Telemedicine refers to the automated, remote administration of healthcare services through technological advancement in communication and information technology, including mobile phone applications, telephone, email, or video conferencing.

It covers online consultations, healthcare procedures, secure data storage, and its seamless transmission through text, images, or sounds. All of this aims to diagnose, treat, and prevent ailments in patients, along with boosted interaction and training among healthcare practitioners.

The Use of Telemedicine and its Benefits

The use of telemedicine has increased multifold due to the COVID-19 pandemic, with several researchers corroborating its use in minimizing the risk of COVID-19.

Telemedicine prevents direct contact, maintains physical isolation, and proves beneficial in controlling the spread of the pandemic. It is also highly advantageous in enabling healthcare access to remote locations without adequate and established healthcare provision mechanisms.

Extensive research has been conducted on the use of telemedicine, and researchers have concluded the efficiency of this advanced technology in primary care services related to COVID-19. It has proved helpful in referring testing, screening suspected cases, and offering personalized care for relatively mild care.

However, other areas not related to COVID-19 have also greatly benefitted from this innovative technology. It has allowed healthcare professionals to manage the consequences of elective care cancellations and clinical service closures, augmenting the quality of healthcare for patients. Other critical uses of telemedicine have developed post-pandemic, some of which are as follows:

• Identification and prompt treatment of patients in rural or underdeveloped settings.
• Management of unavoidable surgeries in patients.
• Treatment of drug users.
• Management of chronic diseases, including immunodeficiencies and asthma.
• Treatment of patients with metabolic disorders.
• Promotion of health in young adults.
• Enhancement of the continuing education of physicians.
• Updating residency education, clinical protocols, and undergraduate education.

Domains of Research in Telemedicine

The uses of telemedicine are not the only research domain surrounding the study of telemedicine. Limitations to its use have also been scrutinized, including the racial/ethnic, socioeconomic, and cultural barriers that impede access to this innovative technology.

The supposed absence of imaging and physical examinations, ethical issues concerning doctor-patient relationships, and complications around consent, privacy, and access have also been the subject of intense debate.

The study in question takes into account the ambiguous innovative features of this technology, along with the context and forms of employment in which telemedicine is used across pluralistic healthcare systems, especially in middle and low-income settings.

This study on telemedicine provides empirical evidence on such issues through the evaluation of responses of medical professionals in a survey conducted in two states in Brazil: São Paulo and Maranhão.

Methods of Analysis

1,183 physicians were questioned about the impact of COVID-19 on their working practice and livelihood, and the responses were analyzed. The survey included questions on the following:

• The frequency of employment of physicians in telemedicine services.
• The particular activities where the physicians were employed.
• The ways in which COVID-19 impacted the adoption and use of telemedicine

Two independent samples were collected from each state and were chalked out based on 152,511 active medical registries in both states. The researchers undertook proportional stratified sampling, along with the preservation of the distributions extending to state, age, gender, and the location of the address.

The researchers conducted a univariate and descriptive analysis based on Fisher’s exact test or the chi-square test to deduce qualitative data and the Mann-Whitney test for the quantitative cases. The collected data was depicted as a proportion and absolute frequency with a confidence interval of 95%.

Results Collected

The sample of physicians put forward the following results:

• Most doctors (76.0%, 95CI 73.6-78.5) employed telemedicine as a form of clinical collaboration.
• Less than a third of the doctors (30.6%, 95CI 28.0-33.3) considered it as a modality to offer healthcare services.

The rise of the pandemic witnessed the use of telemedicine in a predominantly COVID-19-related domain, especially in private clinics, hospital-based in-person patient services, and ambulatory settings.

It was found that younger male doctors employed it the most. It was also found that medical professionals in São Paulo used it more frequently than doctors in Maranhão (p<0.001) or more simply, in urban areas more than in rural settings. The findings in this domain were as follows:

• Almost three-quarters of doctors in larger hospital establishments reported the use of telemedicine services (78.3%, 95 CI 75.9-80.6).
• Doctors in relatively smaller private clinics used it comparatively less (66.4%, 95 CI 63.7-69).
• Primary care doctors exhibited an even smaller percentage (58.4%, 95 CI 55.6-61.2).

Research Conclusions

The study mentioned above suggests that the use of telemedicine may have allowed the expansion of healthcare services provision and communication in low and middle-income settings during COVID-19.

However, its particular use and modality give rise to disproportionate statistics about doctors working in particular privileged domains in the pluralistic healthcare systems. This might also have a direct connection to the patients seeking medical attention there.

Therefore, the study concludes that there is a need for incentives and regulation to manage and support the use of telemedicine in low and middle-income healthcare systems, as it can allow augmented access to healthcare services for less privileged individuals.

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