The Typology of Physicians According to Perspectives on Telemedicine During and Beyond the Covid-19 Pandemic

Marcellus Francis L. Ramirez, Maria Minerva P. Calimag

Apr 2023 DOI 10.35460/2546-1621.2023-0018     Access   

Abstract

Introduction: The coronavirus (CoVid-19) pandemic brought about a massive impact to the healthcare system, including disruption of patient follow-ups and consultations. Subsequently, an increase in physicians’ use of telemedicine was seen. While this technology has been documented to improve delivery of care, it has encountered varied acceptance among physicians. Gaps in specific national legislation, lack of established rules and accreditation standards, and ethical/legal implications add to the concerns. Anchored on the Unified Theory of Acceptance and Use of Technology model, this study aimed to segment physicians according to their perspectives regarding telemedicine during the pandemic.

 

Methods: A mixed methods sequential explanatory design using Q-methodology was applied to identify distinct patterns and perceptions of physicians on the use of telemedicine during the pandemic. A Q-sample of 25 statements on perceptions of telemedicine was developed through literature review, and 24 physicians were purposively selected. Participants were instructed to sort statements into a distribution grid according to their degree of agreement/disagreement. Post-sorting interview was conducted to expound on their response. Data were analyzed using by-person factor analysis through the PQMethod software version 2.35.

 

Result and Conclusion: The analysis identified four profiles which were classified under the following perspective typologies: the “Outcomes-focused Physician” focused on the importance of arriving at a correct diagnosis and lack of physical examination; the “Patient-focused Physician” considered patients’ convenience and safety during the pandemic; the “Empathy-focused Physician” gave importance to the emotional aspect of a consultation; and the “Technology-focused Physician” was concerned about the patient’s technology literacy. The results can generate insights into professional, ethical and legal implications of telemedicine in medical practice, and provide healthcare organizations, academic institutions, and policy makers information and guidance in the modification and improvement of telemedicine services in the 'new normal'.

Key words: telemedicine, perceptions, physicians, pandemic, CoVid-19

  1. World Health Organization. 90% of countries report disruptions to essential health services since COVID-19 pandemic. In: WHO global pulse survey 2020. Available from:  https://www.who.int/news/item/31-08-2020-in-who-global-pulse-survey-90-of-countries-report-disruptions-to-essential-health-services-since-covid-19-pandemic
  2. World Health Organization. Pulse survey on continuity of essential health services during the COVID-19 pandemic, interim report 27 August 2020. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-EHS_continuity-survey-2020.1
  3. World Health Organization. Rapid assessment of service delivery for noncommunicable diseases during the COVID-19 pandemic. Available from: https://www.who.int/docs/default-source/ncds/ncd-covid-19/for-web---rapid-assessment---30-june-2020-(cleared).pdf?sfvrsn=6296324c_20&download=true
  4. World Health Organization. Telemedicine: Opportunities and developments in member states: report on the second global survey on eHealth 2009. Switzerland: WHO Press 2010. Available from: http://www.who.int/goe/publications/ goe_telemedicine_2010.pdf.
  5. Betancourt JA, Rosenberg MA, Zevallos A, Brown JR, Mileski M. The impact of COVID-19 on telemedicine utilization across multiple service lines in the United States. Healthcare (Basel) [Internet]. 2020;8(4):380. Available from: http://dx.doi.org/10.3390/healthcare8040380
  6. Shah S, Diwan S, Kohan L, Rosenblum D, Gharibo C, Soin A, et al. The technological impact of COVID-19 on the future of education and health care delivery. Pain Physician. 2020;23(4S):S367–80.
  7. Centers for Disease Control. What is telemedicine in a non-US setting? 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/telemedicine.html
  8. US Department of Health and Human Sciences. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. HHS.gov. 2020. Available from: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
  9. Rockwell KL, Gilroy AS. Incorporating telemedicine as part of COVID-19 outbreak response systems. Am J Manag Care [Internet]. 2020;26(4):147–8. Available from: http://dx.doi.org/10.37765/ajmc.2020.42784
  10. Department of Health. Department of Health Memorandum Circular No. 2020-0016: Guidelines for the use of telemedicine in CoViD19 response, 2020. Available from: https://www.privacy.gov.ph/wp-content/uploads/2020/10/DOH-mc2020-0016.pdf
  11. UP medical informatics unit: Telemedicine guidance for Filipino physicians and patients [Internet]. The Endocrine Witch. 2020 [cited 2023 Apr 11]. Available from: https://www.endocrine-witch.net/2020/05/02/up-medical-informatics-unit-telemedicine-guidance-for-filipino-physicians-and-patients/ 
  12. Salud G. Get a checkup from home: Metro manila hospitals & clinics offering telemedicine [Internet]. Tripzilla Philippines. 2020 [cited 2023 Apr 11]. Available from: https://www.tripzilla.ph/teleconsultation-metro-manila/17229
  13. Acharya RV, Rai JJ. Evaluation of patient and doctor perception toward the use of telemedicine in Apollo Tele Health Services, India. J Family Med Prim Care [Internet]. 2016;5(4):798–803. Available from: http://dx.doi.org/10.4103/2249-4863.201174
  14. Albarrak AI, Mohammed R, Almarshoud N, Almujalli L, Aljaeed R, Altuwaijiri S, et al. Assessment of physician’s knowledge, perception and willingness of telemedicine in Riyadh region, Saudi Arabia. J Infect Public Health [Internet]. 2021;14(1):97–102. Available from: http://dx.doi.org/10.1016/j.jiph.2019.04.006
  15. Donelan K, Barreto EA, Sossong S, Michael C, Estrada JJ, Cohen AB, et al. Patient and clinician experiences with telehealth for patient follow-up care. Am J Manag Care. 2019;25(1):40–4.
  16. El - Mahalli A, El - Khafif S. Successes and challenges in the implementation and application of telemedicine in the eastern province of Saudi Arabia. Perspect Health Inf Manag. 2012;9:1–27.
  17. Rosen D, McCall JD, Primack BA. Telehealth protocol to prevent readmission among high-risk patients with congestive heart failure. Am J Med [Internet]. 2017;130(11):1326–30. Available from: http://dx.doi.org/10.1016/j.amjmed.2017.07.007
  18. Schreiber SS. Teleneurology for veterans in a major metropolitan area. Telemed J E Health [Internet]. 2018;(tmj.2017.0202);24(9):698-701. Available from: http://dx.doi.org/10.1089/tmj.2017.0202
  19. Sood A, Watts SA, Johnson JK, Hirth S, Aron DC. Telemedicine consultation for patients with diabetes mellitus: a cluster randomised controlled trial. J Telemed Telecare [Internet]. 2017;24(6):1357633X17704346. Available from: http://dx.doi.org/10.1177/1357633X17704346
  20. Taylor A, Morris G, Pech J, Rechter S, Carati C, Kidd MR. Home telehealth video conferencing: Perceptions and performance. JMIR MHealth UHealth [Internet]. 2015;3(3):e90. Available from: http://dx.doi.org/10.2196/mhealth.4666
  21. Alami H, Fortin J-P, Gagnon M-P, Pollender H, Têtu B, Tanguay F. The challenges of a complex and innovative telehealth project: A qualitative evaluation of the Eastern Quebec telepathology network. Int J Health Policy Manag [Internet]. 2017;7(5):421–32. Available from: http://dx.doi.org/10.15171/ijhpm.2017.106
  22. Martínez Álvarez M, Chanda R, Smith RD. How is telemedicine perceived? A qualitative study of perspectives from the UK and India. Global Health [Internet]. 2011;7(1):17. Available from: http://dx.doi.org/10.1186/1744-8603-7-17
  23. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ [Internet]. 2020;368:m1182. Available from: http://dx.doi.org/10.1136/bmj.m1182
  24. Kruse CS, Karem P, Shifflett K. Evaluating barriers to adopting telemedicine worldwide: A systematic review. Journal of Telemedicine and Telecare. 2018;24(1):4–12.
  25. Helou S, El Helou E, Abou-Khalil V, Wakim J, El Helou J, Daher A, et al. The effect of the COVID-19 pandemic on physicians’ use and perception of telehealth: The case of Lebanon. Int J Environ Res Public Health [Internet]. 2020;17(13):4866. Available from: http://dx.doi.org/10.3390/ijerph17134866
  26. Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med [Internet]. 2020;382(18):1679–81. Available from: http://dx.doi.org/10.1056/NEJMp2003539
  27. Timpel P, Harst L. Research implications for future telemedicine studies and innovations in diabetes and hypertension-A mixed methods study. Nutrients [Internet]. 2020;12(5):1340. Available from: http://dx.doi.org/10.3390/nu12051340
  28. Hanlon P, Daines L, Campbell C, McKinstry B, Weller D, Pinnock H. Telehealth interventions to support self-management of long-term conditions: A systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. J Med Internet Res [Internet]. 2017;19(5):e172. Available from: http://dx.doi.org/10.2196/jmir.6688
  29. Knudsen LR, de Thurah A, Lomborg K. Experiences with telehealth followup in patients with rheumatoid arthritis: A qualitative interview study. Arthritis Care Res (Hoboken) [Internet]. 2018;70(9):1366–72. Available from: http://dx.doi.org/10.1002/acr.23483
  30. Warner MM, Tong A, Campbell KL, Kelly JT. Patients’ experiences and perspectives of telehealth coaching with a dietitian to improve diet quality in chronic kidney disease: A qualitative interview study. J Acad Nutr Diet [Internet]. 2019;119(8):1362–74. Available from: http://dx.doi.org/10.1016/j.jand.2019.01.023
  31. du Toit M, Malau-Aduli B, Vangaveti V, Sabesan S, Ray RA. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: A systematic review. J Telemed Telecare [Internet]. 2019;25(1):3–16. Available from: http://dx.doi.org/10.1177/1357633X17734239
  32. Hatcher-Martin J, Factor AE. Patient acceptance and potential cost-savings of teleneurology in an academic outpatient movement disorders practice (P1.022). Neurology. 2016;86(16):P1-022.
  33. Müller KI, Alstadhaug KB, Bekkelund SI. A randomized trial of telemedicine efficacy and safety for nonacute headaches. Neurology [Internet]. 2017;89(2):153–62. Available from: http://dx.doi.org/10.1212/wnl.0000000000004085
  34. Powell RE, Henstenburg JM, Cooper G, Hollander JE, Rising KL. Patient perceptions of telehealth primary care video visits. Ann Fam Med [Internet]. 2017;15(3):225–9. Available from: http://dx.doi.org/10.1370/afm.2095
  35. Provenzano D. Telemedicine healthcare for headache medicine during COVID-19 and beyond. AHM Journal [Internet]. 2020; Available from: http://dx.doi.org/10.30756/ahmj.2020.02.03
  36. Ballester S, Scott JM, Owei MF. Patient preference for time-saving telehealth postoperative visits after routine surgery in an urban setting. Surgery. 2018;163(4):672–9.
  37. Fryer K, Delgado A, Foti T, Reid C, Marshall J. Implementation of obstetric telehealth during COVID - 19 and beyond. Maternal and Child Health Journal. 2020;24:1104–10.
  38. Landow SM, Mateus A, Korgavkar K, Nightingale D, Weinstock MA. Teledermatology: key factors associated with reducing face-to-face dermatology visits. J Am Acad Dermatol [Internet]. 2014;71(3):570–6. Available from: http://dx.doi.org/10.1016/j.jaad.2014.02.021
  39. Tensen E, van der Heijden JP, Jaspers MWM, Witkamp L. Two decades of teledermatology: Current status and integration in national healthcare systems. Curr Dermatol Rep [Internet]. 2016;5(2):96–104. Available from: http://dx.doi.org/10.1007/s13671-016-0136-7
  40. Salongcay RP, Silva PS. The role of teleophthalmology in the management of diabetic retinopathy. Asia Pac J Ophthalmol (Phila) [Internet]. 2018;7(1):17–21. Available from: http://dx.doi.org/10.22608/APO.2017479
  41. Humphreys J, Schoenherr L, Elia G, Saks NT, Brown C, Barbour S, et al. Rapid implementation of inpatient telepalliative medicine consultations during COVID-19 pandemic. J Pain Symptom Manage [Internet]. 2020;60(1):e54–9. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2020.04.001
  42. Cota A, Tarchala M, Parent-Harvey C, Engel V, Berry G, Reindl R, et al. Review of 5.5 years’ experience using E-mail-based telemedicine to deliver orthopedic care to remote communities. Telemed J E Health [Internet]. 2017;23(1):37–40. Available from: http://dx.doi.org/10.1089/tmj.2016.0030
  43. Reider-Demer M, Raja P, Martin N, Schwinger M, Babayan D. Prospective and retrospective study of videoconference telemedicine follow-up after elective neurosurgery: results of a pilot program. Neurosurg Rev [Internet]. 2018;41(2):497–501. Available from: http://dx.doi.org/10.1007/s10143-017-0878-0
  44. Indria D, Alajlani M, Fraser HSF. Clinicians perceptions of a telemedicine system: a mixed method study of Makassar City, Indonesia. BMC Med Inform Decis Mak [Internet]. 2020;20(1):233. Available from: http://dx.doi.org/10.1186/s12911-020-01234-7
  45. Cantos PL, Chua NJ, Florentin MJ, Gomez TG, Hapan MF, Salmon S. Perceived level of satisfaction of Filipino patients residing in Metro Manila towards teleconsultation as new means of healthcare delivery. International Journal of Progressive Research in Science and Engineering. 2021;2(8):229–43.
  46. Peine A, Paffenholz P, Martin L, Dohmen S, Marx G, Loosen SH. Telemedicine in Germany during the COVID-19 pandemic: Multi-professional national survey. J Med Internet Res [Internet]. 2020;22(8):e19745. Available from: http://dx.doi.org/10.2196/19745
  47. Cruz-Lim EM, Co HC, Mendoza MJ, Dumlao P III, Lucero JA, Yap B, et al. Physicians’ perceptions on the role of telemedicine in cancer care during and post-COVID-19 pandemic. Acta Med Philipp [Internet]. 2021;55(2). Available from: http://dx.doi.org/10.47895/amp.v55i2.2836
  48. Brown SR. Q methodology and qualitative research. Qual Health Res 1996;6:561–7. Available from: http://schmolck.org/qmethod/srbqhc.htm
  49. Ladan MA, Wharrad H, Windle R. Towards understanding healthcare professionals’ adoption and use of technologies in clinical practice: using Q-methodology and models of technology acceptance. BMJ Health Care Inform [Internet]. 2018;25(1):27–37. Available from: http://dx.doi.org/10.14236/jhi.v25i1.965
  50. Valenta AL, Wigger U. Q-methodology: definition and application in health care informatics. J Am Med Inform Assoc [Internet]. 1997;4(6):501–10. Available from: http://dx.doi.org/10.1136/jamia.1997.0040501
  51. Watts S, Stenner P. Doing Q methodology: Theory, method and interpretation. Qualitative Research in Psychology. 2005;2:67–91.
  52. Barker JH. Q-methodology: An alternative approach to research in nurse education. Nurse Educ Today [Internet]. 2008;28(8):917–25. Available from: http://dx.doi.org/10.1016/j.nedt.2008.05.010
  53. Kiwanuka A. Acceptance Process: The missing link between UTAUT and diffusion of innovation theory. American Journal of Information Systems. 2015;3(2):40–4.
  54. Venkatesh, Morris, Davis. User acceptance of information technology: Toward a unified view. MIS Q  [Internet]. 2003;27(3):425. Available from: http://dx.doi.org/10.2307/30036540
  55. Taiwo AA, Downe AG. The theory of user acceptance and use of technology (UTAUT): a meta-analytic review of empirical findings. Journal of Theoretical and Applied Information Technology. 2013;49(1):48–58.
  56. Tsai J-M, Cheng M-J, Tsai H-H, Hung S-W, Chen Y-L. Acceptance and resistance of telehealth: The perspective of dual-factor concepts in technology adoption. Int J Inf Manage [Internet]. 2019;49:34–44. Available from: http://dx.doi.org/10.1016/j.ijinfomgt.2019.03.003
  57. Kamal SA, Hussain S, Shafiq M, Jahanzaib M. Investigating the adoption of telemedicine services: an empirical study of factors influencing physicians’ perspective in Pakistan. Nucleus. 2018;55(3):153–63.
  58. Bartlett JE II, DeWeese B. Using the Q methodology approach in human resource development research. Adv Dev Hum Resour [Internet]. 2015;17(1):72–87. Available from: http://dx.doi.org/10.1177/1523422314559811
  59. Van Exel J and de Graaf G. Q methodology: A sneak preview. 2005:pp.1–21. Available from:  https://sites.nd.edu/lapseylab/files/2014/10/vanExel.pdf
  60. Rogers EM. Diffusion of Innovations. 5th Ed. The Free Press 2003. New York.
  61. Cheshire WP, Barrett KM, Eidelman BH, Mauricio EA, Huang JF, Freeman WD, et al. Patient perception of physician empathy in stroke telemedicine. J Telemed Telecare [Internet]. 2021;27(9):572–81. Available from: http://dx.doi.org/10.1177/1357633x19899237
  62. Bashshur R, Doarn CR, Frenk JM, Kvedar JC, Woolliscroft JO. Telemedicine and the COVID-19 pandemic, lessons for the future. Telemed J E Health [Internet]. 2020;26(5):571–3. Available from: http://dx.doi.org/10.1089/tmj.2020.29040.rb
  63. Pasco PM. Physician perspectives in the practice of telemedicine in the Philippines. J Int Soc Telemed eHealth. 2016;4:e26.
  64. Kumar P, Huda F, Basu S. Telemedicine in the COVID-19 era: the new normal. Eur Surg [Internet]. 2020;52(6):300–1. Available from: http://dx.doi.org/10.1007/s10353-020-00666-9
  65. Luz PL da. Telemedicine and the doctor/patient relationship. Arq Bras Cardiol [Internet]. 2019;113(1):100–2. Available from: http://dx.doi.org/10.5935/abc.20190117
  66. Silverman J, Kinnersley P. Doctors’ non-verbal behaviour in consultations: look at the patient before you look at the computer. Br J Gen Pract. 2010;60(571):76–8.
  67. Messer NG. Professional-patient relationships and informed consent. Postgrad Med J [Internet]. 2004;80(943):277–83. Available from: http://dx.doi.org/10.1136/pgmj.2003.012799
  68. Terry C, Cain J. The emerging issue of digital empathy. Am J Pharm Educ [Internet]. 2016;80(4):58. Available from: http://dx.doi.org/10.5688/ajpe80458

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