Home⇛Health Sciences Journal⇛vol. 12 no. 2 (2023)

Experiences and challenges in telemedicine of physicians from the National Capital Region during the COVID-19 pandemic: A qualitative study

Ma. Shaina Isabel Hilomen | Mikaela Marie A. Haveria | Carlo Lorenzo B. Hernandez | Denise D. Hernandez | Gabrielle Dominique I. Herradura | James F. Huan | Greg Mikhail B. Hubo | Alan June O. Icaonapo | Jonathan C. Idolor | Francesca Nadine Wing-Chun O. Ip | Franciosa Gavino Collins | Ma. Peñafrancia L. Adversario | Teresa Diana B. Bongala

Discipline: Health

 

Abstract:

Introduction The COVID-19 pandemic caused a shift to delivering health services through telemedicine. This study recognized the perceptions, experiences, and challenges of physicians who practice synchronous teleconsultation in the Philippines. Methods: A qualitative descriptive research design using purposive sampling, eight physicians from NCR were interviewed. Data collected were subjected to thematic analysis for common themes and integrated into an analytic narrative. Results: Eight physicians were included as participants. Different measures taken to remedy the gap included upskilling of physicians, adjustment of clerical work, ensuring data privacy, and creating a conducive workplace. Remote consultations posed limitations on physical examination and emphasized the reliance on diagnostics. Digital platforms used depended on the physician’s preference, type of practice, and patient’s accessibility. This led to an increased dependency on good internet and network service connections to ensure smooth teleconsultations. A lack of respect for the physician’s personal boundaries and work-life balance was cited as a major challenge. Conclusion: Telemedicine proved to be an option to provide healthcare despite its limitations, but the shift to its practice exposed many challenges as it is not a replacement for physical consultations.



References:

  1. Kemp S. Digital 2020: The Philippines - datareportal – global digital insights [Internet]. DataReportal. DataReportal – Global Digital Insights; 2020 [cited 2020 Apr 29]. Available from: https://datareportal.com/reports/digital-2020-philippines
  2. Papoutsi E, Giannakoulis VG, Ntella V, Pappa S, Katsaounou P. Global burden of COVID-19 pandemic on healthcare workers. ERJ Open Res 2020 Jul 6;6(2):00195 2020. doi: 10.1183/23120541.00195-2020.
  3. Hurst EJ. Evolutions in telemedicine: From smoke signals to mobile health solutions. J Hosp Libr 2016 Apr 2;16(2):174–85.
  4. Combi C, Pozzani G, Pozzi G. Telemedicine for developing countries. Appl Clin Inform 2016 Nov 2;7(4):1025–50.
  5. Omnibus Guidelines on the Implementation of community quarantine in the Philippines. Official Gazette [Internet]. [cited 2020 April 29] Available f r o m : https://www.officialgazette.gov.ph/downloads/2020/05may/20200429-Omnibus-Guidelineson-the-Implementation-of-Community-Quarantine-in-thePhilippines.pdf
  6. Fernandez-Marcelo PG, Ho BL, Faustorilla JF Jr, Evangelista AL, Pedrena M, Marcelo A. Emerging eHealth directions in the Philippines. Yearb Med Inform. 2012;7:144-52.
  7. Adler-Milstein J, Kvedar J, Bates DW. Telehealth among US hospitals: several factors, including state reimbursement and licensure policies, influence adoption. Health Aff (Millwood) 2014 Feb;33(2):207-15. doi: 10.1377/hlthaff.2013.1054.
  8. De Castro L, Lopez AA, Hamoy G, Alba KC, Gundayao JC. A fair allocation approach to the ethics of scarce resources in the context of a pandemic: The need to prioritize the worst-off in the Philippines. Dev World Bioeth 2021 Dec; 21(4):153-72. doi: 10.1111/dewb.12293. Epub 2020 Sep 23.
  9. Lin CC, Dievler A, Robbins C, Sripipatana A, Quinn M, Nair S. Telehealth in health centers: Key adoption factors, barriers, and opportunities. Health Aff (Millwood). 2018 Dec;37(12):1967-74. doi: 10.1377/hlthaff.2018.05125.
  10. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: A systematic review. J Telemed Telecare 2018 Jan;24(1):4-12. doi: 10.1177/1357633X16674087. Epub 2016 Oct 16.
  11. Isip-Tan IT, Sarmiento F, Fong M, Guzman A, Herber JM, Marcelo A, et al. Telemedicine: guidance for physicians in the Philippines. [Internet] UP College of Medicine – Medicine Information Unit; 2020 [cited 2020 Nov 1]. Available from: https://www.philippinemedicalassociation.org/wp-content/uploads/2020/05/1-Telemedicine-for-HealthProfessionals.pdf
  12. Department of Health. DOH Boosts Telemedicine Services for NCR; Service to Expand to Other Regions Soon [Internet]. 2020 [cited 2020 Nov 1]. Available from: http://www.doh.gov.ph/doh-press-release/DOH-BOOSTTELEMEDICINE-SERVICES-FOR-NCR-SERVICE-TOEXPAND-TO-OTHER-REGIONS-SOON
  13. WHO Global Observatory for eHealth. Telemedicine: Opportunities and developments in member states: Report on the second global survey on eHealth [Internet]. World Health Organization; 2010 [cited 2020 Nov 1]. Available from: https://apps.who.int/iris/handle/10665/44497
  14. Deldar K, Bahaadinbeigy K, Tara SM. Teleconsultation and clinical decision making: a systematic review. Acta Inform Med 2016 Jul 16;24(4): 286-92. doi: 10.5455/ aim.2016.24.286-292.
  15. Siegel CA. Transforming gastroenterology care with telemedicine. Gastroenterology 2017 Apr;152(5):958-63. doi: 10.1053/j.gastro.2017.01.048. Epub 2017 Feb 10.
  16. Mahajan V, Singh T, Azad C. Using telemedicine during the COVID-19 pandemic. Indian Pediatr 2020 Jul 15;57(7):652-7. Epub 2020 May 14.
  17. Shamim-Uzzaman QA, Bae CJ, Ehsan Z, et al. The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of Sleep Medicine update. J Clin Sleep Med 2021 May 1;17(5):1103-7. doi: 10.5664/jcsm.9194.
  18. Malasanos T, Ramnitz MS. Diabetes clinic at a distance: Telemedicine bridges the gap. Diabetes Spectr 2013;26(4):226–31. doi: 10.2337/diaspect.26.4.226
  19. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015 Sep 7;2015(9):CD002098. doi: 10.1002/14651858. CD002098.pub2.
  20. Downes MJ, Mervin MC, Byrnes JM, Scuffham PA. Telemedicine for general practice: a systematic review protocol. Syst Rev 2015 Oct 5;4:134. doi: 10.1186/s13643- 015-0115-2.
  21. Parajuli R, Doneys P. Exploring the role of telemedicine in improving access to healthcare services by women and girls in rural Nepal. Telemat Inform 2017;34(7):1166–76. doi: 10.1016/j.tele.2017.05.006.
  22. Kadir MA. Role of telemedicine in healthcare during COVID-19 pandemic in developing countries. TMT [Internet]. 2020 Apr 30 [cited 2020 Nov 5];5(2). Available from: https://telehealthandmedicinetoday.com/index.php/journal/article/view/187
  23. Ohannessian R, Duong TA, Odone A. Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: A call to action. JMIR Public Health Surveill 2020;6(2):e18810. URL: https://publichealth.jmir.org/2020/2/e18810.doi:10.2196/18810
  24. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic - United States, January-March 2020. Morb Mortal Wkly Rep 2020 Oct 30;69(43):1595-9. doi: 10.15585/mmwr.mm6943a3. Erratum in: Morb Mortal Wkly Rep. 2020 Nov 13;69(45):1711.
  25. Willems LM, Balcik Y, Noda AH, et al. SARS-CoV-2- related rapid reorganization of an epilepsy outpatient clinic from personal appointments to telemedicine services: A German single-center experience. Epilepsy Behav 2020 Nov;112:107483. doi: 10.1016/j.yebeh.2020.107483. Epub 2020 Oct 6.
  26. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006;3(2):77-101.
  27. Scott RE, Mars M. Telehealth in the developing world: current status and future prospects. Smart Homecare Technology and Telehealth 2015 Feb 2; 3: 25-37. doi: 10.2147/SHTT.S75184
  28. Picot J. Meeting the need for educational standards in the practice of telemedicine and telehealth. J Telemed Telecare 2000;6 Suppl 2:S59-62. doi: 10.1258/1357633001935608.
  29. Saeed SA, Johnson TL, Bagga M, Glass O. Training residents in the use of telepsychiatry: Review of the literature and a proposed elective. Psychiatr Q 2017 Jun; 88(2):271-283. doi: 10.1007/s11126-016-9470-y.
  30. Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: Challenges and opportunities for innovation. J Adolesc Health 2020 Aug;67(2):164-71. doi: 10.1016/j.jadohealth.2020.05.006. Epub 2020 May 14.
  31. Nittari G, Khuman R, Baldoni S, et al. Telemedicine practice: Review of the current ethical and legal challenges. Telemed J E Health 2020 Dec;26(12):1427-37. doi: 10.1089/tmj.2019.0158. Epub 2020 Feb 12.
  32. Kotsopoulou A, Melis A, Koutsompou VI, Karasarlidou C E-therapy: The ethics behind the process. Procedia Comput Sci 2015;65:492–9. doi: 10.1016/j.procs.2015.09.120.
  33. Krupinski EA. Telemedicine workplace environments: Designing for success. Healthcare (Basel) 2014 Feb 24;2(1):115-22. doi: 10.3390/healthcare2010115.
  34. Colbert GB, Venegas-Vera AV, Lerma EV. Utility of telemedicine in the COVID-19 era. Rev Cardiovasc Med 2020 Dec 30;21(4):583-7. doi: 10.31083/j.rcm.2020.04.188.
  35. Gomez T, Anaya YB, Shih KJ, Tarn DM. A qualitative study of primary care physicians’ experiences with telemedicine during COVID-19. J Am Board Fam Med 2021 Feb;34(Suppl):S61-S70. doi: 10.3122/jabfm.2021. S1.200517.
  36. Kahn JM. Virtual visits--confronting the challenges of telemedicine. N Engl J Med 2015 Apr 30;372(18):1684-5. doi: 10.1056/NEJMp1500533.
  37. Ananthakrishnan AN, Singh S. The doctor will call you now! Telemedicine in the midst of a pandemic. Clin Gastroenterol Hepatol 2020 Jul;18(8):1688-90. doi: 10.1016/j.cgh.2020.04.031. Epub 2020 Apr 18.
  38. Quimba FMA, Calizo SC. Going digital: From innovation to inclusive growth in the Philippines. PIDS Discussion Paper Series [Internet]. 2018 Nov; [cited 2020 Apr 29], Available from: https://pidswebs.pids.gov.ph/CDN/PUBLICATIONS/pidsdps1819.pdf
  39. Paul G, Stegbauer C. Is the digital divide between young and elderly people increasing? First Monday 2005 Oct 3;10(10). doi: 10.5210/fm.v10i10.1286
  40. Rush KL, Howlett L, Munro A, Burton L. Videoconference compared to telephone in healthcare delivery: A systematic review. Int J Med Inform 2018 Oct;118:44-53. doi: 10.1016/j.ijmedinf.2018.07.007. Epub 2018 Jul 25.
  41. Rodriguez JA, Betancourt JR, Sequist TD, Ganguli I. Differences in the use of telephone and video telemedicine visits during the COVID-19 pandemic. Am J Manag Care 2021 Jan;27(1):21-6. doi: 10.37765/ajmc.2021.88573.
  42. Chilelli NC, Dalfrà MG, Lapolla A. The emerging role of telemedicine in managing glycemic control and psychobehavioral aspects of pregnancy complicated by diabetes. Int J Telemed Appl 2014; 621384. doi: 10.1155/2014/621384. Epub 2014 Sep 10.
  43. Reforma LG, Duffy C, Collier AY, et al. A multidisciplinary telemedicine model for management of coronavirus disease 2019 (COVID-19) in obstetrical patients. Am J Obstet Gynecol MFM 2020 Nov;2(4):100180. doi: 10.1016/j.ajogmf.2020.100180. Epub 2020 Jul 25.

Tools


Copyright © 2024  KITE Digital Educational Solutions |  Exclusively distributed by CE-Logic