Telemedicine is an important aspect of healthcare services amid COVID‐19 outbreak: Its barriers in Bangladesh and strategies to overcome

Chowdhury, Saifur Rahman; Sunna, Tachlima Chowdhury; Ahmed, Shakil

doi:10.1002/hpm.3064

Cited by 57 publications

(46 citation statements)

References 23 publications

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“…A study in Bangladesh reporting very similar barriers with telemedicine explained this by emphasising that a provider's physical presence can easily express empathy and compassion non-verbally, while this is much more difficult during a telehealth consultation. 68 A similar concern was reported by midwives in our study who revealed they could not build a warm and trusting bond with the women by telehealth consultations.…”

Section: Bmj Global Healthsupporting

confidence: 84%

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

et al. 2021

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IntroductionThe COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally.MethodsThe second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.ResultsResponses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.ConclusionsTelemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.

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Section: Bmj Global Healthsupporting

confidence: 84%

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

et al. 2021

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“…Distrust, lack of non-verbal feedback and language problems were reported as barriers to telemedicine in our study. A study in Bangladesh reporting very similar barriers with telemedicine explained this by emphasising that a provider's physical presence can easily express empathy and compassion nonverbally, while this is much more difficult during a telehealth consultation [61]. A similar concern was reported by midwives in our study who revealed they could not build a warm and trusting bond with the women by telehealth consultations.…”

Section: Discussionsupporting

confidence: 73%

A double-edged sword - Telemedicine for maternal care during COVID-19: Findings from a global mixed methods study of healthcare providers

Galle

Semaan

Huysmans

et al. 2020

Preprint

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IntroductionThe COVID-19 pandemic has led to a rapid and wide implementation of telemedicine for provision of maternal and newborn health care worldwide. Studies conducted before the pandemic, mainly deriving from high-income countries, showed telemedicine was a safe and cost-effective tool for delivering healthcare under certain conditions. The objective of this study was to document the experiences of healthcare professionals globally with the provision of telemedicine for maternal and newborn healthcare during the COVID-19 pandemic.MethodsWe analysed responses received to the second round of a global, online survey of maternal and newborn health professionals, disseminated through professional networks and social media in 11 languages. Data were collected between July 5, 2020 and September 10, 2020. The questionnaire included questions regarding background, preparedness for and response to COVID-19 and experiences with providing telemedicine during the pandemic. Descriptive statistics and qualitative thematic analysis were used concurrently to analyse responses, disaggregated by country income level.ResultsResponses from 1,060 maternal and newborn health professional were analysed. Among the sample, 58% reported using telemedicine, with the lowest proportion reported by professionals working in low-income countries (24%). Two fifths of telemedicine users reported not receiving guidelines on the provision of care through technology. Key practices along the continuum of maternal and newborn healthcare provided through telemedicine included online group birth preparedness classes, antenatal and postnatal care by video/phone, setting up a COVID-19 helpline at maternity wards, and online psychosocial counselling. Challenges reported technological barriers, lack of technological literacy, financial and language barriers, lack of nonverbal feedback, and distrust from patients. Maternal and newborn health providers considered telemedicine to be an important alternative to in-person consultations to maintain care provision during the COVID-19 pandemic. However, they also emphasized the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.ConclusionsTelemedicine has been applied globally to address the disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. Pitfalls of health care provision by telemedicine include exacerbated inequalities in access to care, patient-provider communication problems, and a financial burden for certain healthcare workers and women. More research regarding the effectiveness, efficacy, and quality of telemedicine for maternal health care in different contexts is highly needed before considering long-term adaptations in provision of care away from face to face interactions. Clear guidelines for care provision and approaches to minimising socio-economic and technological inequalities in access to care are urgently needed.Summary boxWhat is already known?Telemedicine is the delivery of healthcare services by healthcare professionals from distance through using information and communication technologies for the exchange of valid and correct information.Telemedicine for maternal and newborn health can safely be used to deliver certain components of care in highly controlled settings where the technology is available and accessible to patientsTelemedicine has been applied rapidly and on a wide scale during the COVID-19 pandemic to replace face to face visits along the continuum of maternal and newborn health care.What are the new findings?Maternal and newborn healthcare providers globally considered telemedicine of benefit during the pandemic and applied it on a wide scale for different aspects of maternal and newborn healthcare.The rapid adaptation to provision of care via telemedicine was not optimally supported by guidelines, training for health providers, adequate equipment, reimbursement for cost of connectivity and insurance payments for care provided remotely.Healthcare providers reported not being able to reach a substantial group of families by telemedicine and encountered different barriers in providing high quality maternity care by telemedicine due to challenges present worldwide, but more prominent in low- and middle-income countries.What do the new findings imply?Pre-existing inequalities in terms of access to high quality care might have increased by the large scale and rapid implementation of telemedicine during the COVID-19 pandemic in different settings.Access to telemedicine for women was hampered by various factors such as internet connection problems, lack of the necessary equipment, digital illiteracy and distrust.In-depth research is needed to formalise evidence-based guidelines for the implementation of telemedicine along the continuum of maternal and newborn care as lessons learned for building back beyond the COVID-19 pandemic and also for future emergency preparedness.

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“…Echoing previous research, this study identi ed limitations of telehealth which resulted in the delivery of care where participants experienced challenges with booking processes and internet connection, and poor patient computer literacy (21,22). These may be magni ed in patients from low socio-economic and culturally and linguistic diverse backgrounds (23,24). Overall participants were required to accommodate for a de cient clinical history, struggled to establish a therapeutic relationship, and spent time extra post consult to follow up referrals and scripts.…”

Section: Discussionmentioning

confidence: 92%

The qualitative experience of telehealth access and clinical encounters in Australian health care during COVID-19: Implications for policy

White

Byles²,

Walley

2021

Preprint

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BackgroundAdaptive models of health care delivery, such as telehealth consultations, have rapidly been adopted to ensure ongoing delivery of essential health care services during COVID-19. However there remain gaps in our understanding of how clinicians have adapted to telehealth. This study aims to explore the telehealth experiences or specialists, based at tertiary hospital in the Hunter Region, and General Practitioners (GP) including barriers, enables and opportunities. Methods In-depth interviews explored the telehealth experiences of specialists, based at tertiary hospital in the Hunter Region of Australia, and General Practitioners (GP) including barriers, enablers and opportunities. Data were analyzed using an inductive thematic approach with constant comparison.ResultsIndividual interviews were conducted with 10 specialist and 5 GPs. Key themes were identified: (1) Transition to telehealth has been valuable but challenging; (2) Persisting telehealth process barriers need addressing; (3) Establishing when face-to-face consults are essential; (4) Changes in workload pressures and potential for double up; (5) Essential modification of work practices and (6) Exploring what is needed going forwardDiscussionWhile there is a need to rationalise and optimise health access during a pandemic, we suggest that more needs to be done improve telehealth going forward. Our results have important policy implications. Specifically, there is a specific need to effectively train clinicians to competently utilize and be confident using this telehealth and to educate patients on necessary skills and etiquette.

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Telemedicine is an important aspect of healthcare services amid COVID‐19 outbreak: Its barriers in Bangladesh and strategies to overcome

Cited by 57 publications

References 23 publications

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

A double-edged sword—telemedicine for maternal care during COVID-19: findings from a global mixed-methods study of healthcare providers

A double-edged sword - Telemedicine for maternal care during COVID-19: Findings from a global mixed methods study of healthcare providers

The qualitative experience of telehealth access and clinical encounters in Australian health care during COVID-19: Implications for policy

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