Harnessing biotechnology and telemedicine for more equitable primary health care

Dear Editor,

We were very interested in the article by Rossetti et al. entitled “Telemedicine in developing countries and international cooperation”, since it demonstrates the potential of telemedicine to improve access to health services, particularly in areas that are poorly served and which have limited resources.¹ The authors rightly stress that for telemedicine to be successfully implemented it is necessary to have adequate technical infrastructure, trained personnel, sustainable financing, effective regulation, and international cooperation.

We wish to extend this discussion by pointing out that telemedicine can achieve higher clinical value if it is combined with accessible biotechnological advances. Although teleconsultations can link patients with healthcare professionals, their diagnostic value may still be restricted if patients do not have access to laboratory tests. The use of portable biosensors, rapid molecular diagnostic systems, point-of-care tests, and digitally connected monitoring devices can help overcome this limitation by providing clinically relevant information at or near the patient's location.

For instance, biotechnology point-of-care tools could be used to quickly detect infectious diseases, measure blood glucose and other biomarkers, monitor cardiovascular risk factors, and identify certain genetic or pharmacogenomic features. If they are properly validated and incorporated into telemedicine systems, such tools would allow primary care providers to evaluate patients remotely by means of objective biological data rather than depending solely on the symptoms that are reported.

This convergence is particularly relevant for geographically isolated communities and developing countries, since patients in these areas might have to travel long distances in order to get access to diagnostic laboratories or to specialist services. It would be possible for community health workers to carry out validated point-of-care tests and to securely pass on the results to primary care physicians. This method could lead to earlier intervention, enhance the monitoring of chronic diseases, and cut down on unnecessary referrals and the costs associated with travel.

Nevertheless, bringing biotechnology into primary care supported by digital technologies gives rise to new challenges. The availability of a technology does not necessarily ensure that it is accessible, reliable, or appropriately applied in clinical practice. Devices that have not been well validated, quality-control procedures that are inadequate, limited digital connectivity, and a lack of proper professional training might result in incorrect interpretations or in exacerbating existing health inequalities. Genetic and biomarker data also require strong safeguards because they may reveal sensitive information not only about patients but also about their biological relatives.

We thus suggest three priorities concerning the responsible incorporation of biotechnology and telemedicine into primary health care.

The medical, nursing, laboratory science, and community health courses should contain training in the area of near-patient diagnostics, in interpreting biosensor readings, in genomic literacy, in data privacy, and in how to communicate uncertain test results. Although primary care practitioners have no need to become molecular biologists, they do need to understand the clinical validity, usefulness, and limitations of the technologies they use.

Second, health authorities should set up definite standards regarding analytical validation, quality assurance, informed consent, data security, interoperability, referral pathways, and fair access.² Affordable technologies should not be accepted simply because they are cheap; they also have to show that they are accurate and clinically useful for the populations for whom they are intended.

Thirdly, the implementation process should include ongoing collaboration by primary care professionals, biotechnologists, laboratory specialists, public health workers, information technology experts, policymakers, and local communities. According to Rossetti et al., international cooperation should aim not only at facilitating the transfer of technology but also at building local capacity, establishing maintenance systems, ensuring culturally appropriate implementation, and securing long-term institutional ownership.

Telemedicine has the potential to bring health professionals closer to patients and biotechnology can make diagnostic facilities more accessible to communities. It follows that their responsible integration could thus enhance preventive, personalized, and evidence-based primary care.³ However, implementation must be based on clinical need, scientific validation, moral oversight, and equity rather than solely on the novelty of technological advancement.

Ethics committee approval

Since this letter is not presenting original research involving human participants, animals, or identifiable personal data, there was no need for approval from an ethics committee.

Informed consent

Not applicable.

Declaration of generative AI and AI-assisted technologies in the writing process

The manuscript was improved in a number of instances through the use of generative artificial intelligence tools, which provided help with language polishing, and organization. The authors went over and revised the manuscript and therefore accept full responsibility for the arguments, accuracy, and final version of the paper.

Funding

The authors received no specific funding for this work.

Conflict of interest

The authors declare no conflicts of interest related to this manuscript.