Challenges of Using Telemedicine in Hospital Specialty Consultations during the COVID-19 Pandemic in Portugal According to a Panel of Experts
DOI:
https://doi.org/10.20344/amp.19931Keywords:
COVID-19, Digital Health, Health Services Accessibility, Portugal, Referral and Consultation, TelemedicineAbstract
Introduction: The COVID-19 pandemic has accelerated the adoption of telemedicine as a means of reducing face-to-face contact and protecting professionals and patients. In Portugal, the number of hospital telemedicine consultations has significantly increased. However, the rapid implementation of telemedicine has also led to disparities in access to these services, resulting in inequalities in healthcare delivery. The aim of this study was to identify the main challenges to accessing hospital medical specialty consultations through telemedicine in Portugal during the COVID-19 pandemic. Additionally, this study aimed to establish a consensus on possible solutions for the challenges which were identified.
Methods: This study used the nominal group technique, which involved a panel of 10 experts. The panel generated a total of 71 ideas, which were then categorized into three groups: A) challenges relating to patients, which impact access to hospital-based medical specialty consultations through telemedicine; B) challenges relating to professionals, institutions and health systems, which impact access to hospital medical specialty consultations through telemedicine; C) recommendations to overcome the challenges faced in adopting telemedicine solutions. Each of the ideas was assessed, scored and ranked based on its relevance considering the study objectives.
Results: This study identified several significant challenges that impacted the adoption of telemedicine in Portugal during the COVID-19 pandemic. The challenges that related to patients (A) that were deemed the most relevant were low digital literacy, lack of information about telemedicine processes, low familiarity with technologies and distrust about the quality of services; the challenges that impacted healthcare professionals, institutions, and health systems (B) and were deemed the most relevant were the lack of integration of telemedicine in the patient’s journey, low motivation to adopt telemedicine solutions, poor interoperability between systems, and the absence of the necessary technological equipment. The most relevant recommendations (C) included investing in healthcare institutions, developing clear guidelines for the safety and quality of telemedicine practices, and incorporating telemedicine into the curricula of health professions.
Conclusion: This study identified several challenges that impacted the adoption and implementation of telemedicine services for hospital care in Portugal during the pandemic period. These challenges were related to digital health literacy, technological and operational conditions, and reluctance in technological adoption. To overcome these challenges, training programs for healthcare professionals and patients may be necessary, along with investment in technological infrastructures, interoperability between systems, effective communication strategies and the strengthening of specific regulations.
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Hincapié MA, Gallego JC, Gempeler A, Piñeros JA, Nasner D, Escobar MF. Implementation and usefulness of telemedicine during the COVID-19 pandemic: a scoping review. J Prim Care Community Health. 2020;11:1-7.
World Health Organization. Looking back at a year that changed the world: WHO’s response to COVID-19. Geneva: World Health Organization; 2021.
Sagan A, Webb E, Mckee M, Greer SL, Williams GA, Cylus J, et al. Health systems resilience during COVID-19: lessons for building back better. Copenhagen: WHO Regional Office for Europe; 2021.
Galiero R, Pafundi PC, Nevola R, Rinaldi L, Acierno C, Caturano A, et al. The importance of telemedicine during COVID-19 pandemic: a focus on diabetic retinopathy. J Diabetes Res. 2020;2020:1-8.
Jiang W, Magit AE, Carvalho D. Equal access to telemedicine during COVID-19 pandemic: a pediatric otolaryngology perspective. Laryngoscope. 2021;131:1175-9.
Omboni S, Padwal RS, Alessa T, Benczúr B, GreenB, Hubbard I, et al. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. Connect Heal. 2022;1:7-35.
Chauhan V, Galwankar S, Arquilla B, Benczúr B, Green B, Hubbard I, et al. Novel coronavirus (COVID-19): leveraging telemedicine to optimize care while minimizing exposures and viral transmission. J Emerg Trauma Shock. 2020;13:20-4.
Organisation for Economic Co-operation and Development. The COVID-19 pandemic and the future of telemedicine. Paris: OECD; 2023.
Ministério da Saúde. Entidade reguladora da saúde. informação de monitorização. impacto da pandemia COVID-19 no sistema de saúde. Porto: Entidade Reguladora da Saúde; 2020.
Ministério da Saúde. Serviço Nacional de Saúde. Consultas em telemedicina SNS. Portal da transparência SNS; 2022. [cited 2022 Aug 29]. Available from: https://www.sns.gov.pt/monitorizacao-do-sns/consultas-em-telemedicina/.
Vidal-Alaball J, Acosta-Roja R, Pastor Hernández N, Sanchez Luque U, Morrison D, Narejos Pérez S, et al. Telemedicine in the face of the COVID-19 pandemic. Atención Primaria. 2020;52:418-22.
Gareev I, Gallyametdinov A, Beylerli O, Valitov E, Alyshov A, Pavlov V, et al. The opportunities and challenges of telemedicine during COVID-19 pandemic. Front Biosci. 2021;13:291-8.
Khoshrounejad F, Hamednia M, Mehrjerd A, Pichaghsaz S, Jamalirad H, Sargolzaei M, et al. Telehealth-based services during the COVID-19 pandemic: a systematic review of features and challenges. Front Public Heal. 2021;9:711762.
Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. 2022;22:3-21.
Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Heal. 2020;67:164-71.
Manteghinejad A, Javanmard SH. Challenges and opportunities of digital health in a post-COVID19 world. J Res Med Sci. 2021;26:11.
Amorim P, Brito D, Castelo-Branco M, Fàbrega C, Gomes Da Costa F, Martins H, et al. Telehealth opportunities in the COVID-19 Pandemic early days: what happened, did not happen, should have happened, and must happen in the near future? Telemed e-Health. 2021;27:1194-9.
Ng BP, Park C. Accessibility of telehealth services during the COVID-19 pandemic: a cross-sectional survey of medicare beneficiaries. Prev Chronic Dis. 2021;18:1-11.
Miyawaki A, Tabuchi T, Ong MK, Tsugawa Y. Age and social disparities in the use of telemedicine during the COVID-19 pandemic in Japan: crosssectional study. J Med Internet Res. 2021;23:e27982.
Poeran J, Cho LD, Wilson L, Zhong H, Mazumdar M, Liu J, et al. Preexisting disparities and potential implications for the rapid expansion of telemedicine in response to the coronavirus disease 2019 pandemic. Med Care. 2021;59:694-8.
Jaffe DH, Lee L, Huynh S, Haskell TP. Health inequalities in the use of telehealth in the United States in the lens of COVID-19. Popul Health Manag. 2020;23:368-77.
Eberly LA, Kallan MJ, Julien HM, Haynes N, Khatana S, Nathan A, et al. Patient characteristics associated with telemedicine access for primary and specialty ambulatory care during the COVID-19 pandemic. JAMA Netw Open. 2020;3:1-12.
Almathami HK, Win KT, Vlahu-Gjorgievska E. Barriers and facilitators that influence telemedicine-based, real-time, online consultation at patients’ homes: systematic literature review. J Med Internet Res. 2020;22:1-25.
Haynes SC, Kompala T, Neinstein A, Rosenthal J, Crossen S. Disparities in telemedicine use for subspecialty diabetes care during COVID-19 shelter-in-place orders. J Diabetes Sci Technol. 2021;15:986-92.
Phimphasone-Brady P, Chiao J, Karamsetti L, Sieja A, Johnson R, Macke L, et al. Clinician and staff perspectives on potential disparities introduced by the rapid implementation of telehealth services during COVID-19: a mixed-methods analysis. Transl Behav Med. 2021;11.
Kaplan B. Access, equity, and neutral space: telehealth beyond the pandemic. Ann Fam Med. 2021;19:75-8.
Lopez AM, Lam K, Thota R. Barriers and facilitators to telemedicine: can you hear me now? Am Soc Clin Oncol Educ B. 2021;41:25-36.
McMillan SS, King M, Tully MP. How to use the nominal group and delphi techniques. Int J Clin Pharm. 2016;38:655-62.
Jones J, Hunter D. Qualitative research: consensus methods for medical and health services research. BMJ. 1995;311:376-80.
Gallagher M, Hares T, Spencer J, Bradshaw C, Webb I. The nominal group technique: a research tool for general practice? Fam Pract. 1993;10:76-81.
Dunham R. Nominal group technique : a users’ guide. University of Wisconsin School of Business; 1998. [cited 2023 Jan 20]. Available from: http://instruction.bus.wisc.edu/obdemo/readings/ngt.html.
Bokolo AJ. Exploring the adoption of telemedicine and virtual software for care of outpatients during and after COVID-19 pandemic. Irish J Med Sci. 2021;190:1-10.
Kronenfeld JP, Penedo FJ. Novel coronavirus (COVID-19): telemedicine and remote care delivery in a time of medical crisis, implementation, and challenges. Transl Behav Med. 2021;11:659-63.
Whaley CM, Pera MF, Cantor J, Chang J, Velasco J, Hagg H, et al. Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Netw Open. 2020;3:1-12.
Chen EM, Andoh JE, Nwanyanwu K. Socioeconomic and demographic disparities in the use of telemedicine for ophthalmic care during the COVID-19 pandemic. Ophthalmology. 2022;129:15-25.
Elam AR, Sidhom D, Ugoh P, Andrews C, De Lott L, Woodward M, et al. Disparities in eye care utilization during the COVID-19 pandemic. Am J Ophthalmol. 2022;233:163-70.
Glintt. Associação Portuguesa de Administradores Hospitalares. Barómetro de saúde digital da adopção telessáude e inteligência artificial. Lisboa: Serviços Partilhados do Ministério da Saúde; 2022.
World Health Organization. Global strategy on digital health 2020-2025. Geneva: WHO ; 2021.
Ministério da Saúde. CNTS. Teleconsulta: guia de boas práticas para profissionais e utentes. centro nacional de telessaúde. 2021. [cited 2023 Feb 26]. Available from: https://www.cnts.min-saude.pt/2021/07/15/teleconsulta-guia-de-boas-praticas-para-profissionais/.
Oliveira Hashiguchi T. Bringing health care to the patient: an overview of the use of telemedicine in OECD countries. OECD Heal Work Pap. 2020;116:1-102.
Leiras G, Arriaga M, Gaspar R, Raposo B, Domingos S. Implementing health literacy intelligence during COVI-19 outbreak. Eur J Public Health. 2020;30:ckaa165.566.
Annaswamy TM, Verduzco-Gutierrez M, Frieden L. Telemedicine barriers and challenges for persons with disabilities: COVID-19 and beyond. Disabil Health J. 2020;13:1-3.
Sun R, Blayney DW, Hernandez-Boussard T. Health management via telemedicine: learning from the COVID-19 experience. J Am Med Informatics Assoc. 2021;28:2536-40.
Whaibeh E, Mahmoud H, Naal H. Telemental health in the context of a pandemic: the COVID-19 experience. Curr Treat Options Psychiatry. 2020;7:198-202.
Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020;382:1679-81.
Direção-Geral da Saúde. PENTS: plano estratégico nacional para a telessaúde 2019-2022. 2019. [cited 2022 Sep 23]. Available from: https://www.spms.min-saude.pt/wp-content/uploads/2019/11/PENTS_português.pdf.
Direção-Geral da Saúde. Plano estratégico nacional para a telessaúde 2019-2022: Plano operacional 2021-2022. 2021. [cited 2022 Oct 06]. Available from: https://www.cnts.min-saude.pt/wp-content/uploads/2021/07/PENTS_2021_22-Julho42.pdf.
Ftouni R, AlJardali B, Hamdanieh M, Ftouni L, Salem N. Challenges of telemedicine during the COVID-19 pandemic: a systematic review. BMC Med Inform Decis Mak. 2022;22.
Alaboudi A, Atkins A, Sharp B, Balkhair A, Alzahrani M, Sunbul T. Barriers and challenges in adopting Saudi telemedicine network: the perceptions of decision makers of healthcare facilities in Saudi Arabia. J Infect Public Health. 2016;9:725-33.
Shaw J, Brewer LP, Veinot T. Recommendations for health equity and virtual care arising from the COVID-19 pandemic: narrative review. JMIR Form Res. 2021;5:1-12.
Eze ND, Mateus C, Cravo Oliveira Hashiguchi T. Telemedicine in the OECD: an umbrella review of clinical and cost-effectiveness, patient experience and implementation. PLoS One. 2020;15:1-24.
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