Telemedicine, Access, and Referral Burden in Guyana’s Hinterland Regions: A Retrospective Study, 2022–2026
Abstract:
Healthcare
access in Guyana’s hinterland regions is constrained by geographic isolation,
long travel distances, high transport costs, and limited specialist
availability at peripheral facilities. Telemedicine has emerged as a strategy
to bridge these gaps by enabling remote consultation, supporting local clinical
decision-making, and reducing unnecessary patient referrals. This retrospective
descriptive study analyzed annual program data and site-level operational
records from the national telemedicine program across Guyana’s hinterland from
2022 to 2026. Key indicators included communities served, telemedicine calls,
patient visits, serious cases, critical care encounters, remote ultrasound
examinations, medical evacuations, and hospital referrals eliminated. The
program expanded from 4 communities in 2022 to 130 in 2026. Telemedicine calls
increased from 55 to approximately 2,500, and patient visits from 84 to
approximately 25,000. Patient visits per community rose from 21.0 in 2022 to
192.3 in 2026, indicating deepening service intensity beyond geographic
expansion. Serious cases increased from 11 to approximately 850, critical care
encounters reached approximately 200, and remote ultrasound use grew from 106
in 2024 to approximately 800 in 2026. Hospital referrals eliminated increased
from 423 in 2024 to approximately 1,900 in 2026. Medical evacuations remained
stable despite growing clinical volumes. These findings indicate that Guyana’s
hinterland telemedicine program achieved meaningful improvements in access,
supported local management of complex clinical presentations, and contributed
to referral burden reduction. Implementation quality and local integration
appear to mediate utilization beyond geography alone. Future research should
evaluate patient-level outcomes, referral appropriateness, and household cost
savings.
References:
[1]. Ministry of Health, Guyana, 2026, Guyana telemedicine program:
Annual performance data 2022–2026. Ministry of Health, Georgetown, Guyana.
[2]. Pan American Health Organization (PAHO), 2019, Health in the
Americas: Guyana country profile. PAHO/WHO Regional Office for the Americas,
Washington, DC, https://www.paho.org/en/countries/guyana
[3]. Government of Guyana, 2022, National health sector development plan.
Ministry of Health, Georgetown, Guyana.
[4]. Kruse, C. S., Karem, P., Shifflett, K., Vegi, L., Ravi, K., Brooks,
M., 2016, Evaluating barriers to adopting telemedicine worldwide: A systematic
review. Journal of Telemedicine and Telecare, 24(1), 4–12, https://doi.org/10.1177/1357633X16674087
[5]. Wootton, R., 2012, Twenty years of telemedicine in chronic disease
management: An evidence synthesis. Journal of Telemedicine and Telecare,
18(4), 211–220, https://doi.org/10.1258/jtt.2012.120219
[6]. Scott Kruse, C., Karem, P., Shifflett, K., Vegi, L., Ravi, K.,
Brooks, M., 2022, Telemedicine effectiveness during COVID-19 and beyond: A
systematic review. Journal of Medical Internet Research, 24(8), e38643, https://doi.org/10.2196/38643
[7]. Orlando, J. F., Beard, M., Kumar, S., 2020, Systematic review of
patient and caregivers’ satisfaction with telehealth videoconferencing as a
mode of service delivery in managing patients’ health. PLOS ONE, 14(8),
e0221848, https://doi.org/10.1371/journal.pone.0221848
[8]. Iyengar, P., Mabvakure, B., Yadav, P., Adams, J., 2021,
Strengthening last-mile supply chains in low-density settings: Lessons for
resilience. Global Health: Science and Practice, 9(Suppl 2), S272–S285, https://doi.org/10.9745/GHSP-D-21-00008
[9]. Watkins, K., Bertone, M. P., Witter, S., 2022, Health infrastructure
maintenance and uptime: Evidence and frameworks. Health Policy and Planning,
37(6), 738–748, https://doi.org/10.1093/heapol/czac016
[10]. Gilmore, B., McAuliffe, E., Power, J., Vallières, F., 2021, Data
analysis and synthesis within a realist evaluation: Toward more transparent
methodological approaches. International Journal of Qualitative Methods,
18, 1–10, https://doi.org/10.1177/1609406919859754
[11]. Alkmim, M. B., Figueira, R. M., Marcolino, M. S., Cardoso, C. S., de
Abreu, M. P., Cunha, L. R., Antunes, A. P., Resende, A. G., Resende, E. S.,
Ribeiro, A. L., 2012, Improving patient access to specialized health care: The
Telehealth Network of Minas Gerais, Brazil. Bulletin of the World Health
Organization, 90(5), 373–378, https://doi.org/10.2471/BLT.11.099408
[12]. Marchildon, G. P., 2020, Canada’s Medicare and health system
resilience: Lessons from rural and remote care. Healthcare Papers,
19(3), 8–19, https://doi.org/10.12927/hcpap.2020.26273
[13]. World Health Organization and World Bank, 2023, Tracking universal
health coverage: 2023 global monitoring report. WHO, Geneva, https://www.who.int/publications/i/item/9789240080379
[14]. Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H.,
Roder-DeWan, S., et al., 2018, High-quality health systems in the Sustainable
Development Goals era: Time for a revolution. The Lancet Global Health,
6(11), e1196–e1252, https://doi.org/10.1016/S2214-109X(18)30386-3
[15]. Weiss, D. J., Nelson, A., Vargas-Ruiz, C. A., Gligorić, K.,
Bavadekar, S., Gabchenko, E., et al., 2020, Global maps of travel time to
healthcare facilities. Nature Medicine, 26(12), 1835–1838, https://doi.org/10.1038/s41591-020-1059-1
[16]. Arsenault, C., Jordan, K., Lee, D., Dinsa, G., Manzi, F., Marchant,
T., Kruk, M. E., 2020, Equity in primary care access in the global south:
Cross-sectional analysis. PLoS Medicine, 17(6), e1003125, https://doi.org/10.1371/journal.pmed.1003125
[17]. Ouma, P. O., Maina, J., Thuranira, P. N., Macharia, P. M., Alegana,
V. A., English, M., Okiro, E. A., Snow, R. W., 2018, Access to emergency
hospital care provided by the public sector as a function of travel time in
sub-Saharan Africa. The Lancet Global Health, 6(3), e342–e350, https://doi.org/10.1016/S2214-109X(18)30069-X
[18]. Hone, T., Rasella, D., Barreto, M. L., Atun, R., Majeed, A.,
Millett, C., 2017, Large reductions in amenable mortality associated with
Brazil’s primary care expansion and strong health governance. Health Affairs,
36(1), 149–158, https://doi.org/10.1377/hlthaff.2016.0966
[19]. Schneider, H., Blaauw, D., Gilson, L., Chabikuli, N., Goudge, J.,
2021, Health systems and access to antiretroviral drugs for HIV in Southern
Africa: Service delivery and human resource challenges. Reproductive Health
Matters, 14(27), 12–23, https://doi.org/10.1016/S0968-8080(06)27232-X
[20]. Dolea, C., Stormont, L., Braichet, J. M., 2010, Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 88(5), 379–385, https://doi.org/10.2471/BLT.09.070607
