|Year : 2013 | Volume
| Issue : 2 | Page : 105-108
Assistants' awareness of teleconsultation in Isfahan AL-Zahra hospital
Nahid Tavakoli1, Asghar Ehteshami2, Zohreh Savadkoohi2, Shirin Sheivan2
1 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
|Date of Web Publication||4-Mar-2014|
Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan
Source of Support: None, Conflict of Interest: None
Introduction: The use of health information transmitted by communication tool to provide health, medical care or patient education aimed at improving the patient's condition is named "teleconsultation". Simply put teleconsultations uses communication and information technology to facilitate access to medical specialists and aims to increase the quality and reduce the cost of health care through exchange of medical informations. The aim of this project is to investigate the knowledge of residents about teleconsultation. Materials and Methods: This was an applied and descriptive study in which the residents of Isfahan's Alzahra hospital were taken as the population study. The cluster random sampling was carried out using Morgan table to determine 146 persons. The data collection tool was made by the researchers and its validity and reliability were proofed using content validity and Cronbach's alpha (r = 80.1), respectively. Data were analyzed by using SPSS. Result: Residents' knowledge about the existent technologies of teleconsulting was 62.5 percent and about the benefits of this technology was 60.5 percent, and the limitations was 67.5 percent. The mean of resident's knowledge was 62.7. Conclusion: Most of the resident's knowledge was in regard to teleconsultations restrictions and the lowest knowledge in relation to the existent teleconsultation technologies. Residents were fairly good estimate of the total amount. Residents still need training to learn more about this technology and also to create the appropriate infrastructure, such as increased bandwidth of the internet and promote the culture of users can be appropriated.
Keywords: Knowledge, resident, tele medicine, tele consultation
|How to cite this article:|
Tavakoli N, Ehteshami A, Savadkoohi Z, Sheivan S. Assistants' awareness of teleconsultation in Isfahan AL-Zahra hospital. Int J Health Syst Disaster Manage 2013;1:105-8
|How to cite this URL:|
Tavakoli N, Ehteshami A, Savadkoohi Z, Sheivan S. Assistants' awareness of teleconsultation in Isfahan AL-Zahra hospital. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2022 Jan 25];1:105-8. Available from: https://www.ijhsdm.org/text.asp?2013/1/2/105/128125
| Introduction|| |
The rapid development of information technology in the field of health leads to global great changes in health service. , One of the fields affected by this technology, is telemedicine that is the most important factors in the transformation and development of health systems. Teleconsultation is one of the important applications of telemedicine, that enables to create an environment for consultation between physicians and other health centers, associated with possibility of texts, images and data interchange between physicians by using the virtual sound and image, and provide their participation and consultation in patient care through the electronic network. It also, transforms the health care systems through patient needs rapid compliance with the appropriate level of car.  Therefore, one of the most factors is considered in change and development in health systems, is the geographical bridge for special care presentation. ,,,,,, The simplicity and broad applicability of this technology, has increased its share of telemedicine, , so provides 45% of the cost for visits in the home and remotely. In the U.S, this technology eliminated 95% and 40% of direct visits of prisoners and children to clinics, respectively. ,
Lack of resources in the health system in many developing countries, has led to focus on specialized services in large cities and as a result, the lack of adequate access to the population of small towns and villages to these services.  One of the most important factors in utilization of teleconsultation is capabilities and awareness of health professionals in using this technology for improving health care delivery, rising to universal access to specialized services, especially in underserved areas, thereby reducing the patients' waiting time to receive services, eliminating the geographical distance, reducing medical diagnostic and therapeutic travels, reducing the risks of transferring critically ill-patients to specialties and subspecialty centers, reducing the number of inpatients, reducing the cost of care, improving users and patient satisfaction, improving referral system quality and communication between health care providers at all levels of health system. ,, The health system can transmit, medical knowledge and services to underserved areas by using teleconsultation, and can replace the physical presence of physicians by teleconsultation. As a result, the need for new treatment centers is reduced and is leading to significant savings in health system financial and human resources.  Hayavi's study at Hormozgan University of Medical Sciences suggests that due to an unfavorable level of specialists' awareness, it is not possible to provide telemedicine services at the university there. 
In Iran, in the Fifth National Development Plan, telemedicine regarded as one of the opportunities facing the community to increase access to services and improve service quality in the health system are taken into consideration.  Due to the benefits of teleconsultation in solving previous problems, the utilization of this technology seems to be essential in the subspecialty hospitals. The aim of this study has been assessed by the awareness of professional assistants in this hospital about teleconsultation technology.
| Materials and Methods|| |
This study is an applied descriptive study which was performed in the first half of 2013 in the Isfahan Al-Zahra hospital. Research community included 570 resident assistants in the hospital. Research sample was calculated to 232 people by using Morgan's table and confidence level of 95%. The data gathering tool was a researcher-made questionnaire containing 50 multiple choice questions [Table 1]. Content validity of the questionnaire was confirmed by the faculty members of the Health Information Technology and Medical Informatics departments at Isfahan University of Medical Sciences and its reliability was confirmed through test-retest on 20% of the sample (Cronbach's alpha = 0.8). Version 18 of SPSS software, descriptive statistics (central tendency and dispersion parameters such as frequency, relative frequency, and mean) were used in order to study the Assistants' awareness. If an awareness score of each item was 0-20%, it would be considered too low, an awareness score of 21-40%were considered less, an awareness score of 41%-60% were considered on average. An awareness score of 61%-80% were considered relatively favorable (requiring modification), and 81%-100% was acceptable and favorable (no modification required).
|Table 1: Distribution of questions related to assistants' awareness of teleconsultation assessment|
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| Results|| |
The findings indicate that the average score of assistants' awareness of teleconsultation was 62.8% and that the highest score in awareness was related to radiology assistants (76.6%), and the lowest score in awareness of teleconsultation was related to pediatric's assistants (45.5%).
In the teleconsultation technology axis, the average of assistant's awareness was 62.8%. Oral and Maxillofacial Surgery assistants had the highest awareness (85%) and psychiatry assistants had the lowest awareness (37.5%) about teleconsultation technology. Among the items of this axis, the most awareness of assistants related to Smartphone usage in teleconsulting (74.6%) and the least of awareness was related to wearable biosensors in a teleconsultation (47%).
In the teleconsultation benefits axis, average of assistants' awareness was 60.5%; that the highest percentage was related to Periodontic's assistants (84.3%) and the lowest one was related to psychiatry assistants (43.3%). Among the items of this axis, the most awareness score was about the time savings (81%) and the least awareness was about the similarity of teleconsultation and face-to-face consulting (12%).
About limitations of this technology, average of assistants' awareness was 68.5%, the most awareness related to lung assistants (84.6%) and the least awareness related to pediatric assistants (51%). Most of the awareness of limitations axis in teleconsulting related to lack of eye contact in a teleconsultation between physician and patient (90.3%) and the lowest awareness was about the cost of equipment needed to (46%), respectively [Table 2].
|Table 2: Assistants' awareness of teleconsultation in AL-Zahra hospital in 2013|
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| Discussion|| |
The results indicate that despite the global developments of recent decades in the field of Information and Communications Technology (ICT) in the health field, our country has not benefited from these technologies and physicians as the most important health service providers have a fair awareness of this technology, but there is no readiness to implement this technology in providers of health care services. Other studies have also shown that the network setup for teleconsultation, can boost the community's access to health services, and can lead to reduce the costs of health care; but, in spite of favorable executive culture, telemedicine have been prevented due to inadequate infrastructure and the current level of expert's awareness. , However, it seems that the Ministry of Health and Medical Education and the Ministry of Information and Communications Technology should take the necessary measures to provide adequate infrastructure, cultural, and establishment of teleconsultation network. According to the findings, the majority of assistants believes that teleconsultation saves time, costs, and reduces unnecessary hospital expense. According to Lopez findings on Colombian rural health, patients' satisfaction with teleconsultation were 80% and 63% of them have embraced this technology for the service. In addition, 65% of them believed that telemedicine improves medical care and that more than half of them have had a positive impact on improving care, saving time, and costs. However, 27% of patients felt that the teleconsultation was not effective as in-person consulting. Lopez concluded that lack of familiarity with ICT is the biggest obstacle to use of telemedicine and possible cognitive factors is important in the acceptance of this technology by patients and their satisfaction.  According to our findings, 71.4% of the assistants agreed to the implementation of teleconsultation in rural and underserved areas. In these areas, due to aging and chronic diseases overpopulation under control, it feels the need to be constantly monitored and controlled them. But the lack of proper infrastructure and limited access to the internet in rural areas and low-bandwidth internet lines possibility implementation of teleconsultation in the areas that is needed to this technology more than elsewhere can be felt practically not possible. While in a poor country like Colombia, where two-thirds of the population lives in rural areas, this technology has been utilized and welcomed by villagers and 80% of them has achieved in-full or partial satisfaction.  In addition, Martin acknowledged that America's rural hospitals have the highest degree of readiness and the best features for implementing of teleconsultation, because teleconsultation is the solution to eliminate the gap between diversified and specialized care. 
According to our findings, 65% of assistants believe that teleconsultation increase collaboration between physicians, and assistants are more willing to use teleconsultation between the physicians with a physician than the physician with a patient. Moreover, they believe that due to high speed internet lacks and expensive equipment such as video conferencing cannot properly be used to teleconsultation for information exchange, as Larcher et al., showed a positive sense of physicians into increasing good communication with colleagues by teleconsultation. 
In this study, 90.4% of the assistants believe that there is no eye contact between physicians and patients in the teleconsultation; but, Sezeur showed that not only teleconsultation transforms the physician-patient relationship and the quality of the messages sent, but allows the relationship between the oncology team with several scientific centers by remote. 
Also Kim's in South Korea showed that telehealth is used in 75.4% of the cases in a hospital primary care and patients who have less access to medical care are the best group for telemedicine services, but the cost of telehealth care is equal to or greater than the cost of personal medical consultation. 
| Conclusions|| |
According to the findings, the most significant problem in the assistants' awareness of teleconsultation is the insufficient training of assistants in the field of teleconsultation that tend to lack its using. One of the obstacles to the implementation of this technology is its high and initial cost of equipment. Also, one of the reasons for assistants' unreliability to use this technology is that wishing to visit the patient and believe that the physical examination of the patient brings more confidence. Another important advantageous point is the low speed internet in the countryside that leads to make technology using difficult in health care. The followings can be key in the benefits of teleconsultations; training courses for assistants and health care providers of IT health professionals, inclusion of familiar courses in information technology in the training program of assistants and care providers and explaining service providers. Also important is the use of media for culture and general orientation of teleconsultation and increase in internet bandwidth for use of this technology.
| Acknowledgement|| |
The authors would like to express their gratitude to all those who helped us with their valuable comments, including hard working assistants in AL-Zahra Hospital, and dear journal experts.
| References|| |
|1.||Bashshur RL. Critical issues in telemedicine. Telemed J 1997;3:113-26. |
|2.||Torani S, Khammarnia M, Delgoshaei B. The ability of specialized hospitals of iran university of medical sciences in establishing remote medical advice. Health Inf Manage 2011;8. |
|3.||Hayavi Haghighi MH, Alipour J, Mastaneh Z, Mouseli L. Feasibility study of telemedicine implementation in Hormozgan university of medical sciences. Hormozgan Med J 2011;15:128-37. |
|4.||Ghafari A. Telemedicine: Another type of world. Biomed Eng 2006;92. |
|5.||Ibraghimova I. Teleconsultation. American International Health Alliance; 2009; Available from: http://www.toolkit.lrcnetwork.org/English/Training/teleconsult-eng.pdf. [Last accessed on 2013 Jul 05]. |
|6.||Kern J. Evaluation of teleconsultation systems. Int J Med Inform 2006;75:330-4. |
|7.||Behbahani S, Yavari F, Karimi M. Telemedicine: From yesterday to today. Biomed Eng 2009;104. |
|8.||Burke L, Weill B. Information technology for the health professions: Prentice Hall Press; 2008. |
|9.||Yaghoubi T, Azarbod L, Sanayei A, Saghaeiannejad S. Feasibility of telemedicine implementation using information and communication technology. First international conference on innovation and management; Iran: Civilica; 2010. |
|10.||Engbers L, Bloo H, Kleissen R, Spoelstra J, Vollenbroek-Hutten M. Development of a teleconsultation system for communication between physiotherapists concerning children with complex movement and postural disorders. J Telemed Telecare 2003;9:339-43. |
|11.||Hafezi M, MoayedRezaei S. ICT′s role in exchanging information in telemedicine. Homaye Salamat 2008;26:11-4. |
|12.||Ewers R, Schicho K, Wagner A, Undt G, Seemann R, Figl M, et al. Seven years of clinical experience with teleconsultation in craniomaxillofacial surgery. J Oral Maxillofac Surg 2005;63:1447-54. |
|13.||Krüger C, Niemi M. A telemedicine network to support paediatric care in small hospitals in rural Tanzania. J Telemed Telecare 2012;18:59-62. |
|14.||Rörtgen D, Bergrath S, Rossaint R, Beckers SK, Fischermann H, Na IS, et al. Comparison of physician staffed emergency teams with paramedic teams assisted by telemedicine - A randomized, controlled simulation study. Resuscitation 2012;84:85-92. |
|15.||Kasitipradith N. The ministry of public health telemedicine network of Thailand. Int J Med Inform 2001;61:113-6. |
|16.||Keshvari H. Telemedicine: An efficient tool for justice achivement in health sector. Commun 2011. |
|17.||Gackowski A, Czekierda £, Chrustowicz A, Ca³a J, Nowak M, Sadowski J, et al . Development, implementation, and multicenter clinical validation of the TeleDICOM-advanced, interactive teleconsultation system. J Digit Imaging 2011;24:541-51. |
|18.||Health of Iran in fifth economic development, social program. In: Education MOHME, editor. Iran: Ministry of Health and Medical Education; 2009. |
|19.||López C, Valenzuela JI, Calderón JE, Velasco AF, Fajardo R. A telephone survey of patient satisfaction with realtime telemedicine in a rural community in Colombia. J Telemed Telecare 2011;17:83-7. |
|20.||Martin AB, Probst JC, Shah K, Chen Z, Garr D. Differences in readiness between rural hospitals and primary care providers for telemedicine adoption and implementation: Findings from a statewide telemedicine survey. J Rural Health 2012;28:8-15. |
|21.||Larcher B, Arisi E, Berloffa F, Demichelis F, Eccher C, Galligioni E, et al. Analysis of user-satisfaction with the use of a teleconsultation system in oncology. Med Inform Internet Med 2003;28:73-84. |
|22.||Sezeur A, Degramont A, Touboul E, Mosnier H. Teleconsultation before chemotherapy for recently operated on patients. Am J Surg 2001;182:49-51. |
|23.||Kim JE, Song YM, Park JH, Lee JR. Attitude of korean primary care family physicians towards telehealth. Korean J Fam Med 2011;32:341-51. |
[Table 1], [Table 2]