Telemedicine: Practices and Beliefs among Medical Students of a Government Medical College in Bengaluru, Karnataka

Introduction

Digital Health Interventions can be a potential tool for continuous and contact health coverage, thereby contributing to Universal Health Coverage.¹ Successful adaptation and integration of the concepts of telemedicine and e-Health with clinical practice depends on structural issues in the settings where they are being used, on available infrastructure, the health needs to be addressed,and the ease of use of the technology itself.² There is a need for progressive evaluation of the needs of the end user, preferences, barriers and benefits for appropriate implementation of e-health and telemedicine.

This study was conducted to assess the beliefs as well as the practices among medical students to evaluate the end user needs, preferences, benefits and barriers regarding e-Health and telemedicine.

Subjects and Methods

A cross-sectional study was conducted in the undergraduate medical students of a Government Medical College in Bengaluru from the month of April to June 2022 . Universal sampling method was adopted for the study. A pre-tested, semi-structured questionnaire3 which assessed self- reported views, barriers and benefits in the backdrop of e-Health and telemedicine was used. Data was collected through the online platform using Google forms and consent was taken through the same. In this study, 102 students had participated. Data was entered in MS Office Excel and SPSS version 20.0 was used for statistical analysis. Descriptive data has been presented in the form of proportions and percentages. Normally distributed qualitative data were expressed as mean and standard deviation.

Results

In the online survey which was conducted , 102 students out of 1000 students who were contacted had participated in the study. The average age of the participants of the study was 21.24 ± 1.46 years. Among the 102 study participants, 61.8% (n=63) of the participants were females and 38.2% (n=39) of the participants were males.

Figure 1 depicts the perceived information of participants on e-Health and telemedicine. The mean scores of information of participants about e-Health and telemedicine was obtained as 2.75 ± 0.93. (Range: 1= poorly informed to 5 = well informed)

On assessing the participant views on e-Health and telemedicine (range: 1 indicates very low approval and 5 indicates high approval), it was found that the mean score of statement of approval that it is useful to collect data by way of portable sensors and to recommend healthy lifestyle was 3.08±0.82. Usefulness to collect health information through portable sensors to monitor chronic illness or disability had a mean score of 3.03± 0.90. The reasonability of health information exchange between health care professionals and patients had a mean score of 2.91 ±0.81. The reliability of health information from internet had a lower mean score of approval, 2.58± 0.83 among the medical students.

Table 1 explains the benefits as well as barriers for telemedicine. Telemedicine offers location independent services is a statement that had the highest approval (mean score: 3.28 ±1.066). The security of the data and privacy of the data are assured in the health data collected electronically is a statement that had least approval. Figure 2 describes the overall approval rates of the benefits as well as the barriers of e health and telemedicine among the study participants.

Figure 3 depicts the preferences for retrieval of health related information among the study subjects. Upon ranking the options, it was found that specific diseases, symptoms were searched the most, followed by meaning of specific medical terms. The adverse effects of prescription and non-prescription medicines and dosage of drugs were also commonly searched items by medical students.

Discussion

The recent advancements and innovations in technology has brought about developments in the fields of e-Health and telemedicine. It has given more costeffective treatment options to physicians as well to patients through telecommunication technology in medical practice. It can offer to provide both inpatient and outpatient care, educate the patients and also the physicians, respond to emergencies and disasters and provide care to remote and underserved population. This study was undertaken to assess the practices as well as the beliefs among medical students to evaluate the end user needs, preferences, benefits and barriers regarding e-Health and telemedicine.

Most of the study subjects perceived that they are only moderately informed (42%) about telemedicine and e-Health. Only 20% percent perceived that they are informed to well informed about telemedicine and e-Health. Telemedicine integration and training of medical professionals are not very well established around the world. In a study conducted by Sarina Yanghobian et al., among French medical students, though 82.8% of their study participants, medical students and residents acknowledged the relevance of telemedicine for improving access to care, majority (84.8%) were unfamiliar with the telemedicine regulations.⁴ It was found that interaction of medical students with telemedicine during their undergraduate medical training leads to the core competencies development in patient care, medical knowledge, and practice-based learning.⁵

The participant views on use of portable sensors for recommending healthy lifestyles and monitoring chronic illnesses and disability had higher mean scores. The advancement in low- power, compact wearables, inexpensive computing and storage devices coupled with modern communication technologies have given way for low-cost, unobtrusive, and long-term health monitoring system. Continuous monitoring of health status of patients with the portable sensors can provide comprehensive information about individuals’ health status over a period of time along with cost-effective remote health care services.⁶

Considering the perceived barriers as well as the benefits of telemedicine, the provision of location independent health services (3.28±1.066), reduction health care costs (3.26±1.080), facilitation of medical care (3.22±0.951), enhancement of quality of health care (3.10±0.839), improvement of patient knowledge (3±0.912) had higher mean scores of approval among study participants. Enhancement of doctor-patient relationship (2.97±0.906), interaction between physicians and patients can be improved (2.92±0.898), holistic view of the patients improvement (2.88±0.787), guarantee for the security as well as the privacy for the health care related data collected electronically (2.85±0.959) had lower mean scores of approval among the study participants.

Study by Balestra M et al., described few of the barriers of telemedicine such as limitations when performing comprehensive physical examinations, technical difficulties possibilities, breaches in security, and barriers in regulation.⁷ Few other studies have also shown that the continuity of care may be affected, stating that impersonal and dangerous interactions can occur online and the benefit of acquiring a complete proper history and examining the patient to aid with diagnosis and treatment is missed.⁸ 

The concern about the security as well as the privacy related to telehealth systems is another hurdle for the acceptance and implementation of telehealth on a broader scale. The present study also showed a lower approval among study participants about security as well as the privacy of the health data collected electronically. Several laws that provide protection , security and privacy for the information related to health that is collected by the covered entities such as health care plans, health care clearing houses, and the providers of health care by whom electronic resources are used for the transmission of information related to health care. Awareness about legal aspects of telemedicine and etiquettes for practice is important for appropriate use of this system.

Other potential hurdle which can affect the practice of telemedicine effectively is the accuracy of data transmission which can further lead to clinical treatment decisions which are incorrect and recommendations. For obtaining clear standards of acceptable information, there must be formats which are standardized in case of digital imaging and in communications.

For improving the provision and access to health care services, E-health and telemedicine is now increasingly expanding across geographical areas. Along with technological advancements in care, the acceptance and approval of these systems by patient as well as provider is important for improving the access to health care and their outcomes. The present study has identified various barriers to telemedicine perceived among medical students such as security of the data and privacy, poor interaction between physician and patients, poor doctor-patient relationship, reduced health care administration. Also, few benefits of telemedicine identified were location independent health services, reduced health care costs, facilitation of medical care and quality of medical care enhancement. The barriers of telemedicine identified can be overcome to some extent by educating the medical students about telemedicine, e-Health, its etiquettes and legal aspects.

Based on the study, it is recommended that an integral part of the medical curriculum should be telemedicine and e-health thereby increasing the awareness and knowledge in the health care professionals and better incorporation of telemedicine practices in health care administration.

Conflicts of Interest

None