ArticlePDF Available

Telemedicine as an unexpected catalyst during and beyond the COVID-19 Pandemic

Authors:
Mahendra Kumar at Post Graduate Institute of Medical Education and Research
Mahendra Kumar
Pushpa Rani at All India Institute of Medical Sciences Rishikesh
Pushpa Rani
Binal Joshi at Charotar University of Science and Technology
Binal Joshi
Roop Kishor Soni at Post Graduate Institute of Medical Education and Research
Roop Kishor Soni
Show all 6 authorsHide
Download full-text PDF
Read full-text
Download citation

Abstract

Telemedicine that also known as the practice of medicine at a distance whereby information technology is used to ensure the delivery of medical care services. Telemedicine is not a new concept in the world and India.Indian Space Research Organization (ISRO) started telemedicine in India during year 2001 as a pilot project and in year 2005 Ministry of Health and family welfare started full time program of telemedicine by connecting all major health institutions. Telemedicine is connecting people across border and culture. The need-based changes are coming in telemedicine sectors such as smart apps, involvement of private sector players and high intensity internet connections reaching to rural areas and difficult demographic locations. During Covid-19 pandemic telemedicine benefited people by supplying health information and consultation without breaching them without breeching physical contact restrictions. The ease of access to telemedicine applications, its low cost, and the lack of infrastructure requirements propelled to become the top choice in these dayswhere physical distancingconsidered the aforementioned, thus we can conclude that telemedicine is promising tool.
Content uploaded by Mahendra Kumar
Author content
All content in this area was uploaded by Mahendra Kumar on Apr 01, 2022
Content may be subject to copyright.
1171
Nepal Journal of Epidemiology
Telemedicine as an unexpected catalyst during and beyond the COVID-19 Pandemic
Mahendra Kumar1, Pushpa Rani2, Binal Joshi3, Roop Kishor Soni4, Anita Kumari5, Kusum K Rohilla6
Copyright © 2022 CEA& INEA. Published online by NepJOL-INASP.
www.nepjol.info/index.php/NJE
Correspondence: Mahendra Kumar, Stroke Team Coordinator, Department of Neurology, Post Graduate
Institute of Medical Education & Research, Chandigarh, India
Email: kumarmahen9@gmail.com
Received 17 Jan 2022/Revised 12 Mar 2022/Accepted 17 Mar 2022
Citation: Kumar M, Rani P, Joshi B, Soni RK, Kumari A, Rohilla KK. Telemedicine as an unexpected catalyst
during and beyond the COVID-19 Pandemic.Nepal J Epidemiol. 2022;12(1):1171-1174.
DOI: 10.3126/nje.v12i1.42459
This work is licensed under a Creative Commons Attribution 4.0 International License.
Short Communication Open Access
Abstract:
Telemedicine that also known as the practice of medicine at a distance whereby information technology is used
to ensure the delivery of medical care services. Telemedicine is not a new concept in the world and India.Indian
Space Research Organization (ISRO) started telemedicine in India during year 2001 as a pilot project and in year
2005 Ministry of Health and family welfare started full time program of telemedicine by connecting all major
health institutions. Telemedicine is connecting people across border and culture. The need-based changes are
coming in telemedicine sectors such as smart apps, involvement of private sector players and high intensity
internet connections reaching to rural areas and difficult demographic locations. During Covid-19 pandemic
telemedicine benefited people by supplying health information and consultation without breaching them without
breeching physical contact restrictions. The ease of access to telemedicine applications, its low cost, and the
lack of infrastructure requirements propelled to become the top choice in these dayswhere physical
distancingconsidered the aforementioned, thus we can conclude that telemedicine is promising tool.
Keywords: Coronavirus Infections, Disease Outbreak, Pandemics, Patient Care Management, Telemedicine
eISSN 2091-0800
1172
Background
Health for all India's mission is experiencing a major roadblock
due to the lack of availability of an adequate number of doctors
and nurses, especially in the underprivileged areas of the
country due to the misdistribution of resources [1]. In India, the
most recent data shows a doctor-to-patient ratio of about
0.62:1000 people, which is far much lower than the
recommended 1:1,000 as per World Health Organization
(WHO) [2, 3]. COVID-19 persistent spread worsens the
situation further by creating an acute shortage of health care
professionals, especially qualified doctors [4].
Pandemics pose challenges to any health care systems and
restrict face-to-face physician-patient communication. The
emergence of the coronavirus disease in laterpart of 2019 has
changed our lives drastically. To flatten the curve of COVID-
19, social distancing restrictions and lockdowns have been
announced by civic agencies globally. The routine outpatient
department (OPD) has not been functioning to full capacity in
physical mode at most hospitals and has led to an increasing
dependence on virtual medical visits to their patients [5]. World
Health Organization and the Centers for Disease Control also
suggest encouraging telemedicine to provide a safe and
effective alternative to physical visits.
During pandemic, health systems are under pressure to weigh
aforementioned limitations to meet increasing demands. Social
distancing restrictions in COVID pandemic have provided a
unique opportunity for the widespread use of telemedicine.
There has been an exponential increase in usage of telemedicine
in COVID-19 pandemic. Therefore to provide uninterrupted
health coverage to every corner of society, telemedicine is the
answer to bypass and break the COVID-19 infection chain [6].
What is Telemedicine?
Telemedicine is part of telehealth. The word “Tele” meaning
“distance” and “Medicine” meaning “to heal”. Another
synonymous of telemedicine by Time Magazine as “healing by
wire” [7]. Telemedicine also refers to the practice of medicine
at a distance whereby information technology is used to ensure
the delivery of medical care services. By using mobile phones,
laptops and computers, healthcare providers and doctors can
communicate with their patients virtually and write
prescriptions or follow-ups [8,9].
Advantages of Tele medicine
As a combination of both technologies and devices
telemedicine supports health care centers to assess the health
status of people sitting from a far overcoming geographical
barriers and connecting users remotely. Telemedicine also
reduced cost and effort as well as time, as patients does not need
to travel long distances to get consultation as well as
treatment.Thus, family and caregivers’inconvenience are also
reduced significantly [10].
Newer technology has enabled the digitization of records, to
provide better coverage to privacy. Telemedicine can help in the
decongestion of hospitals for routine visits of the patient such
as regular or routine check-ups or continuous monitoring,and
nonsurgical treatment. Thus, this can reduce the burden on
health centers already crumbling due to the pressure of the
current pandemic. Before COVID-19 pandemic, usage of
telemedicine in USA was about 8% only, since announcement
of the COVID-19 pandemic a stark increase of 683% usage of
telemedicine [7].
Telemedicine services in India
Telemedicine is not novice concept in the world along with
India. WHO defined telemedicine as “healthcare services
delivery to a distance” [11]. Continuity in follow-up through
telemedicine can help patients to better manage their disease's
condition and adhere to their medication regimens? Reference
Telemedicine works are either real-time or store-and-transfer
models. This depends on data relay, availability of network, and
infrastructure facilities. In India, most common model used for
telemedicine networks is hub-and-spoke model, where the hub
is typically a tertiary level healthcare center like medical college
hospitals and spokes are the peripheral health facilities such as
sub-centers, community health centers, primary health care
centers, and district hospitals [12]. India has one of the cheapest
costs of data available in mobile networks. Various type of free
software currently available, such as Google meet, Skype,
Zoom, WhatsApp and Webex. An availability of good camera
quality mobile phones allowsproper teleconsultation evaluation
of any patient.
Experts' and users opinions about Telemedicine
The recent updates in telemedicine practice guidelines, massive
advancement of internet infrastructure and internet speed,
improved information storage databases, made telemedicine
stress-free and user-friendly. Importantly many studies reported
that patients, doctors, and clinical experts are in favor of
telemedicine due to a sense of comfort at being home, and
interaction with physician increasing acceptance amongst
patients [13]. Another large benefit of using telemedicine is
short triage, which can be done even before the arrival of the
patient at the health care center. In lower-income countries like
India, telemedicine effectively reduces transport costs and
health consultation expenses.
Additional benefits of telemedicine are that they do not
requirement of multi-infrastructure set-up, low-cost operations,
all specialist availability on a single platform and it save time
and efforts. Furthermore, in remote areas, telemedicine is a gift
and the distance factor is completely wiped out so that patients
1173
from anywhere can receive specialist consultations irrespective
of the distance.
Another study form Poland reported that the participants
acknowledge the positive impact of telemedicine. They found it
more comfortable to share their problems with their doctors
[14]. Paucity of researches examined effectiveness of
telemedicine and their finding suggested that it reduced both
hospital admissions and cost of treating any patients [15].
Another study from India by Dash S, et al also highlighted
positive role of telemedicine during COVID-19 pandemic [16].
Constraints to Telemedicine
Apart from the many benefits and advantages of telemedicine,
there are some limitations too. Many doctors believe that
technical issues are the main barrier encounteredin
telemedicine. In the absence of a physical examination, doctors
are not 100% sure about the initial diagnosis because any
important sign or symptom may be missed.
Another common concern with telemedicine is the lack of
effective interaction between doctor and patient and missing the
“human touch” [7]. Furthermore there is an urgent need to
improve awareness about telemedicine and strong technical
support to providers and end-users for a sound experience of
consultation [17].
A study sharing experience of telemedicine during pandemic
from Madhya Pradesh conducted by Saxena S, et al. India also
reveals that expansion of telemedicine is still a concern and
people prefer physical outpatient department (OPD) than tele
mode [18].
The risk of a communication gap or language can be a barrier.
People do not want to pay high consultation fees for online
consultations, which is an odd but true fact. Many people found
this expensive as, without any physical visit, there is no physical
examination that is as accurate as that of the physical model.
For support and cons of Telemedicine
A. For Support of telemedicine
• It promote social distancing and reduce chance of hospital
burn infection
• Promote health care delivery in remote and far ahead areas
• Open new door for opportunities in health care
• Provide better privacy and solve mobility concerns of patients
who found it difficult to reach health centers
• Reduce cost and investment
B. Cons of Telemedicine
• Required high end internet connectivity
• Consenting and ethical issue in some cases
• Need to improve tele infrastructure
• Patient satisfaction is still a concern.
The world has not yet got rid of the pandemic and many phases
are to come. Today telemedicine is becoming popular at a rapid
pace. Telemedicine has been found to be the mainstay of patient
care during the current pandemic. Telemedicine helped to
provide critical patient follow-ups continuity and avoid
exposure to health systems and healthcare workers.
Acknowledgement
None
Authors’ affiliations:
1Stroke Team Coordinator, Department of Neurology,
PGIMER, Chandigarh, India
2All India Institute of Medical Sciences, Rishikesh, India
3Manikaka Topawala Institute of Nursing Charotar University
of Science and Technology, India
4PGIMER, Chandigarh, India
5Captain at Military Nursing Core, Indian Army Chandigarh,
India
6Ph.D. Scholar (Palliative Care), All India Institute of Medical
Sciences, Rishikesh, India
Authors’ contribution
All authors have made substantial contributions to all of the
following: (1) the conception and design of the study (2)
drafting the article or revising it critically for important
intellectual content, (3) final approval of the version to be
submitted
Competing interests
There is no conflict of interest for any author of this manuscript.
Source of Support:
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sector.
References
1. Kasthuri A. Challenges to Healthcare in India - The Five A's.
Indian J Community Med. 2018 Jul-Sep;43(3):141-143.
https://doi.org/10.4103/ijcm.IJCM_194_18.
PMiD: 30294075; PMCiD: PMC6166510.
2. Kumar R, Pal R. India achieves WHO recommended doctor
population ratio: A call for paradigm shift in public health
discourse! J Family Med Prim Care. 2018;7(5):841-4.
https://doi.org/10.4103/jfmpc.jfmpc_218_18
PMid:30598921 PMCid:PMC6259525
3. Bennett B. Using Telehealth as a Model for Blockchain HIT
Adoption. Telehealth and Medicine Today [online] 2020. [cited
18 March 2022] Available from URL:
https://www.middleeastmedicalportal.com/using-telehealth-as-
a-model-for-blockchain-hit-adoption/
4. Sharma Raman KM, Rohilla Kusum K. .-19 Infodemic:
Evaluating Information-Seeking Behaviour Among Healthcare
Workers During a Pandemic Cureus Journal of Medical
Science. 2022;14(1).
https://doi.org/10.7759/cureus.20910
5. Hurst EJ. Evolutions in Telemedicine: From Smoke Signals
to Mobile Health Solutions. Journal of Hospital Librarianship.
1174
2016;16(2):174-185.
https://doi.org/10.1080/15323269.2016.1150750
6. Monaghesh E, Hajizadeh A. The role of telehealth during
COVID-19 outbreak: a systematic review based on current
evidence. BMC Public Health. 2020;20(1):1193.
https://doi.org/10.1186/s12889-020-09301-4
PMid:32738884 PMCid:PMC7395209
7. Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-
19 transforms health care through telemedicine: Evidence from
the field. Journal of the American Medical Informatics
Association : JAMIA. 2020;27(7):1132-5.
https://doi.org/10.1093/jamia/ocaa072
PMid:32324855 PMCid:PMC7188161
8. Kichloo A, Albosta M, Dettloff K, et al. Telemedicine, the
current COVID-19 pandemic and the future: a narrative review
and perspectives moving forward in the USA. Family medicine
and community health. 2020;8(3).
https://doi.org/10.1136/fmch-2020-000530
PMid:32816942 PMCid:PMC7437610
9. Oh JY, Park YT, Jo EC, Kim SM. Current Status and
Progress of Telemedicine in Korea and Other Countries.
Healthc Inform Res. 2015 Oct;21(4):239-43.
https://doi.org/10.4258/hir.2015.21.4.239.
PMiD: 26618029 PMCiD: PMC4659880.
10. Ganapathy K. Telemedicine and Neurological Practice in
the COVID-19 Era. Neurology India. 2020;68(3):555-9.
https://doi.org/10.4103/0028-3886.288994
PMid:32643663
11. Scalvini S, Vitacca M, Paletta L, Giordano A, Balbi B.
Telemedicine: a new frontier for effective healthcare services.
Monaldi archives for chest disease = Archivio Monaldi per le
malattie del torace. 2004;61(4):226-33.
https://doi.org/10.4081/monaldi.2004.686
PMid:15909613
12. Elrod JK, Fortenberry JL. The hub-and-spoke organization
design: an avenue for serving patients well. BMC Health
Services Research. 2017;17(1):457.
https://doi.org/10.1186/s12913-017-2341-x
PMid:28722550 PMCid:PMC5516840
13. Ramaswamy A, Yu M, Drangsholt S, et al. Patient
Satisfaction With Telemedicine During the COVID-19
Pandemic: Retrospective Cohort Study. Journal of medical
Internet research. 2020;22(9):e20786.
https://doi.org/10.2196/20786
PMid:32810841 PMCid:PMC7511224
14. Kludacz-Alessandri M, Hawrysz L, Korneta P, Gierszewska
G, Pomaranik W, Walczak R. The impact of medical
teleconsultations on general practitioner-patient
communication during COVID- 19: A case study from Poland.
PLOS ONE. 2021;16(7):e0254960.
https://doi.org/10.1371/journal.pone.0254960
PMid:34270587 PMCid:PMC8284634
15. Benatar D, Bondmass M, Ghitelman J, Avitall B. Outcomes
of chronic heart failure. Archives of internal medicine.
2003;163(3):347-52.
https://doi.org/10.1001/archinte.163.3.347
PMid:12578516
16. Dash S, Aarthy R, Mohan V. Telemedicine during COVID-
19 in India-a new policy and its challenges. Journal of Public
Health Policy. 2021;42(3):501-9.
https://doi.org/10.1057/s41271-021-00287-w
PMid:34012012 PMCid:PMC8131484
17. Layfield E, Triantafillou V, Prasad A, Deng J, Shanti RM,
Newman JG, et al. Telemedicine for head and neck ambulatory
visits during COVID-19: Evaluating usability and patient
satisfaction. Head & neck. 2020;42(7):1681-9.
https://doi.org/10.1002/hed.26285
PMid:32476228 PMCid:PMC7300847
18. Saxena S, Srivastava K, Dilbagi R, Saxena A. Telemedicine
units for COVID-19: An experience from Madhya Pradesh.
Indian Journal of Community Health. 2020;32(2 (Supp)):277 -
80. doi: 10.47203/IJCH.2020.v32i02SUPP.021.
https://doi.org/10.47203/IJCH.2020.v32i02SUPP.021
... Digital transformation of healthcare has the potential to improve operational efficiencies (Al-Jaroodi et al. 2020), high-quality patient experience (Bennett and Hauser 2013), healthcare costs reduction (Al-Jaroodi et al. 2020;Lee 2019), improved quality of life for patients (Cai et al. 2019;Yamin 2018) and healthcare professionals (Lin et al. 2019), as well as improved accuracy of diagnostic and prognostic outcomes for better treatment and rehabilitation (Abdel-Basset et al. 2021;Qadri et al. 2020). Areas of digital transformation in healthcare include precision medicine and personalised care (Ahad et al. 2019;Araiza-Garaygordobil et al. 2020;Chen et al. 2016;Li 2019), telemedicine (Kumar et al. 2022;Mann et al. 2020), clinical decision support systems (CDSS) (Lin et al. 2019), and smart health (Kelly et al. 2020;Qadri et al. 2020). ...
... 5G-enabled Augmented Reality (AR) and Virtual Reality (VR), with interconnected medical devices using faster 5G-enabled internet connections can facilitate improved diagnosis, treatment, rehabilitation, training and telemedicine (Li 2019). Although telemedicine is an age-old technology (Kumar et al., 2022), its adoption and use by patients and healthcare professionals increased significantly at the height of the Covid-19 pandemic (Mann et al. 2020;Kumar et al., 2022). 5G and IoT technologies provide rapid data transfer speeds for smart healthcare (Muhammed et al. 2018) with low latency and ultra-reliable internet communication, making it possible to carry out sensitive medical procedures and remote surgery (Ahad et al. 2020). ...
... 5G-enabled Augmented Reality (AR) and Virtual Reality (VR), with interconnected medical devices using faster 5G-enabled internet connections can facilitate improved diagnosis, treatment, rehabilitation, training and telemedicine (Li 2019). Although telemedicine is an age-old technology (Kumar et al., 2022), its adoption and use by patients and healthcare professionals increased significantly at the height of the Covid-19 pandemic (Mann et al. 2020;Kumar et al., 2022). 5G and IoT technologies provide rapid data transfer speeds for smart healthcare (Muhammed et al. 2018) with low latency and ultra-reliable internet communication, making it possible to carry out sensitive medical procedures and remote surgery (Ahad et al. 2020). ...
Application of Fourth Industrial Revolution Technologies in Application of Fourth Industrial Revolution Technologies in Healthcare Healthcare Application of Fourth Industrial Revolution Technologies in Healthcare Completed Research Full Paper
Conference Paper
  • Aug 2023
The aim of this systematic literature review (SLR) is to explore how Fourth Industrial Revolution (4IR) digital technologies are transforming the healthcare sector. Peer-reviewed, full-text research papers published between January 2016 and April 2021, which focused on data-driven healthcare, health data management systems, and the disruptive role of digital technologies in healthcare were retrieved from three electronic databases, namely PubMed Central, Institute of Electrical and Electronics Engineers (IEEE) and MEDLINE. Articles included in the SLR were identified and selected using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. Three main themes were identified from 84 research papers included in the SLR, namely, (i) digital technologies driving the transformation of healthcare, (ii) the impact of digital transformation on healthcare, and (iii) areas of transformation in healthcare. The results showed that technological innovations can mitigate the impact of unequal distribution of healthcare services, reduce healthcare costs, improve the quality of care, and the quality of life for patients and healthcare professionals.
View
... In the United States and other countries where most subspecialists are clustered in urban settings [3], individuals living in remote areas disproportionately suffer the burden of chronic diseases like cancer [4] and have unacceptably high mortality and morbidity rates associated with these diseases [5,6]. This is mainly due to the disproportionate quality of care provided to these patients. ...
... Teleoncology has proven effective in improving cancer care globally by allowing low-income nations with limited resources and few trained medical experts to tap into the vast reservoir of resources available in developed countries. In low-income nations where adequate medical infrastructure is typically lacking [3,17] and where the number of trained specialists is "woefully inadequate" [3], teleoncology provides a reliable method of linking healthcare specialists regardless of geographic separation [36,40]. This is especially true in oncology subspecialties such as neuro-oncology, as the mortality in these subgroups can be as high as 90% in economically disadvantaged countries compared to approximately 4% mortality in welldeveloped nations [25]. ...
... Teleoncology has proven effective in improving cancer care globally by allowing low-income nations with limited resources and few trained medical experts to tap into the vast reservoir of resources available in developed countries. In low-income nations where adequate medical infrastructure is typically lacking [3,17] and where the number of trained specialists is "woefully inadequate" [3], teleoncology provides a reliable method of linking healthcare specialists regardless of geographic separation [36,40]. This is especially true in oncology subspecialties such as neuro-oncology, as the mortality in these subgroups can be as high as 90% in economically disadvantaged countries compared to approximately 4% mortality in welldeveloped nations [25]. ...
Teleoncology: Novel Approaches for Improving Cancer Care in North America
Article
Full-text available
  • Aug 2023
Due to widespread healthcare workforce shortages, many patients living in remote and rural North America currently have reduced access to various medical specialists. These shortages, coupled with the aging North American population, highlight the need to transform contemporary healthcare delivery systems. The exchange of medical information via telecommunication technology, known as telemedicine, offers promising solutions to address the medical needs of an aging population and the increased demand for specialty medical services. This progressive movement has also improved access to quality health care by mitigating the current shortage of trained subspecialists. Minimizing the effects of these shortages is particularly urgent in the care of cancer patients, many of whom require regular follow-up and close monitoring. Cancer patients living in remote areas of North America have reduced access to specialized care and, thus, have unacceptably high mortality and morbidity rates. Teleoncology, or the use of telemedicine to provide oncology services remotely, has the ability to improve access to high-quality care and assist in alleviating the burden of some of the severe adverse events associated with cancer. In this review, the authors describe how recent advances in teleoncology can reduce healthcare disparities and improve future cancer care in North America.
View
... [6,14] This study also emphasizes the impact of stress and poor sleep during the COVID-19 pandemic on HCPs. [15] People's health and wellbeing may be negatively impacted by a public health crisis for both short-term and long-term periods. ...
View
... [6,14] This study also emphasizes the impact of stress and poor sleep during the COVID-19 pandemic on HCPs. [15] People's health and wellbeing may be negatively impacted by a public health crisis for both short-term and long-term periods. ...
Impact of the heartfulness program on stress and sleep among healthcare professionals: Pre experimental study
Article
Full-text available
  • May 2024
A BSTRACT Background Healthcare professionals (HCPs) worldwide suffer from stress and poor sleep and the COVID-19 pandemic has further raised these issues. This study sought to determine whether HCPs had reduced stress and increased sleep quality while participating in a heartfulness meditation program. Subjects and Methods For a 2-month (8 weeks) heartfulness meditation program, we included 41 individuals in a prospective one-group pretest post-test intervention design from February 2023 to April 2023. Scores on the Perceived Stress Scale and Pittsburgh Sleep Quality Index were gathered at baseline and 8 weeks. Forty-one (76%) of the 54 participants completed this study for 8 weeks. Results Results showed a substantial decline in stress (preintervention mean ± standard deviation [SD] = 20.54 ± 4.46; postintervention mean ± SD = 18.42 ± 6.14; t-value = -1.947 [0.05*]) and improvement in sleep quality (preintervention mean ± SD = 6.63 ± 3.82; postintervention mean ± SD = 5.29 ± 2.44) among HCPs after following this 8-week heartfulness meditation program. In the end, a substantial decrease in perceived stress score and an improvement in the sleep quality index was found. Conclusion Additionally, practicing heartfulness meditation may aid in developing the traits of empathy, acceptance, and inner serenity. We draw the conclusion that more extensive research is required to fully understand the impact of heartfulness meditation practice.
View
... Though telemedicine was initiated in India by the Indian Space Research Organization (ISRO) way back in 2001, it was only after the COVID-19 pandemic that the tipping point was reached. [8] India formally issued policy guidelines for practicing telemedicine in March 2020. [9] The intervening 2 decades witnessed enhanced Internet penetration and smartphone access which have set the stage for increased rollout of telemedicine services. ...
Preparedness of diabetic patients for receiving telemedical health care: A cross-sectional study
Article
Full-text available
  • Apr 2024
A BSTRACT Introduction This study evaluates feasibility of telemedicine to deliver diabetic care among different regions of the country. Materials and Methods Medical interns affiliated with Rotaract Club of Medicrew (RCM) organized a Free Diabetes Screening Camp called “ Diab-at-ease” at multiple sites across the country. Of all beneficiaries of the camp >18 years of age, patients previously diagnosed with diabetes and undiagnosed patients with a random blood sugar level of more than 200 mg/dL were interviewed regarding their knowledge, attitude, and practice regarding diabetes care and preparedness and vigilance to receiving care through telemedicine. Random blood sugar, height, weight, and waist circumference were also documented. Results About 51.1% ( N = 223) of female patients aged 57.57 ± 13.84 years (>18 years) with body mass index (BMI) =26.11 ± 4.63 were the beneficiaries of the health camps. About 75.3% ( n = 168) of them were on oral hypoglycemic agents (OHAs), 15.7% ( n = 35) were on insulin preparations, and 59.6% ( n = 156) and 88.5% ( n = 31) of which were highly compliant with treatment, respectively. About 35% ( n = 78) and 43.9% ( n = 98) of them were unaware of their frequency of hypoglycemic and hyperglycemic episodes, respectively. About 64.6% ( n = 144) of the patients were equipped for receiving teleconsultation. Glucometer was only possessed by 51.6% (115) of which only 46.95% ( n = 54) can operate it independently. Only 80 patients (35.9%) were aware of the correct value of blood glucose levels. Conclusion While a majority of the population is compliant with treatment and aware about diabetes self-care, they lack adequate knowledge and resource equipment for the same leading to very limited utilization.
View
... However, they are frequently used interchangeably, with their scopes overlapping. 1 Telemedicine is not a brand-new concept. 2 Technological advances have vastly improved telemedicine. 3 To ensure that healthcare service quality and accessibility are not compromised, the unprecedented crisis caused by COVID-19 has acted as a catalyst for integrating telemedicine within various healthcare and medical practices. ...
A scoping review of foot and ankle telemedicine guidelines
Article
Full-text available
  • Jan 2023
Background and Aims The COVID‐19 pandemic accelerated the adoption of telemedicine in general. Its use has been widely adopted in the healthcare sector, but relatively little research has been conducted on the use of telemedicine for podiatry. This review aimed to explore and compare existing guidelines on telemedicine related to foot and ankle pathologies within a primary care setting. Methods The preferred reporting guidelines for the extension of scoping reviews were used in this review, and a set of inclusion and exclusion criteria were developed and implemented. This study made use of both databases and gray literature searches. Between 2012 and 2022, these databases were searched using various subject headings and free‐text terms for the keywords “telemedicine” “foot health” and “guidelines” with appropriate Boolean operators. Results The search yielded 356 articles, which were reduced to 283 after removing duplicates. Six more records were discovered through a Google and Google Scholar search and one through an article reference search. Six articles and three institutional practice guidelines were selected for synthesis after screening. The findings were classified according to the level of evidence and research quality, the function of telemedicine and the communication used, the research outcomes sought, and the type of recommendations and guidelines made available. Conclusion This review highlights the lack of podiatric telemedicine guidelines for foot and ankle pathologies. Although foot and ankle guidelines for orthopedic and musculoskeletal virtual consultations have been mentioned, they do not cover the full range of potential case scenarios that fall within the remit of podiatric consultations in a primary care setting. This review suggests the development of foot and ankle telemedicine guidelines with recommendations on how they can better provide accessible care to their patients, making foot and ankle care management not only a hand‐on‐one but also reachable virtually, where applicable.
View
... This can be attributed to the userfriendliness of Zoom especially for the first-time users. 54,55 WhatsApp is one of the most widely used instant messaging applications in healthcare and is one of the most popular free applications in the world. It has about 1.5 billion users worldwide and is compatible with all smartphone operating systems such as iPhone, Android, and Windows Phone. ...
Utilization of telehealth to manage the Covid-19 pandemic in low- and middle-income countries: a scoping review
Article
  • Dec 2022
Objective Recently, the coronavirus disease 2019 (Covid-19) pandemic has led to an increase in the use of telehealth technology. It seems that the application of this technology in low- and middle-income countries (LMICs) has been limited, and few studies have been undertaken to review the current state of knowledge in this area. The aim of the present study was to explore the utilization of telehealth to manage the Covid-19 pandemic in LMICs. Materials and Methods This scoping review was conducted in 2022. PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest were searched, and all quantitative research, qualitative studies, case reports, and case studies related to the use of telehealth to manage Covid-19 in LMICs and published since 2020 were included in the study. The findings were analyzed and reported narratively. Results In total, 18 articles were included in the research. These studies were conducted in South Asia, sub-Saharan Africa, the Middle East and North Africa, and East Asia and Oceania. Telehealth interventions included teleconsultation, telecoaching, teledermatology, televisit, mhealth applications, telerehabilitation, telepharmacy, and telepsychiatry. WhatsApp was the most common way for service delivery and in most studies, patients and health care providers were satisfied with services. Conclusion Although the use of telehealth interventions was limited in LMICs during the Covid-19 pandemic, in most cases, it was an effective solution to combat the outbreak of Covid-19 and had positive outcomes. A comparison between the characteristics and clinical effectiveness of similar interventions in different countries including LMICs are worth investigation in the future studies.
View
... At the time of writing this paper, the COVID pandemic has crossed three years and mortality crossed 5 million lives across the world and over 300 million get affected. The disruption created by the COVID pandemic has resulted in a massive employment crisis [37]. ...
When Love Turns Hate: Consequences of Marital Discord, Marital Dissolution and HCW's under Risk
Article
Full-text available
  • Jun 2022
Life is a path usually travelled with a partner. Marriage is the foundation of any healthy society and family basic forms of interpersonal social relationship. Marriage as a union of trust and happiness among husband and wife. Conflict in intimate human relationships, such as marriage, is inevitable especially whenever two people get together some of their traits and habits annoy other and eventually leads to disagreements and conflicts. This uneasy relationship could easily put the couple in the unenviable situation of getting separated. Regarding its consequences, divorce doesn’t come with a limited effect on the couple but affects the entire family economically, emotionally, and physically. Children if present are the immediate victims who face the possible consequences. This paper is discussing about impact of divorce among family, children and individuals health. Keywords: Divorce , HCW, Nurses, Domestic Violence
View
Enhancing rural healthcare through internet-based remote collaborative outpatient services: A comprehensive evaluation in Changzhi, Shanxi Province
Article
  • Sep 2024
  • MEDICINE
Background: The advancement of digital technology, particularly telemedicine, has become crucial in improving healthcare access in rural areas. By integrating cloud computing and mHealth technologies, Internet-based Collaborative Outpatient Clinics offer a promising solution to overcome the limitations of traditional healthcare delivery in underserved communities. Methods: A trial was conducted in 4 counties of Changzhi City in Shanxi Province, China. The system extended to 495 rural communities and served over 5000 rural residents. Deep learning algorithms were employed to analyze medical data patterns to increase the accuracy of diagnoses and the quality of personalized treatment recommendations. Results: After the implementation of the system, there was a significant improvement in the satisfaction levels of rural residents regarding medical services; the accuracy of medical consultations increased by 30%, and the convenience of medical access improved by 50%. There was also a notable enhancement in overall health management. Satisfaction rates among healthcare professionals and rural inhabitants were over 90% and 85%, respectively, indicating that the system has had a significant positive impact on the quality of health-care services. Conclusion: The study confirms the feasibility of implementing telemedicine services in rural areas and offers evidence and an operational framework for promoting innovative healthcare models on a large scale.
View
COVID-19 Infodemic: Evaluating Information Seeking Behaviour Among Healthcare Workers During a Pandemic
Article
Full-text available
  • Jan 2022
Introduction With the surge in coronavirus disease 2019 (COVID-19) cases across nations worldwide, World Health Organization (WHO) declared it a pandemic on March 11, 2020. Besides various policy guidelines and directions issued from time to time to combat the menace, there was the dissemination of a lot of misinformation and disinformation through social media or otherwise. This led to emotional, psychological, and mental agonies in the general population as well as Healthcare Workers (HCWs). Methods A cross-sectional quantitative study using purposive sampling techniques was done to assess the health-seeking behavior during the pandemic among HCWs of a tertiary care hospital in North India, designated as a dedicated COVID-19 hospital by the Ministry of Health and Family Welfare, India. A semi-structured questionnaire validated by experts with a reliability value (r=0.92) was taken. To maintain minimal contact and to follow COVID-19 Appropriate Behavior (CAB), a web-based link was used to obtain the data. Privacy of the participants and confidentiality of data obtained was maintained. Results Out of the total 250 participants enrolled in the study, the response rate was 81% (203). For 123 (60%) respondents, social media was one of the sources of access to information during the pandemic. The most common social media app(s) accessed were WhatsApp 82 (40%), Facebook, and Instagram 67 (33%). Social media had both positive as well as negative impacts on the mindset of respondents as 147 (72%) agreed that social media networks helped to further improve their understanding, whereas 178 (88%) stated that it aroused fear and panic among them. Conclusion During epidemics, timely, accurate, and authentic information is vital in shaping public opinion; on the contrary, an infodemic can pose a serious threat and panic in society by disseminating false and wrong information as was seen in the COVID-19 pandemic.
View
The impact of medical teleconsultations on general practitioner-patient communication during COVID- 19: A case study from Poland
Article
Full-text available
According to the outbreak of the Covid-19 pandemic, medical teleconsultations using various technologies have become an important tool to mediate communication between general practitioners (GP) and the patients in primary health care in many countries. The quality of the GP-patient communication is an essential factor, which improves the results of treatment and patient satisfaction. The objective of this paper is to study patients’ satisfaction from teleconsultation in primary care and the impact of teleconsultations on GP-patient communication through the Covid-19 pandemic in Poland. We analyse whether the teleconsultations performed without physical examinations have a positive impact on GP-patient communication. The quality of teleconsultation and GP-patient communication have been measured using a questionnaire regarding the quality of medical care in a remote care conditions. Among 36 items, nine questions have been related to the dimension of GP-patient communication and ten to system experience. Our results suggest that the quality of teleconsultations is not inferior to the quality of consultation during a face-to-face visit. The patients indicated a high level of satisfaction regarding communication with their GP during teleconsultation. We have also identified that the technical quality and the sense of comfort during teleconsultation positively impact the communication quality.
View
Telemedicine during COVID-19 in India—a new policy and its challenges
Article
Full-text available
  • Sep 2021
  • J PUBLIC HEALTH POL
During the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India’s first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.
View
Telemedicine units for COVID-19: An experience from Madhya Pradesh
Article
Full-text available
  • Apr 2020
  • IJCH
On 31st December 2019, the World Health Organization (WHO) China Country Office was informed of cases of pneumonia of unknown aetiology detected in Wuhan City, Hubei Province of China.(1) The first cases of COVID-19 outside of China were identified on January 30 in India and it has spread to 210 countries in all world regions by 10th April 2020, with more than 1.6 million confirmed and more than 0.1 million deaths worldwide.(2) Disasters and pandemics pose exceptional challenges to providing health care. Though telemedicine will not solve them all, it is well suited for scenarios in which medical practitioners can evaluate and manage patients. Previous work has specifically described the potential for using telemedicine in disasters and public health emergencies, wherein Patients prioritize convenient and inexpensive care, whether in-person visits becomes the last option for meeting patient needs.(3,4)
View
Telemedicine, the current COVID-19 pandemic and the future: a narrative review and perspectives moving forward in the USA
Article
Full-text available
  • Aug 2020
A narrative review was conducted to examine the current state of the utilisation of telemedicine amid the current COVID-19 pandemic and to evaluate the benefits of continuing telemedicine usage in the future. A literature review was performed for articles related to telemedicine. Databases including PubMed, Google Scholar, Cochrane Library and Ovid MEDLINE were searched. Three reviewers independently performed article selection based on relevance to our topic. We included all articles between 1990 and 2020 related to telemedicine using the following keywords: ‘telemedicine’, ‘telehealth’, ‘policy’, ‘COVID-19’, ‘regulation’, ‘rural’, ‘physical examination’, ‘future’. A total of 60 articles were identified, and through careful selection we narrowed the final number of articles to 42 based on relevance to our topic. Telemedicine has been rapidly evolving over the past several decades. Issues with regulation and reimbursement have prevented its full immersion into the healthcare system. During the current pandemic, Centers for Medicare and Medicaid services have expanded access to telemedicine services. The advantages of telemedicine moving forward include its cost-effectiveness, ability to extend access to specialty services and its potential to help mitigate the looming physician shortage. Disadvantages include lack of available technological resources in certain parts of the country, issues with security of patient data, and challenges in performing the traditional patient examination. It is critically important that changes are made to fully immerse telemedicine services into the healthcare landscape in order to be prepared for future pandemics as well as to reap the benefits of this service in the future.
View
Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: A Retrospective Cohort Study (Preprint)
Article
Full-text available
  • May 2020
  • J MED INTERNET RES
Background: New York City was the international epicenter of the COVID-19 pandemic. Healthcare providers responded by rapidly transitioning from in-person to video visits. Telemedicine (i.e. video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: To determine if patient satisfaction differs between video vs. in-person visits. Methods: Retrospective observational cohort study in which we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs. 37,989 in-person visits) at a single-institution urban, quaternary academic medical center in New York City for patients aged 18 years during April 1, 2019 to March 31, 2020. Time was categorized as pre-COVID-19 vs. COVID-19 (before vs. after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8,729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs. 92.5%; P<0.001). In adjusted analysis, video visits (Parameter Estimate [PE] 2.18; 95% confidence interval [CI] 1.20, 3.16) and the COVID-19 period (PE 0.55; 95%CI 0.04, 1.06) were associated with higher patient satisfaction. Younger age (PE -2.05; 95%CI -2.66, -1.22), female gender (PE -0.73; 95%CI -0.96, -0.50), and new visit type (PE -0.75; 95%CI -1.00, -0.49) were associated with lower patient satisfaction, respectively. Conclusions: Patient satisfaction with video visits is high and is not a barrier towards a paradigm shift away from traditional in-person clinic visits. Future research to compare other clinic visit quality indicators is needed to guide and implement widespread adoption of telemedicine. Clinicaltrial:
View
The role of telehealth during COVID-19 outbreak: A systematic review based on current evidence
Article
Full-text available
  • Aug 2020
  • BMC PUBLIC HEALTH
Background: The outbreak of coronavirus disease-19 (COVID-19) is a public health emergency of international concern. Telehealth is an effective option to fight the outbreak of COVID-19. The aim of this systematic review was to identify the role of telehealth services in preventing, diagnosing, treating, and controlling diseases during COVID-19 outbreak. Methods: This systematic review was conducted through searching five databases including PubMed, Scopus, Embase, Web of Science, and Science Direct. Inclusion criteria included studies clearly defining any use of telehealth services in all aspects of health care during COVID-19 outbreak, published from December 31, 2019, written in English language and published in peer reviewed journals. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies. Quality assessment was based on the Critical Appraisal Skills Program (CASP) checklist. Narrative synthesis was undertaken to summarize and report the findings. Results: Eight studies met the inclusion out of the 142 search results. Currently, healthcare providers and patients who are self-isolating, telehealth is certainly appropriate in minimizing the risk of COVID-19 transmission. This solution has the potential to prevent any sort of direct physical contact, provide continuous care to the community, and finally reduce morbidity and mortality in COVID-19 outbreak. Conclusions: The use of telehealth improves the provision of health services. Therefore, telehealth should be an important tool in caring services while keeping patients and health providers safe during COVID-19 outbreak.
View
Telemedicine and Neurological Practice in the COVID-19 Era
Article
  • May 2020
Background: The COVID-19 pandemic has within months turned the world upside down. With personal distancing and shortage of personal protective equipment, face-to-face health care encounters are increasingly becoming problematic. Neurological manifestations are also being observed in clinical presentations. Objective: Worldwide most countries, the World Health Organization (WHO) and Centre for Disease Control (USA) have recommended use of Telemedicine during the current pandemic.With acute shortage of neurologists and neurosurgeons and their lopsided distribution, it becomes more difficult to provide neurological care to those who need it the most, particularly with travel restrictions. The author has since 2002 been advocating use of Telemedicine in Neurosciences. Materials and methods: This article reviews the increasing deployment of Telemedicine in neurological practice in the last few years, particularly the radical exponential use in the last few months due to COVID-19. Conclusions: With possible reduction in face-to-face consultations, remote evaluation may become mainstream. Webinars will play an increasing role. CME's and resident training will become more and more digital. The world will never be the same again. It is imperative that we accept and start deploying the "New Normal".
View
Telemedicine for head and neck ambulatory visits during COVID ‐19: Evaluating usability and patient satisfaction
Article
  • Jun 2020
Background In light of the COVID‐19 pandemic, there has been a rapid increase in telemedicine visits. Otolaryngology patient satisfaction with these visits has not yet been extensively studied using a validated survey. Methods All patients who had telemedicine visits with three head and neck surgeons, by phone or video‐based platform, between March 25, 2020 and April 24, 2020. Retrospective chart reviews were conducted to determine demographic, disease, and treatment information. Patients who had a video visit were contacted by telephone and, if they could be reached and consented, were administered the telehealth usability questionnaire (TUQ). Results Hundred surveys were completed. The average score across all questions was 6.01 on a scale from 1 to 7, where 7 indicated the highest level of patient agreement. The highest scores were for questions related to satisfaction with telehealth (6.29), while the lowest were related to reliability (4.86). Conclusions Patients are generally highly satisfied with telemedicine.
View
COVID-19 transforms health care through telemedicine: Evidence from the field
Article
  • Apr 2020
This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and non-urgent health care delivery from one large health system (NYU Langone Health) at the epicenter of the COVID-19 outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 369.1 daily to 866.8 daily (135% increase) in urgent care after the system-wide expansion of virtual health visits in response to COVID-19, and from 94.7 daily to 4209.3 (4345% increase) in non-urgent care post expansion. Of all virtual visits post expansion, 56.2% and 17.6% urgent and non-urgent visits, respectively, were COVID-19-related. Telemedicine usage was highest by patients aged 20-44, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and non-urgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate. INTRODUCTION The COVID-19 pandemic is rapidly transforming the US healthcare system, with telemedicine,
View