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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 8
| Issue : 1 | Page : 37-43 |
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Knowledge, attitude, and Practices of telemedicine among the health-care practitioners during COVID pandemic: A cross-sectional study
Mahalaxmi S Petimani1, Nagapati P Bhat2, P Preethishree3, Prabhakar Adake2
1 Associate Professor of Biochemistry, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
2 Associate Professor of Pharmacology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
3 Assistant Professor of Microbiology, Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore, Karnataka, India
| Date of Submission | 28-Jul-2021 |
| Date of Decision | 24-Nov-2021 |
| Date of Acceptance | 27-Dec-2021 |
| Date of Web Publication | 8-Jul-2022 |
Correspondence Address:
Prabhakar Adake
Yenepoya Medical College, Yenepoya (Deemed to be University), Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcrsm.jcrsm_59_21
Introduction: COVID pandemic created a difficult situation for the medical fraternity. Many health-care practitioners achieved their work through telemedicine. For delivering better patient care, especially during the pandemic, the present study was conducted to assess the Knowledge, Attitude, and Practices (KAP) of telemedicine among healthcare practitioners of our institution.
Materials and Methods: A prevalidated questionnaire form containing 13 questions on KAP of telemedicine was circulated to health-care practitioners through Google Form by snowball technique. A total of 96 responses were collected. Descriptive statistical method was applied and results are expressed in percentages.
Results: Out of 96 responses, 61 (63.5%) were from men and 35 (36.5%) from women. About 63.5% of health-care practitioners were aware of the term telemedicine, 22.9% were aware but not practising, and 13.5% were aware and currently practising telemedicine. Regarding the mode of telemedicine, 42.7% preferred video calling (Skype/hangout/WhatsApp), followed by 27.1% personalized website (HODO/Healzapp), 17.7% by text message (SMS/Email/Fax), and 12.5% for an audio phone call. With respect to taking consent, 59.4% expressed that consent is required and 40.6% expressed that consent is implied when the patient initiates the call. Regarding challenges in telemedicine, 83.3% expressed that clinical examinations cannot be done, 76% for connectivity issues, 55.2% worried about patient safety, and 54.2% for medico-legal issues. 53.1% of health-care practitioners would like to charge the same fees for telemedicine, followed by 27.1% lower fees, 12.5% no fees, and 7.3% would like to charge higher fees than routine.
Conclusion: Telemedicine is essential for patient care, especially during a pandemic. Hence, National Medical Commission should incorporate telemedicine modules in the undergraduate curriculum for better patient care.
Keywords: Health-care practitioners, pandemic, telemedicine
How to cite this article:
Petimani MS, Bhat NP, Preethishree P, Adake P. Knowledge, attitude, and Practices of telemedicine among the health-care practitioners during COVID pandemic: A cross-sectional study. J Curr Res Sci Med 2022;8:37-43 |
How to cite this URL:
Petimani MS, Bhat NP, Preethishree P, Adake P. Knowledge, attitude, and Practices of telemedicine among the health-care practitioners during COVID pandemic: A cross-sectional study. J Curr Res Sci Med [serial online] 2022 [cited 2023 May 30];8:37-43. Available from: https://www.jcrsmed.org/text.asp?2022/8/1/37/347049 |
| Introduction | |  |
Due to the spread of COVID-19 across the World, many countries implemented unprecedented measures like suspension of public transportation, the closing of public spaces, close management of communities, isolation and care for infected people, and suspected cases.[1] The government had enforced and extended lockdown and movement control orders for the entire India, wherein residents are also required to just stay at home to avoid contact with others. Because of the increased number of active cases after unlocking, both the patients and the doctors are equally finding it difficult to deal with the emergency conditions and other consultations/treatments. As per the World Health Organization, telemedicine is the delivery of health-care services, where distance is a critical factor, by all healthcare professionals using information and communication technologies for the exchange of information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and for the continuing education of health-care providers, all in the interests of advancing the health of individuals and their communities.[2] Developing countries have opted for telemedicine to address various issues which are being faced by the health-care delivery system, like inadequate health infrastructure and clinical services and paucity of qualified doctors. Since most of the specialists are busy with COVID duties, the regular non-COVID patients are facing difficulty in getting specialist care.
Information and Communication Technology (ICT) has evolved dramatically over time, even in the health sector. With the help of ICT, telemedicine has the potential to fundamentally change the current practice of medical care. Due to the increased number of COVID-19 cases across the country and increasing anxiety among the patients about their emergencies and treatments, telemedicine would be a useful tool to provide patient education, consultation and in creating awareness by maintaining physical distancing and yet providing necessary information and primary care. Knowing the current knowledge, attitude, and practice (KAP) about telemedicine among the health-care practitioners would facilitate us to expand their knowledge and its applications into their future clinical practice.
Given the ongoing COVID-19 crisis, on March 25, 2020, the Board of Governors in supersession of the Medical Council of India along with NITI Aayog recognized the need to protect and preserve the functioning and efficiency of the health-care practitioners and released “Telemedicine Practice Guidelines” as an amendment in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulation, 2002. It is now legal to provide telemedicine consultation and prescription by Registered Medical Practitioners (RMPs) as per compliance with guidelines.[3]
To know the gaps and implement telemedicine, the present study was conducted to assess the KAP toward Telemedicine among health-care practitioners of our institution.
| Materials and Methods | | |
This is a questionnaire-based cross-sectional study conducted from October 20, 2020, to December 20, 2020, in Yenepoya Medical College, Mangalore, after the ethics committee approval (YEC-1/2020/056). A questionnaire form [Annexure 1] containing 13 questions on KAP of telemedicine was structured by the authors, and face validity was done by two external members. The questionnaire form was circulated via WhatsApp and email to various health-care practitioners of our institution through Google Form by snowball technique. Informed consent was obtained (in Google Form) from the health-care practitioners after describing the purpose of the study and the assurance to maintain anonymity and confidentiality. A total of 96 responses (with a 5% level of significance and fixing precision at 10%)[4] were collected. The responses along with the demographic data of the participants were analyzed and interpreted. A descriptive statistical method was applied and results are expressed in percentages.
| Results | | |
[Table 1] shows demographic details of participated health-care practitioners. Out of 96 responses, 61 (63.5%) were men and 35 (36.5%) women. There was equal participation from the healthcare practitioners of different designations and teachers of different phases of MBBS.{Table 1}
In our study, nearly 63.5% of the participants said they are well aware of telemedicine and 22.9% of participants said they are aware but not practising and 13.5% of participants said they are well aware and even practising telemedicine for patient care. Hence, it depends on the treating doctor to practice telemedicine depending on the clinical condition as well.
Regarding views of health-care practitioners on the usefulness of telemedicine, 66.7% of the participants opined that telemedicine is helpful when the patient is not able to visit a doctor. 60.4% opined that it is helpful during the pandemic, and 24% said that telemedicine is time-saving and convenient to both patients and doctors.
For practising telemedicine, 53.1% of health-care practitioners would like to use smartphones followed by laptops (30.2%), desktops (9.4%), and tablets (6.3%). Regarding the mode of telemedicine, 42.7% preferred video calling (Skype/hangout/WhatsApp), followed by 27.1% by a personalized website (HODO/Healzapp), 17.7% by text message (SMS/Email/Fax), and 12.5% for an audio phone call.
With respect to taking consent in telemedicine, 59.4% expressed that consent is required and 40.6% of health-care practitioners expressed that consent is implied when the patient initiates the call. About 94.8% of health-care practitioners want to communicate only with patients in telemedicine, 67.7% with caregivers, and the remaining 47.9% with other RMPs.
[Figure 1] shows the opinions of the health-care practitioners for a prescription through telemedicine consultation. 63.5% are aware that valid e-prescription is required, 60.4% opined that only over-the-counter medicines can be prescribed, 37.5% expressed that prescribing antibiotics and injections is difficult, and the remaining 28.1% advised that add-on drugs can be prescribed for diabetes and hypertension.{Figure 1}
Regarding medical services that can be offered through telemedicine, 56.3% expressed that adverse events are difficult to find in telemedicine, 55.2% opined that referral services can be easily done, 51% for laboratory services and the remaining 20.8% mentioned that adverse drug reactions can be easily identified in telemedicine.
[Figure 2] illustrates various challenges faced by health-care practitioners in telemedicine. About 83.3% expressed that clinical examinations cannot be done in telemedicine followed by 76% for connectivity issues, 55.2% worried about patient safety, 54.2% for medico-legal issues. Regarding consultation fees in telemedicine practice, 53.1% of health-care practitioners would like to charge the same routine fees followed by 27.1% lesser fees, 12.5% no fees, and 7.3% would like to charge higher fees than routine.{Figure 2}
[Figure 3] shows the purview of the health-care practitioners in including telemedicine as a part of the undergraduate curriculum. Twenty-four percent of health-care practitioners strongly agreed followed by 40.6% agreed, 19.8% were neutral, and 9.4% disagreed for implementation.{Figure 3}
| Discussion | | |
COVID pandemic has brought up newer challenges to the health-care system. Patient care and communication are the important parts of the health-care system apart from hospital setup and the availability of health-care workers in the hospital environment. On the other hand, the COVID situation has shown the importance of telemedicine among the health-care facilities to provide patient care, where the patient cannot approach the doctor by visiting the hospital physically due to lockdown and to avoid crowding in the hospitals. The implementation of telemedicine has proved better patient care and satisfaction as it provides communication with the treating doctor through the digital mode either by email, video conferencing, WhatsApp calling which increases the patient convenience and avoids traveling. Starting with the use of telephonic consultation, telemedicine has been reformed to more sophistication with technology to reach out to any patient in any place.[5],[6]
Medical practitioners can manage more patients than routine with improved access and connected level of care. Both doctors and patients can work together to achieve their therapeutic goals, particularly in the home environment.
Telemedicine will be a basic need for the health-care system and for COVID-19 patients who are quarantined. It enables them to provide immediate consultation for their health issues. Telemedicine consultation through live video conferencing can avoid direct contact and thereby reducing the risk of exposure and preventing the transmission of infection to physicians and other health-care workers.[7]
A study conducted by Mohammed Elhadi on telemedicine awareness, knowledge, and practices among health-care workers found that 28 (4.2%) participants in their study expressed laboratory findings could be shared with patients with telemedicine mode and 81 (12%) participants said that follow-up of the patients, treatment compliance, and response evaluation could be performed with telemedicine.[8] Whereas in our study, 51% of the participants expressed that laboratory services could be provided through telemedicine and 83.3% speculated that clinical examinations cannot be done and 55.2% of participants worried about patient safety.
In the same study, 616 (91.5%) participants thought that telemedicine could facilitate better doctor-patient communication and cooperation during the pandemic. Furthermore, 622 (92.4%) participants thought that telemedicine as a remote health-care facility saved a lot of their time. Accordingly, 606 (90%) participants felt that telemedicine could avoid the risk of exposure and transmission of COVID-19.[8] Similarly, in our study, 94.8% of participants expressed that treating doctors can have good communication with their patients, 67.7% felt communication can be done with caregivers too and 47.9% agreed for good communication with other RMPs. The majority of health-care practitioners in our study insisted implementation of telemedicine in the undergraduate curriculum; this not only makes it a cost-efficient service for the users and the service providers but also a safe mode of health-care delivery, especially during the pandemic.[9]
Another study by Kirubel Biruk and Eden Abetu in North West Ethiopia observed that 64% of the participants had good knowledge and attitude toward telemedicine. The majority of the participants were men and from a bachelor's degree.[10] A recent study by Rehana Parvin and Md Shahjahan included 112 doctors from Bangladesh for assessing KAP toward e-health. The study found that 78% of doctors had a favorable attitude and knowledge toward e-health. About 42% of doctors in this study were using e-health services for patient follow-ups and 63% of the doctors opted for mobile phones for e-health purposes.[11] The results of these two studies are very similar to our study findings. Most of our study participants were men (63%) and 53% of participants were comfortable in using mobile for telemedicine.
| Conclusion | | |
Telemedicine has been of great support to the health-care system for achieving better patient communication, monitoring, and treatment during the pandemic. The majority of the health-care practitioners in our study have enough knowledge and a good attitude with a greater extent of adopting it in treating patients in remote areas. The inclusion of telemedicine in the academic curriculum for undergraduates has been emphasized in our study as telemedicine proves to be a promising model of health-care managing system, especially in this pandemic time.
Acknowledgment
Authors are thankful to all the teaching faculties of Yenepoya Medical College, Mangalore, for their valuable contribution for this study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| Annexure Legend | | |
Annexure 1: Questionnaire form
Participant details:
Age: ________ Gender: ________
Designation: ________________
Department: ________________
(Note: Multiple options can be marked wherever necessary)
Questions:
11. Are you aware of telemedicine in clinical practice?
- Yes
- No
- If Yes, Are you currently practising telemedicine or practised before?
2. As a practitioner, what do you feel about telemedicine?
- It is helpful in pandemic situations
- It is advisable only when the patient is not able to visit a doctor
- It is time-saving and convenient both for patient and doctor
3. According to you, which device you would like to prefer for telemedicine?
- Desktop
- Laptop
- Smartphone
- Tablet
- Other, Specify: ________
4. What mode of telemedicine you would prefer for a patient?
- Text message: SMS/WhatsApp message/Fax/Email
- Audio: Phone call
- Video: Skype/Hangout/WhatsApp
- Personalized website/Systems like HODO/Healzapp
- Other, Specify: ________
5. As a practitioner, do you feel patient consent is required even in telemedicine?
- Yes
- No
- In most cases it is implied consent if the patient initiates the call to a doctor
6. In telemedicine, the practitioner can communicate with,
- Patients
- Caregivers
- Other Registered Medical Practitioners
7. As a practitioner, what do you feel about prescribing medicines in telemedicine?
- Only simple/over the counter drugs can be prescribed to a patients
- Prescribing antibiotics and injectable medication is difficult
- Valid e-prescription format is required
- Add on drugs for diabetes and hypertension can be advised
- Other, Specify:--------
8. As a practitioner, what is your opinion about the following services through telemedicine?
- Lab services/Imaging centre/Chemist should honour it
- Referral services can be done
- The adverse effect of medicines can be easily/quickly identified by telemedicine
- Difficult to identify the adverse effect of medicines by telemedicine
- Other, Specify:--------
9. What are the challenges you would face during telemedicine?
- Connectivity issue
- Problem with clinical examination, which affects your diagnosis and treatment
- Problem with taking consent
- Problem with prescription
- Problem with counselling
- Problem with fees
- Worried about medico-legal issues
- Worried about patient safety
- Other, Specify: ________
10. What do you feel about consultation fees in telemedicine?
- No Fees
- Less than routine fees
- Same as routine fees
- More than routine fees
11. What is the best way to collect fees in telemedicine?
- NEFT/IMPS (Directly to your account)
- Wallet transfer (Paytm/Amazon pay/G pay etc)
- Collecting cash in next offline visit
- Others: Specify____________
12. Do you feel training in telemedicine would benefit in practice?
- Yes
- No
- Can't say
13. As an academician and practitioner, what do you feel about incorporating telemedicine in UG/PG curriculum in future?
- Strongly agree
- Agree
- Don't know
- Disagree
- Strongly disagree
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