lastname: Dogjani
authors.affiliation: 7 Department of Family and Community Medicine, University of Cincinnati , Cincinnati, Ohio.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Doarn
authors.affiliation: 8 USAID/Albania, Tirana, Albania .
authors.forename: Zhaneta
authors.initials: Z
authors.lastname: Shatri
authors.affiliation: 8 USAID/Albania, Tirana, Albania .
authors.forename: Agim
authors.initials: A
authors.lastname: Kociraj
authors.affiliation: 3 International Virtual e-Hospital Foundation and Integrated Telemedicine and e-Health Program of Albania , Tirana, Albania .
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Merrell
mesh_terms: D000328:Adult; D000368:Aged; D000415:Albania; D000070642:Brain Injuries, Traumatic / Q000628:therapy; D003906:Developing Countries; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D012017:Referral and Consultation; D019114:Remote Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D020521:Stroke / Q000628:therapy; D019112:Teleradiology / Q000379:methods; D013997:Time Factors
keywords: initiate-build-operate-transfer (IBOT); low- and middle-income countries; teleconsultations; telemedicine; teleneurotrauma; teleradiology; telestroke