3rd Edition of Preventive Medicine World Conference 2027

Abstract

Background: Non-communicable diseases (NCDs) constitute 66% of mortality in Nepal, with rural primary health infrastructure inadequately equipped for chronic disease management. Telemedicine interventions have been deployed across mountainous regions, but systematic evidence on clinical efficacy and implementation barriers is lacking.

Objective: To systematically review telemedicine interventions for hypertension, diabetes, and chronic obstructive pulmonary disease (COPD) in rural Nepal, evaluating clinical outcomes, operational models, and system-level barriers.

Methods: Systematic review conducted per PRISMA guidelines. PubMed, Google Scholar, and Nepal Health Research Council archives were searched (2015-2026) using terms: "telemedicine," "mHealth," "Nepal," "hypertension," "diabetes," "COPD," "rural health." Inclusion criteria: Nepal-based studies, NCD interventions using digital health tools, reporting clinical or implementation outcomes. Quality assessment used Cochrane Risk of Bias tool (RCTs) and CASP checklist (qualitative studies).

Results: Seven studies were included (1 RCT, 2 quasi-experimental pilots, 1 program evaluation, 3 qualitative studies; n=1,847 total participants). Three operational models were identified: (1) Provider-to-Provider Hub-and-Spoke teleconsultation (Dhulikhel Hospital)—high clinical efficacy but resource-intensive; (2) Direct-to-Patient mHealth (TEXT4BP RCT)—SMS reminders significantly reduced systolic blood pressure (mean difference: -5.2 mmHg, 95% CI: -7.8 to -2.6, p<0.001) and improved medication adherence (OR: 2.4, 95% CI: 1.6-3.7); (3) Crisis Response telephonic monitoring (Dang Model)—85.3% recovery rate for COVID-19 home-isolated patients. COPD telerehabilitation demonstrated clinical feasibility despite bandwidth limitations. Qualitative synthesis identified pharmaceutical supply chain failures—not technology acceptance—as the primary implementation barrier.

Conclusions: Class I evidence supports mHealth interventions for hypertension management in rural Nepal. However, telemedicine efficacy is constrained by last-mile pharmaceutical logistics. Integration with national health insurance and supply chain strengthening are essential for sustainable impact.