EVOLVING TELEMEDICINE PRACTICE: EXPERIENCES OF HEALTH CARE WORKERS DURING COVID-19 PANDEMIC

A.A. Adeyemo1,2, S.A. Ogunkeyede2,3, O.A. Ogundoyin2, and O.A. Oyelakin2

  1. Institute of Child Health, College of Medicine, University of Ibadan, Ibadan.
  2. Department of Otorhinolaryngology, University College Hospital, Ibadan.
  3. Department of Otorhinolaryngology, College of Medicine, University of Ibadan, Ibadan.

Abstract

Background: Telemedicine is employed in patient care when direct physical contact is not possible or discouraged, as was seen during the COVID-19 pandemic. The use of smartphone technology could make telemedicine affordable and available in low and medium-income countries (LMICs). However, the evolution of telemedicine care depends on multiple factors.

Aim: To explore the practice of telemedicine by Nigerian health care workers (HCWs) during the COVID-19 pandemic

Methods: A cross-sectional study of the Nigerian HCWs on telemedicine practice in patient care during the COVID-19 pandemic period. Recruitment of respondents was done through dedicated WhatsApp and Telegram social media platforms for HCWs over a period of 40 days (May 1st and June 10th,2020).

Results: A total of 481 HCWs participated in the study consisting of 153(31.8%) doctors, 150(31.2%) nurses and 178(37%) other HCWs. Though 89.2% of the HCWs agreed that telemedicine is important, it was only 266 (55.3%) that practiced telemedicine, phone consultation was the form of telemedicine used in all the health institutions. Telemedicine was practiced more by doctors 91(18.9%), nurses 79(16.4%) and pharmacists 35(7.3%) than other groups of health care workers. Inadequate COVID-19 screening test and lack of personal protective equipment were strong motivators for the attending HCWs to practice telemedicine.

Conclusion: There was widespread use of phone consultation by all cadres of health care workers during the pandemic. Hence there should be a health policy that will encourage greater use and acceptance of telemedicine in clinical practice and in the patients care beyond the pandemic period

Keywords: COVID-19 pandemic, Health care workers, Telemedicine, Low and Medium-income countries

Correspondence:

Dr. S.A. Ogunkeyede
Department of Otorhinolaryngology,
University College Hospital,
Ibadan
E mail: segunkeyede@yahoo.com.

Introduction

Telemedicine provides an audio-visual means of remote practise of medicine. Patients can communicate remotely with health care workers (HCWs) via telephone or via internet facilities at the comfort of their homes or within designated places in the community or hospital premises. Clinical images of lesions can be taken at home by the patients or relations which can be shared with physicians to aid accurate diagnosis. It has been shown that images acquired by HCWs and non-HCWs are equally effective for adequate clinical diagnosis comparable with conventional face-to-face clinical evaluation1, although, some specific examination and evaluation are not currently supported by telemedicine.2 Nonetheless, telemedicine has been employed in the care of patients without direct physical contact with HCWs or in remote areas where HCWs are not available.3,4

Telemedicine can be an essential innovation to cater for the shortage of HCWs in low and medium-income countries (LMICs). However, early report shows that adoption of telemedicine usage by HCWs in LMICs is limited.5 Several factors may be responsible for the low adoption of telemedicine in LMICs. These may include inertia by clinicians to adopt telemedicine, it may also include lack of adequate infrastructure to aid telemedicine deployment, lack of clarity on who will bear the associated costs and medico-legal issues surrounding physicians’ obligations. All these factors may have led to the slow pace of adoption of telemedicine in LMICs, despite the fact that telemedicine has aided medical practice globally.5 The advent of COVID-19 pandemic may however alter the usage of telemedicine in clinical practice within
LMICs.

One of the dilemmas faced by HCWs during COVID19 pandemic was sustaining capacity in continued offering of clinical service, while protecting themselves and other patients within the health facilities. COVID19 is a highly contagious infection transmitted through droplets or aerosols from the respiratory system.6,7 HCWs are exposed to high risk of this infection in the course of duty; some cadres of HCWs endure even greater risk of infection during examination of patient’s oral cavity, pharynx, nasal cavities, head and neck.8 The risk of infection with COVID-19 can be eliminated by avoiding contact with infected individuals, this can be achieved through the use of telemedicine in the hospital setting. Telemedicine will permit clinical consultation and limited examination to be done while preventing contact with infected patients.1,2 Moreover, the use of telemedicine during COVID-19 pandemic can prevent crowding in the hospital premises – a significant measure in breaking
transmission of COVID-19 infection – it is therefore important to examine usage of telemedicine by HCWs in Nigeria. The results would provide evidence on the practise and acceptability of telemedicine in Nigeria. This study determined telemedicine practise by HCWs at various healthcare facilities in Nigeria during the COVID -19 pandemic.

METHODS
This was a cross-sectional electronic survey of HCWs using a convenient sample size, among the HCWs that are actively involved in patients care during the pandemic in Nigeria. This study was approved by the Research Ethics Committee of University of Ibadan/ University College Hospital Ibadan (UI/UCHECR20/ 0334). HCWs were recruited from WhatsApp and Telegram social media pages dedicated for health workers (approximately 20 chat groups of between 25 and 200 participants) between May 1st and June 10th, 2020. WhatsApp and Telegram are the most widely used social media platform in Nigeria.9

A structured Google Forms questionnaire (a 35-item survey) was used to collect data on demography, type of health institution, the average number of patients attending the health facility availability of personal protective equipment (PPE), availability and the type of telemedicine, and the use of telemedicine by HCWs during the COVID-19 pandemic. The data was automatically saved to a dedicated Google drive account on completion of the questionnaire by the respondents. The continuous variables and proportions were analysed with descriptive statistics while inferential statistics was used for categorical variables using Statistical Product and Service Solutions (IBM-SPSS) software version 20.