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.
Downloads
References
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. DOI: https://doi.org/10.1177/2150132720980612
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. DOI: https://doi.org/10.1155/2020/9036847
Jiang W, Magit AE, Carvalho D. Equal access to telemedicine during COVID-19 pandemic: a pediatric otolaryngology perspective. Laryngoscope. 2021;131:1175-9. DOI: https://doi.org/10.1002/lary.29164
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. DOI: https://doi.org/10.20517/ch.2021.03
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. DOI: https://doi.org/10.4103/JETS.JETS_32_20
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. DOI: https://doi.org/10.1016/j.aprim.2020.04.003
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. DOI: https://doi.org/10.52586/E885
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. DOI: https://doi.org/10.3389/fpubh.2021.711762
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. DOI: https://doi.org/10.1016/j.jadohealth.2020.05.006
Manteghinejad A, Javanmard SH. Challenges and opportunities of digital health in a post-COVID19 world. J Res Med Sci. 2021;26:11. DOI: https://doi.org/10.4103/jrms.JRMS_1255_20
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. DOI: https://doi.org/10.1089/tmj.2020.0386
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. DOI: https://doi.org/10.5888/pcd18.210056
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. DOI: https://doi.org/10.2196/27982
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. DOI: https://doi.org/10.1097/MLR.0000000000001585
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. DOI: https://doi.org/10.1089/pop.2020.0186
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. DOI: https://doi.org/10.1001/jamanetworkopen.2020.31640
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. DOI: https://doi.org/10.2196/16407
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. DOI: https://doi.org/10.1177/1932296821997851
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. DOI: https://doi.org/10.1093/tbm/ibab060
Kaplan B. Access, equity, and neutral space: telehealth beyond the pandemic. Ann Fam Med. 2021;19:75-8. DOI: https://doi.org/10.1370/afm.2633
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. DOI: https://doi.org/10.1200/EDBK_320827
McMillan SS, King M, Tully MP. How to use the nominal group and delphi techniques. Int J Clin Pharm. 2016;38:655-62. DOI: https://doi.org/10.1007/s11096-016-0257-x
Jones J, Hunter D. Qualitative research: consensus methods for medical and health services research. BMJ. 1995;311:376-80. DOI: https://doi.org/10.1136/bmj.311.7001.376
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. DOI: https://doi.org/10.1093/fampra/10.1.76
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. DOI: https://doi.org/10.1007/s11845-020-02299-z
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. DOI: https://doi.org/10.1093/tbm/ibaa105
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. DOI: https://doi.org/10.1001/jamanetworkopen.2020.24984
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. DOI: https://doi.org/10.1016/j.ophtha.2021.07.003
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. DOI: https://doi.org/10.1016/j.ajo.2021.07.024
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. DOI: https://doi.org/10.1093/eurpub/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. DOI: https://doi.org/10.1016/j.dhjo.2020.100973
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. DOI: https://doi.org/10.1093/jamia/ocab145
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. DOI: https://doi.org/10.1007/s40501-020-00210-2
Hollander JE, Carr BG. Virtually perfect? Telemedicine for COVID-19. N Engl J Med. 2020;382:1679-81. DOI: https://doi.org/10.1056/NEJMp2003539
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. DOI: https://doi.org/10.1186/s12911-022-01952-0
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. DOI: https://doi.org/10.1016/j.jiph.2016.09.001
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. DOI: https://doi.org/10.2196/23233
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. DOI: https://doi.org/10.1371/journal.pone.0237585
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
