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      Knowledge and Attitude Regarding Telemedicine Among Doctors in Karachi

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          Abstract

          Background

          Telemedicine is an affordable use of information and communication technology (ICT) to enable long-distance patient care and health care services. While the developed world continues to take advantage of this technology, its concept remains new to Pakistan. This study aims to assess the knowledge and perceptions regarding telemedicine among health care professionals in Karachi, Pakistan.

          Methods 

          This cross-sectional study was carried out among doctors employed in the public health sector in Karachi from June 2018 to August 2018. Data were collected using a self-designed well-structured questionnaire using a five-point Likert scale, built after an extensive literature review. Statistical analysis was carried out using SPSS version 22. Categorical data were reported as frequencies and percentages.

          Results

          A total of 224 doctors, working in the Department of Internal Medicine (27.6%), Pediatrics (9.8%), Cardiology (6.6%), Gynecology (5.35%), Neurology (5.8%), and other specialties (44.6%), participated in the study. A total of 80.7 % of the doctors were aware of the definition of telemedicine. A total of 28.1% of them believed telemedicine to be effective in providing faster medical care while 23.2% thought of it as a means of reducing the white coat syndrome. A total of 42.9% believed that telemedicine disrupts the doctor-patient relationship and causes a breach of patient privacy. A total of 34.8% of the doctors favored the idea of introducing national standards for practicing telemedicine while 33.5% of doctors also agreed that providing a legal explanation of telemedicine to patients was of paramount importance. Poverty and lack of education (90.6%) was thought to be the biggest barrier to the practice of telemedicine in the developing world.

          Conclusions

          The knowledge regarding telemedicine among doctors in Karachi was found to be average. However, the perceptions about and attitude towards the introduction and implementation of this new technology were welcomed by the majority of participants with an emphasis on increasing awareness. Conferences and workshops are needed to increase knowledge about telemedicine in Pakistan.

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          Most cited references18

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          Effectiveness and Cost-Effectiveness of eHealth Interventions in Somatic Diseases: A Systematic Review of Systematic Reviews and Meta-Analyses

          Background eHealth potentially enhances quality of care and may reduce health care costs. However, a review of systematic reviews published in 2010 concluded that high-quality evidence on the benefits of eHealth interventions was still lacking. Objective We conducted a systematic review of systematic reviews and meta-analyses on the effectiveness/cost-effectiveness of eHealth interventions in patients with somatic diseases to analyze whether, and to what possible extent, the outcome of recent research supports or differs from previous conclusions. Methods Literature searches were performed in PubMed, EMBASE, The Cochrane Library, and Scopus for systematic reviews and meta-analyses on eHealth interventions published between August 2009 and December 2012. Articles were screened for relevance based on preset inclusion and exclusion criteria. Citations of residual articles were screened for additional literature. Included papers were critically appraised using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement before data were extracted. Based on conclusions drawn by the authors of the included articles, reviews and meta-analyses were divided into 1 of 3 groups: suitable, promising, or limited evidence on effectiveness/cost-effectiveness. Cases of uncertainty were resolved by consensus discussion. Effect sizes were extracted from papers that included a meta-analysis. To compare our results with previous findings, a trend analysis was performed. Results Our literature searches yielded 31 eligible reviews, of which 20 (65%) reported on costs. Seven papers (23%) concluded that eHealth is effective/cost-effective, 13 (42%) underlined that evidence is promising, and others found limited or inconsistent proof. Methodological quality of the included reviews and meta-analyses was generally considered high. Trend analysis showed a considerable accumulation of literature on eHealth. However, a similar percentage of papers concluded that eHealth is effective/cost-effective or evidence is at least promising (65% vs 62%). Reviews focusing primarily on children or family caregivers still remained scarce. Although a pooled (subgroup) analysis of aggregate data from randomized studies was performed in a higher percentage of more recently published reviews (45% vs 27%), data on economic outcome measures were less frequently reported (65% vs 85%). Conclusions The number of reviews and meta-analyses on eHealth interventions in patients with somatic diseases has increased considerably in recent years. Most articles show eHealth is effective/cost-effective or at least suggest evidence is promising, which is consistent with previous findings. Although many researchers advocate larger, well-designed, controlled studies, we believe attention should be given to the development and evaluation of strategies to implement effective/cost-effective eHealth initiatives in daily practice, rather than to further strengthen current evidence.
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            Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth 2009 (Global Observatory for eHealth Series, Volume 2)

            Seewon Ryu (2012)
            Information systems and communication technologies (ICTs) gave us new and innovative wave of communication life such as living in cyber space, instant messaging, and communications with whom anyone in anywhere. These are changing not only life-style, but also mode of business in every industry. Health care service industry is resource-intensive, process-oriented, and doing business traditionally by method of confrontation between medical professionals and patients. ICTs have great potential to address some of the challenges faced by both developed and developing countries in providing accessible, cost-effective, high-quality health care services. Telemedicine uses ICTs to overcome geographical barriers, and increase access to health care services. These are particularly beneficial for rural and underserved communities in developing countries - groups that traditionally suffered from lack of access to health care. In light of this potential, the World Health Organization (WHO) established the Global Observatory for eHealth (GOe) to review the benefits that ICTs can bring to health care and patients' wellbeing. The Observatory is charged with determining the status of eHealth solutions, including telemedicine, at the national, regional, and global levels, and providing WHO's Member States with reliable information and guidance on best practices, policies, and standards in eHealth. In 2005, following the formation of WHO's eHealth strategy, the Observatory conducted a global eHealth survey to obtain general information about the state of eHealth among Member States. Based on the data from that survey, the GOe carried out a second global survey in 2009; it was designed to explore eight thematic areas in detail, the results of each being reported and analysed in individual publications - the Global Observatory for eHealth series. The telemedicine module of the 2009 survey examined the current level of development of four fields of telemedicine: teleradiology, teledermatogy, telepathology, and telepsychology, as well as four mechanisms that facilitate the promotion and development of telemedicine solutions in the short- and long-term: the use of a national agency, national policy or strategy, scientific development, and evaluation. Telemedicine - opportunities and developments in Member States discusses the results of the telemedicine module, which was completed by 114 countries (59% of Member States). There are comprehensive reviews about telemedicine in the world; Overview of telemedicine: definition, history, applications, and potential barriers to telemedicine diffusion Telemedicine in developing countries such as Mongolia, Mexico Barriers, Legal and ethical considerations, to realizing the promise of telemedicine in developing Implications for telemedicine development, implementation, evaluation, and sustainability GOe Second Global Survey on eHealth: Methods and process Telemedicine services in the world by groups Telemedicine initiatives occurring around the world Norway's teleECG initiative Factors facilitating telemedicine development: Governance, policy and strategy, scientific development, evaluation processes The Swinfen Charitable Trust Telemedicine Network Discussions and recommendations about factors facilitating and barriers to telemedicine development Following the analysis of the survey results, WHO recommends steps Member States can take to capitalize on the potential of ICTs. One such step is creation of national agencies to coordinate telemedicine and eHealth initiatives, ensuring they are appropriate to local contexts, cost-effective, consistently evaluated, and adequately funded as part of integrated health service delivery. Ultimately telemedicine initiatives should strengthen - rather than compete with - other health services. Korea has been implementing trial projects of telemedicine in limited service area and populations for more than twenty years from the late 1980s. The Korean Government continued trial projects to develop safe and efficient telemedicine model, and intended to economic buildup. However, medical professional groups think that telemedicine would not be safe, and they are worried about whether it would be beneficial to themselves and patients. Scientists and medical doctors in cooperation with ICTs companies and local governments have been tried various models of telemedicine for more than 20 years in Korea. Recently, effectiveness of telemedicine in public health care has been revealed: compliance and effectiveness of telemedicine of hypertensive patients in the underserved communities [1,2], and effectiveness of eHealth services of public area [3], factors to adoption of telehealth services [4], and the effect of eHealth services of managing metabolic syndrome in rural area [5]. There are also accumulated and structured experiences and technological and managerial systems in participants of telemedicine projects. In Korea, a bill about telemedicine to the limited underserved populations and communities was made and submitted to the national assembly in May, 2010. The Ministry of Health and Welfare should have more interest and be active to realize the needed and safe telemedicine services. We recommend this report to those persons or groups interested about telemedicine in Korea and other countries that do not think about telemedicine, and are hesitating to adopt actively. Especially, we should understand what were successful service models and technological systems of eHealth in view of their culture and healthcare policy, and consider those factors facilitating and barriers of telemedicine recommended in the last of report. We expect that the report would be contributed that telemedicine be an alternative and useful solution to the communities underserved, and the general public, in case of limited and indispensible case.
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              Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status

              Background Mobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps. Objective The objective of this study was to explore behaviors and perceptions about mobile phone–based apps for health among individuals with chronic conditions. Methods Data were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition. Results Among participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity. Conclusions Results from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                9 February 2020
                February 2020
                : 12
                : 2
                : e6927
                Affiliations
                [1 ] Internal Medicine, Jinnah Sindh Medical University (SMC), Karachi, PAK
                [2 ] Internal Medicine, Dow University of Health Sciences, Karachi, PAK
                [3 ] General Surgery, Jinnah Sindh Medical University (SMC), Karachi, PAK
                [4 ] Internal Medicine, Dow Medical College, Civil Hospital Karachi, Karachi, PAK
                [5 ] Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
                Author notes
                Article
                10.7759/cureus.6927
                7065727
                32190480
                22307294-f9f3-4404-b2f9-70f5e706cbd9
                Copyright © 2020, Ashfaq et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 December 2019
                : 9 February 2020
                Categories
                Medical Education
                Healthcare Technology
                Epidemiology/Public Health

                telemedicine,e-health,knowledge,attitudes,remote consultation,doctors,karachi

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