Will telemedicine survive after COVID-19?

Brunet, Fabrice; Malas, Kathy; Desrosiers, Marie-Eve

doi:10.1177/08404704211031264

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Will telemedicine survive after COVID-19?

Author(s): Fabrice Brunet ¹ ^, ² , Kathy Malas ¹ ^, ² , Marie-Eve Desrosiers ³

Publication date (Electronic): August 03 2021

Journal: Healthcare Management Forum

Publisher: SAGE Publications

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Abstract

During the last 20 years, telemedicine has evolved in Quebec despite several barriers. We studied how a university health centre in Montreal implemented a strategy to enhance the use of telemedicine with the deployment of appropriate infrastructures, continuous training, and the use of advanced technologies, before and during the pandemic. COVID-19 accelerated the use of telemedicine by overcoming some pre-existing barriers. However, telemedicine was mainly limited to a distance consultation during the pandemic using telephone calls or videoconference. The future of telemedicine depends on lifting these obstacles. We need to better define telemedicine and in-person medicine to guarantee the quality of medical and professional acts. We propose some strategies to achieve these goals, combining cultural change, continuous training, new technologies to improve quality of care, and a vision of healthcare with telemedicine oriented on value creation.

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Most cited references 12

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Evaluating barriers to adopting telemedicine worldwide: A systematic review

Clemens Scott Kruse, Priyanka Karem, Kelli Shifflett … (2016)

Introduction and objective Studies on telemedicine have shown success in reducing the geographical and time obstacles incurred in the receipt of care in traditional modalities with the same or greater effectiveness; however, there are several barriers that need to be addressed in order for telemedicine technology to spread. The aim of this review is to evaluate barriers to adopting telemedicine worldwide through the analysis of published work. Methods The authors conducted a systematic literature review by extracting the data from the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed (MEDLINE) research databases. The reviewers in this study analysed 30 articles (nine from CINAHL and 21 from Medline) and identified barriers found in the literature. This review followed the checklist from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009. The reviewers organized the results into one table and five figures that depict the data in different ways, organized by: barrier, country-specific barriers, organization-specific barriers, patient-specific barriers, and medical-staff and programmer-specific barriers. Results The reviewers identified 33 barriers with a frequency of 100 occurrences through the 30 articles. The study identified the issues with technically challenged staff (11%), followed by resistance to change (8%), cost (8%), reimbursement (5%), age of patient (5%), and level of education of patient (5%). All other barriers occurred at or less than 4% of the time. Discussion and conclusions Telemedicine is not yet ubiquitous, and barriers vary widely. The top barriers are technology-specific and could be overcome through training, change-management techniques, and alternating delivery by telemedicine and personal patient-to-provider interaction. The results of this study identify several barriers that could be eliminated by focused policy. Future work should evaluate policy to identify which one to lever to maximize the results.

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Telemedicine Practice: Review of the Current Ethical and Legal Challenges

Giulio Nittari, Ravjyot Khuman, Simone Baldoni … (2020)

Background: Telemedicine involves medical practice and information and communications technology. It has been proven to be very effective for remote health care, especially in areas with poor provision of health facilities. However, implementation of these technologies is often hampered by various issues. Among these, ethical and legal concerns are some of the more complex and diverse ones. In this study, an analysis of scientific literature was carried out to identify the ethical and legal challenges of telemedicine. Materials and Methods: English literature, published between 2010 and 2019, was searched on PubMed, Scopus, and Web of Science by using keywords, including “Telemedicine,” “Ethics,” “Malpractice,” “Telemedicine and Ethics,” “Telemedicine and Informed consent,” and “telemedicine and malpractice.” Different types of articles were analyzed, including research articles, review articles, and qualitative studies. The abstracts were evaluated according to the selection criteria, using the Newcastle–Ottawa Scale criteria, and the final analysis led to the inclusion of 22 articles. Discussion: From the aforementioned sample, we analyzed elements that may be indicative of the efficacy of telemedicine in an adequate time frame. Ethical aspects such as informed consent, protection data, confidentiality, physician's malpractice, and liability and telemedicine regulations were considered. Conclusions: Our objective was to highlight the current status and identify what still needs to be implemented in telemedicine with respect to ethical and legal standards. Gaps emerged between current legislation, legislators, service providers, different medical services, and most importantly patient interaction with his/her data and the use of that data.

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Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study

Sharon E Orrange, Arpna Patel, Wendy Jean Mack … (2021)

Background Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit. Methods In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r =0.51, P <.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit ( r =–0.16), concerns about privacy ( r =–0.19), concerns about cost ( r =–0.23), satisfaction with telemedicine convenience ( r =0.41), and amount of time spent ( r =0.47; all P <.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues ( P <.001), less concern about privacy ( P <.001) or cost ( P =.02), and successful face-to-face video ( P <.001). The only patient variable with a significant positive association was income and level of trust in physician ( r =0.18, P <.001). Younger age was associated with higher satisfaction with the telemedicine visit ( P =.005). Conclusions There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed.