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Singh M, Chauhan AS, Mukherjee R, Pawar P, Sharma D, Yoosuf AS, Vaishnav B, Nargotra S, Gudibanda KR, Mohapatra A. Stakeholders' Initial Experience With Telemedicine Services Introduced at 13 Government Medical Colleges in Uttar Pradesh, India During the COVID-19 Lockdown: A Qualitative Study. Cureus 2023; 15:e41269. [PMID: 37533613 PMCID: PMC10391304 DOI: 10.7759/cureus.41269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND India went into a stringent lockdown in response to the coronavirus disease 2019 (COVID-19) pandemic in March 2020, and routine outpatient and elective health services were suspended. Thus, access to healthcare services got significantly disrupted. To mitigate the impact, 21 state-owned medical colleges in Uttar Pradesh, the most populous and among the most resource-constrained states in India, had to hastily launch telemedicine (TM) services. This created an opportunity to understand how stakeholders would react to such services and what initial challenges could be faced during service delivery. Through this study, we explored the experiences of stakeholders from 13 such "new-adopter" TM centres with the main objective to identify the perceived benefits and gaps related to TM services, and what "people-centric" TM services could look like going forward. METHODS We used an exploratory-descriptive qualitative design with a constructivist paradigm. Using interview schedules with open-ended questions and unstructured probes, we interviewed 13 nodal officers, 20 doctors, and 20 patients (i.e., one nodal officer and one to two doctors and patients from each of the 13 new-adopter centres) and stopped thereafter since we reached saturation of information. We analysed the data on NVivo (QSR International, Burlington, MA) and reported the findings using the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS The perceived benefits that were reported included non-dependency on physical contact, economic benefit, better management of patient load, and ease of access to healthcare services. The common gaps identified in the TM services were lack of physical clinical examination, impeded communication due to lack of face-to-face interaction, technological challenges (e.g., inconsistent internet connectivity and unavailability of smartphones), lack of human resources and resources to manage the TM centres, cumbersome compliance requirements coupled with unclarity on medico-legal implications, and limited awareness of services among clients. Need for adequate promotion of TM services through information-education-communication efforts and frontline workers, strengthening of logistics for long-term sustainability, setting up a dedicated TM department at the hospitals, capacity building of the existing staff, reducing gaps in communication between doctors and patients for better consultation, and improved access to the prescribed medicines were some of the suggestions from different stakeholders. CONCLUSION The stakeholders clearly appreciated the benefits of TM services offered through the new-adopter centres amidst the pandemic disruptions. However, there were certain gaps and unmet expectations, which, if addressed, could improve the TM centres' performance with further people-centricity and enhance healthcare access and the popularity of system-based services. Avenues for sustaining the TM services and their efficient scale-up should be explored.
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Affiliation(s)
- Manish Singh
- Department of Community Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND
| | - Abhimanyu S Chauhan
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Ritika Mukherjee
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Priyanka Pawar
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Divita Sharma
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Ahmed Shammas Yoosuf
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Bharathi Vaishnav
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Shikha Nargotra
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Kavita Rajesh Gudibanda
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
| | - Archisman Mohapatra
- Department of Programs, Generating Research Insights for Development (GRID) Council, Noida, IND
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Roskvist R, Wearn A, Eggleton K, Gauznabi S, Goodyear-Smith F. Teaching medical students in general practice when conducting remote consults: a qualitative study. EDUCATION FOR PRIMARY CARE 2023; 34:204-210. [PMID: 37621057 DOI: 10.1080/14739879.2023.2243597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/08/2023] [Accepted: 07/23/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Telehealth involves real-time communication (telephone or video-call) between patients and health providers. The COVID-19 pandemic propelled general practitioners to conduct most consultations remotely, seeing patients face-to-face only when required. Placement opportunities and experience for medical students were reduced. Initially online learning programmes replaced clinical attachments. Subsequently, clinical teachers supervised students to engage in remote consultations, either in clinics or from their homes. This study aimed to explore the experience of New Zealand general practitioners undertaking clinical teaching with medical students when telehealth consulting. METHODS Semi-structured interviews with general practitioners who had taught medical students whilst consulting remotely. General inductive thematic analysis of transcribed interviews. RESULTS Six female and four male participants aged 40 to over 65 years. Participants often focused on general practicalities of telehealth consultations and effects on the patient-doctor relationship, and needed direction to consider remote consultations with students, which added to the interactions. Four themes were identified: changes needed in teaching delivery format; direct comparison with face-to-face; challenges and advantages to remote teaching, each with subthemes. DISCUSSION Clinicians needed to determine practical logistics and develop skills for both remote consulting and teaching. New format and structures of consultations needed planning. Differences from face-to-face teaching included scene-setting for the consultation and supervision factors. Telehealth teaching conferred new opportunities for learning but also challenges (e.g. consent, cues, uncertainty). Remote consultations are likely to remain a significant mode for doctor-patient interactions. Preliminary guidelines for teaching and learning using telehealth need to be developed and embedded into medical programmes and then evaluated.
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Affiliation(s)
- Rachel Roskvist
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Andy Wearn
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Kyle Eggleton
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Shomel Gauznabi
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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Solanes-Cabús M, Paredes E, Limón E, Basora J, Alarcón I, Veganzones I, Conangla L, Casado N, Ortega Y, Mestres J, Acezat J, Deniel J, Cabré JJ, Ruiz DS, Sánchez M, Illa A, Viñas I, Montero JJ, Cantero FX, Rodriguez A, Martín F, Baré M, Ripollés R, Castellet M, Lozano J, Sisó-Almirall A. Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1600. [PMID: 36674354 PMCID: PMC9866570 DOI: 10.3390/ijerph20021600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.
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Affiliation(s)
- Mònica Solanes-Cabús
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Onze de Setembre, Institut Català de la Salut, 25005 Lleida, Spain
| | - Eugeni Paredes
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Onze de Setembre, Institut Català de la Salut, 25005 Lleida, Spain
| | - Esther Limón
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Ronda Prim, Mataró, Institut Català de la Salut, 08302 Barcelona, Spain
| | - Josep Basora
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- IDIAP Jordi Gol, Institut Català de la Salut, 08007 Barcelona, Spain
| | - Iris Alarcón
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Service Dreta i Muntanya Barcelona, Institut Català de la Salut, 08007 Barcelona, Spain
| | - Irene Veganzones
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- School of Medicine, Vic University, 08500 Barcelona, Spain
| | - Laura Conangla
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Badalona Centre, Institut Català de la Salut, 08911 Barcelona, Spain
| | - Núria Casado
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Nova Lloreda, Badalona Serveis Assistencials, 08917 Barcelona, Spain
| | - Yolanda Ortega
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Salou, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Jordi Mestres
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Sanllehy, Institut Català de la Salut, 08024 Barcelona, Spain
| | - Jordi Acezat
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Casernes, Institut Català de la Salut, 08030 Barcelona, Spain
| | - Joan Deniel
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Multiprofessional Teaching Unit of Primary Care in Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain
| | - Joan Josep Cabré
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Reus-1, Institut Català de la Salut, 43202 Tarragona, Spain
| | - Daniel Sánchez Ruiz
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Sardenya, ACEBA, 08025 Barcelona, Spain
| | - Marcos Sánchez
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Les Corts, CAPSBE, 08028 Barcelona, Spain
| | - Aroa Illa
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Celrà, Institut Català de la Salut, 17460 Girona, Spain
| | - Ignasi Viñas
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Montilivi-Vilaroja, Institut Català de la Salut, 17003 Girona, Spain
| | - Juan José Montero
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Rocafonda, Institut Català de la Salut, 08304 Barcelona, Spain
| | - Francesc Xavier Cantero
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Igualada Urbà, Institut Català de la Salut, 08700 Barcelona, Spain
| | - Anna Rodriguez
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Santa Eugènia de Berga, Institut Català de la Salut, 08507 Barcelona, Spain
| | - Francisco Martín
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Healthcare Research Support Unit, Departament of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Tarragona, Spain
| | - Montserrat Baré
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Creu Alta, Institut Català de la Salut, 08208 Barcelona, Spain
| | - Rosa Ripollés
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Temple, Institut Català de la Salut, Terres de l’Ebre, 43500 Tarragona, Spain
| | - Montse Castellet
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Dr. Joan Mirabell, Institut Català de la Salut, 08006 Barcelona, Spain
| | - Joan Lozano
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
| | - Antoni Sisó-Almirall
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Les Corts, CAPSBE, 08028 Barcelona, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
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Macariola AD, Santarin TMC, Villaflor FJM, Villaluna LMG, Yonzon RSL, Fermin JL, Kee SL, AlDahoul N, Karim HA, Tan MJT. Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines. Front Pharmacol 2021; 12:754011. [PMID: 34819860 PMCID: PMC8606793 DOI: 10.3389/fphar.2021.754011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Aitana Dy Macariola
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines
| | | | | | | | | | - Jamie Ledesma Fermin
- Yo-Vivo Corporation, Bacolod City, Philippines.,Department of Electronics Engineering, University of St. La Salle, Bacolod, Philippines
| | - Shaira Limson Kee
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines.,Yo-Vivo Corporation, Bacolod City, Philippines
| | - Nouar AlDahoul
- Yo-Vivo Corporation, Bacolod City, Philippines.,Faculty of Engineering, Multimedia University, Cyberjaya, Malaysia
| | | | - Myles Joshua Toledo Tan
- Department of Natural Sciences, University of St. La Salle, Bacolod, Philippines.,Yo-Vivo Corporation, Bacolod City, Philippines.,Department of Chemical Engineering, University of St. La Salle, Bacolod, Philippines
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Fabricius MM, Hitchcock NM, Reuter ZC, Simon ME, Pierce RP. Impact of the COVID-19 Pandemic & Telehealth Implementation in a Student Run Free Clinic. J Community Health 2021; 47:179-183. [PMID: 34550505 PMCID: PMC8456683 DOI: 10.1007/s10900-021-01034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 10/27/2022]
Abstract
Student run free clinics (SRFCs) fill a void in healthcare access for many communities and have been subject to unprecedented shifts in care delivery brought about by the coronavirus disease 2019 (COVID-19) pandemic. Our single-center institution serving uninsured patients in central Missouri switched from in-person visits to strictly telehealth visits with the onset of the pandemic. This study investigated the impact of the pandemic and the switch to telehealth on the clinic return rates by ethnicity, race, gender, rurality, and age. The pandemic led to a 47.4% reduction in the number of monthly patient encounters. Of the established SRFC population (N = 309), only 87 patients (28.2%) returned for a telehealth visit during the COVID-19 pandemic. Older patients (≥ 45 years old) were more likely to return (OR 1.71, 95% CI 1.02-2.85) for care via telehealth after the onset of the pandemic than younger patients (< 45 years old). No differences in the likelihood of returning for a telehealth visit were identified by race, ethnicity, gender, or rurality. Telehealth offers an effective solution to the complex problems faced by SRFCs during the COVID-19 pandemic and has not added barriers to care with regards to race, ethnicity, gender, or rurality at our SRFC.
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Affiliation(s)
- Michela M Fabricius
- University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA.
| | - Nicole M Hitchcock
- University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA
| | - Zachary C Reuter
- University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA
| | - Madeline E Simon
- University of Missouri School of Medicine, One Hospital Drive, Columbia, MO, USA
| | - Robert P Pierce
- Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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