Commentary: Telemedicine: The unsung corona warrior

Facilitators and Barriers for Telemedicine Systems in India from Multiple Stakeholder Perspectives and Settings: A Systematic Review

Background: Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at health care facilities. However, its adoption in health care is not entirely realized due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian health care system, observed at the infrastructural, sociocultural, regulatory, and financial levels, from the perspectives of health care providers, patients, patient caregivers, society, health organizations, and the government. Methods: This review complies with the current Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2015. A total of 2,706 peer-reviewed studies published from December 2016 to September 2023 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE, and PsycInfo databases were considered for the title and abstract screening, after which 334 articles were chosen for the full-text review. In the end, 46 studies were selected for data synthesis. Results: Analysis of the literature revealed key barriers such as data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), infrastructure issues, and ICT training gaps. Facilitators included reduced health care delivery costs, enhanced patient access to health care in remote areas, and shorter patient wait times. The real-world experiences of Indian telemedicine practitioners and pioneers are also explored to complement literature-based perspectives on telemedicine implementation. Both stress the need for reliable internet connectivity, technological adoption, comprehensive ICT training, positive sociocultural attitudes, stringent data privacy measures, and viable business models as crucial for effective telemedicine adoption, with experts emphasizing practical adaptability alongside the literature-recognized facilitators.

Understanding the changes in practice patterns in ophthalmology following COVID-19 lockdown

Purpose:

Severe acute respiratory syndrome-Coronavirus 2 pandemic has brought the world to a halt. We performed a questionnaire-based survey to know more about these issues which affected them due to this pandemic and resultant lockdown.

Methods:

A questionnaire-based survey (53 questions) was conducted online among Indian ophthalmologists with a 2-week response time. The invitation to participate was also circulated widely among various ophthalmologists as members on different social media platforms and emails. It was mandatory to answer all the questions in the questionnaire to make it a valid response.

Results:

A total of 903 responses were received across the country. A majority of these responses, 403 (44.6%), were from private practitioners. Almost 876 (97%) of the responders had either kept the daily working hours as same as pre-COVID-19 era or had reduced the actual working hours. Overall, 547 (60.6%) responders did not downsize their staff and 569 (63%) did not reduce the staff salary. Consultation charges were not revised by a majority (659, 73%) of responders. Total of 663 (73.4%) were following the appointment system and 702 (77.7%) responders had reduced the number of patients to less than 6 an hour. Only 106 (11.7%) were doing a mandatory RT-PCR test before surgery, whereas 567 (62.8%) did on the basis of suspicious symptoms.

Conclusion:

Our survey gives valuable inputs regarding the changes made by different ophthalmologist groups during the times of COVID-19 and lockdown.