Teleconsultations for Hypertension Management in Rural Kazakhstan: A Two-Phase Service Evaluation of Patient...

Rural regions of Kazakhstan face persistent barriers to specialist access. Arterial hypertension (AH) remains highly prevalent, while limited digital literacy may restrict the uptake of telemedicine solutions.

To evaluate medical and digital literacy, patient satisfaction, and perceived barriers associated with cardiology teleconsultations for AH in rural Kazakhstan, and to explore changes in patient trust and demographic differences between survey phases.

A two-phase service evaluation was conducted. Phase 1 (offline, February 2023) surveyed rural adults with AH (n = 134). Phase 2 implemented mobile-based cardiology teleconsultations (July 2023-January 2024) and included a post-consultation online survey (n = 51, September-December 2024). Descriptive data were summarized as n (%) or mean ± SD; inferential analyses included Welch's t-test (age), the Wilcoxon signed-rank test (trust before/after), Spearman correlation (digital literacy-trust), the chi-square test (gender-satisfaction), and Kruskal-Wallis (age group-satisfaction).

In Phase 1, awareness of hypertension and complications was high (96% and 76%), but knowledge of risk factors was lower (78%). Most participants owned a BP monitor (81%) and could measure blood pressure at home (78%); 40% did so daily. Digital engagement was limited-73% were unfamiliar with "digital medicine," and 75% did not use health apps. In Phase 2, 82% of patients found teleconsultations convenient, and 90% rated remote care as excellent or good; 73% rated physician performance as excellent. Reported barriers included poor internet connectivity (43%), and most consultations occurred via mobile phones (92%). The mean participant age declined from 59 ± 11 years (offline) to 48 ± 13 years (online) (Welch's t p < 0.0001). Trust in telemedicine significantly increased after the consultation (Wilcoxon p < 0.00001). Satisfaction did not differ by gender (p = 0.79) or age group (p = 0.349). A simplified cost analysis indicated ∼66.7% lower per-visit cost compared with in-person consultations.

Mobile teleconsultations for hypertension management were feasible, well accepted, and associated with a significant improvement in patient trust among rural populations. Targeted efforts to improve digital literacy and connectivity could enhance equitable adoption. Early economic signals support integrating teleconsultations into routine rural health care services.